Vertigo or dizziness

"Vertigo always refers to an alteration of the vestibular system, while dizziness is a balance disorder not always related to it".

DR. NICOLÁS PÉREZ FERNÁNDEZ
CODIRECTOR. OTORHINOLARYNGOLOGY DEPARTMENT

The sensation of movement is usually one of rocking, turning or displacement, either of its own or of the support base (such as inclination of the ground or precipitation in a vacuum) but, in reality, these modifications in the subject or environment do not occur.

Dizziness is an alteration of the balance also in which we include unpleasant sensations of emptiness in the head, insecurity and instability, sensation of discomfort and imminent fainting, all accompanied by nausea and vomiting, cold sweat and pallor.

Vertigo always refers to an alteration of the vestibular system (lodged in the inner ear and whose neurological center is in the brain stem), while dizziness is a balance disorder not always related to it.

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What are the usual symptoms of vertigo?

The usual symptoms of vertigo are the sensation of spinning objects, instability, inability to perform normal activities and nausea.

When a vertigo crisis occurs, the patient is in a very incapacitating situation and requires immediate medical treatment.

Do you have any of these symptoms?

You may suffer from vertigo

What are the causes of vertigo?

As far as ear alterations are concerned, we must mention, in order of frequency, the benign paroxysmal positional vertigo, Ménière's disease and vestibular neuritis, which represent 54% of the consultations for dizziness and vertigo.

Other causes of otological or peripheral origin, such as tumors (acoustic neurinoma), traumatic, infectious, toxic or idiopathic, account for 33%.

Within the neurological pathology, those of vascular origin and multiple sclerosis are the ones with the highest incidence.

Who can suffer from it?

Anyone can suffer from vertigo. Symptoms of instability can arise in both childhood and old age.

In the case of children it has very different forms of vertigo from those catalogued. It usually suffers very brief spontaneous crises that with the years are cured or transformed into migraines. Usually it is a matter of middle ear problems that manifest themselves with vertigo.

In the elderly, multi-sensorial vertigo can develop into chronic instability. In these cases, the three balance systems that have to be coordinated in the brain (sight, hearing and joints) fail.

Types of vertigo

Dizziness can be classified in many different ways. One of them is based on the location of the disease that causes it and divides them into peripheral and central.

  • Peripheral vertigo is that caused by the involvement of the labyrinth (inner ear) and vestibular nerve (the one that carries balance information from the inner ear to the brain), and is the most frequent. Patients also tend to have hearing loss and tinnitus, pressure and pain in the ear.
  • Central vertigo is due to the alteration of the neurological mechanisms of the vestibular system itself. In these cases it is frequent the existence of alterations of the march and posture with very showy instability, double vision, problems for the swallowing, intense headache, etc.

How is vertigo diagnosed?

In the pathology of vertigo and balance disorders, a correct clinical history is especially important to advance the diagnosis and represents one of the most important parts of the consultation of these patients.

Special attention is paid to the limitation that vertigo generates for the development of daily activities of the patient's life, trying to evaluate and determine the degree of disability that the disease produces for the patient and his or her family.

The exploration is then carried out and consists of a thorough otolaryngological examination covering the ear, nostrils, nasopharynx, oral cavity and larynx.

The objective is not only to explore its conformation, but also to carefully evaluate the dependent function of certain cranial pairs (cranial nerves), which can provide important information for the differentiation between central and peripheral vertigo.

How is vertigo treated?

Experts in the treatment of vertigo with intrantimpanic gentamicin

The treatment will depend on the cause that produces it. As Menière disease is produced by an alteration of the inner ear, for its treatment, the patient must first follow a low-salt diet and eliminate liquids, since, when they accumulate in the inner ear, they cause vertigo.

When the care of the feeding is not effective, it is necessary to go to the medical treatment.

There are various drugs that are indicated according to the characteristics of the patient:

  • Diuretics: by eliminating water, the amount existing in the inner ear is reduced, in order to reduce the sensation of vertigo. In this way, hearing is improved and the rest of the symptoms disappear.
  • Betahistine: is a highly effective drug whose effect is to increase circulation in the inner ear and reduce the excitability of vestibular neurons without drowsiness. The fluid exchange is faster and the accumulation is less.
  • Others, such as calcium antagonists and cell protectors against local toxic agents (trimetazidine), are of great importance in the mechanism involved in the development of diseases with vertigo, hearing loss and tinnitus.

Approximately 70% of patients improve with proper medical and dietary treatment. When this is not the case, a treatment with intratympanic gentamicin is performed.

Gentamicin is an antibiotic that is injected through the eardrum, passes into the inner ear and acts on the balance cells. The application of gentamicin is done on an outpatient basis and is introduced into the middle ear through a hole made in the tympanic membrane.

It is left in the middle ear for 30 minutes and then removed. During this time the gentamicin diffuses into the inner ear exerting its effect.

The patient goes for a new check-up after one week and, at that time, the effects of the previous application of gentamicin and the need for a new application are assessed; if a minimal reaction is found in the inner ear, the treatment is terminated.

The effects of the treatment are observed during its own application and, in many cases, there is a progressive reduction in the intensity, severity and frequency of the vertigo attacks until they disappear completely.

With intratympanic gentamicin, vertigo is controlled in 90% of the patients in whom medical treatment has failed; for the rest, a surgical intervention must be performed which, depending on whether or not there is useful hearing, will be a vestibular neurectomy or a labyrinthectomy, respectively.

In labyrinthtectomy, all the sensory receptors of balance in the inner ear are surgically removed and, consequently, the patient loses his or her hearing. This intervention is performed in extreme cases where the disease itself would annul the patient's hearing.

In vestibular neurectomy, the balance (vestibular) nerve is cut so that the patient maintains hearing.

Where do we treat it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM
Specialists from the Department of Otolaryngology

The Department of Otorhinolaryngology of the University of Navarra Clinic is a national and world reference in numerous highly specialized surgical procedures.

We have the latest technology and we perform all diagnostic tests in less than 48 hours in order to offer our patients the best solution in the shortest time possible.

We were one of the first centers in Spain to use robotic surgery in the surgical treatment with the Da Vinci® System. 

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  • Otology - Hearing.
  • Rhinology - Nose.
  • Pharyngology - Throat.
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  • Balance disorders.
  • Head and neck problems.
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