In this article, Niketrainers.com.co will tell you:
What is vertigo and what is the mechanism of its occurrence?
Dizziness (Latinvertigo) is a subjectively perceived sensation of spinning motion by the patient. Dizziness is a symptom and can be triggered by various diseases and disorders.
Dizziness and imbalanceare common symptoms. They are reported by about 5–8% of patients visiting GPs. In laryngological offices, the number of patients with dizziness is 10-15%.
Dizziness may occur as a single episode or recur for months, sometimes years, depending on the cause.
To maintain balance, the cooperation of three sensory organs is necessary: the vestibular organ, located in the inner ear, the organ of vision and deep feeling receptors, located in muscles, joints, tendons, joint capsules and skin. The vestibular organ can be divided into a peripheral and a central part. The peripheral part consists of: the vestibule and semicircular canals located in the inner ear, the vestibular nerve and the cerebellar-bridge angle, which is an important part of the brain. The central part consists of the vestibular nuclei located in the brainstem and their numerous connections with other structures, as well as the vestibular centers in the cerebral cortex.
Dizziness is an interdisciplinary problem, therefore the cooperation of doctors of many specializations is important in its diagnosis and treatment.Most often, patients seek help from an ENT, neurologist or ophthalmologist, but the help of an internist, cardiologist (treatment of arterial hypertension), orthopedist (treatment of cervical spine degeneration), neurosurgeon or even a psychiatrist (psychogenic dizziness) may be useful . The role of the ENT doctor is to confirm or rule out the vestibular origin of the dizziness, as well as to establish at which level the damage occurred.
Vertigo of vestibular origin
Due to the site of damage to the vestibular organ, it can be divided into a complex of peripheral and central lesions.
Symptoms of peripheral injuryinclude sudden onset dizziness that can be precisely timed. They take the form of seizures lasting at least several minutes, and sometimes even several hours. The symptoms rarely last longer than 2-3 weeks. The symptoms decrease with time and head movements increase the dizziness. The onset of an episode may be associated with unilateral hearing loss or tinnitus, blurred vision, paresis, or paralysis of the facial nerve.
Peripheral syndromecan be caused by:
- inflammatory diseases of the inner ear (common chronic, such asinflammation of the vestibular nerve,labyrinthitis),
- vascular disorders (spasm of the atrial artery, embolism / thrombosis of the labyrinth arteries, labyrinthine haemorrhage, circulatory disorders in the inner ear),
- inner ear injuries (fracturesof the temporal bone pyramid,acoustic trauma ofthe vestibular organ, labyrinth shock, barotrauma, i.e. an injury caused by a pressure difference, e.g. when an open hand hits the external auditory canal),
- inner ear cancers(primary neoplastic infiltrates or metastases of other neoplasms),
- systemic diseases (atherosclerosis, diabetes, hormonal disorders),
- the use of drugs toxic to the hearing organ (toxic to the inner ear),
- poisoning with nicotine, heavy metals or carbon monoxide,
- vestibulocochlearotosclerosis ,
- Meniere’s disease,
- tumors of the cerebellopontine angle.
Symptoms of a central lesioninclude dizziness, a feeling of swaying, uncertainty of posture and gait appearing secretly, the onset of which is difficult to determine. A single seizure usually lasts from a few seconds to a minute, but the symptoms persist for months, sometimes years. They are usually accompanied by falls,impaired consciousness, headaches, double vision, blurred vision or scotomas. Seizures or other signs of damage to the central nervous system may appear.
The causes of the central syndromemay include:
- meningitis,
- encephalitis,
- brain abscess,
- head injuries:concussion, contusion of the brain,
- blood circulation disorders in the central nervous system (also caused by systemic diseases, e.g. atherosclerosis or diabetes),
- brain tumors
- multiple sclerosis.
The peripheral syndrome is usually treated by ENT specialists, while the central syndrome is treated by neurologists or neurosurgeons.
What will the doctor do if we report dizziness?
An interview is of great importance in the diagnostic process of vertigo. The doctor will try to determine exactly what the patient considers dizziness, the circumstances in which it occurs, the duration of the episode, and whether there are additional visual acuity disturbances, scotoma in front of the eyes or other symptoms. It will also ask if the patient has a history of ear inflammation, a head injury, and what medications the patient is currently taking and what medications have been taken in the past.
During the visit to the ENT specialist, a complete ENT examination will be performed, with particular emphasis on the patency of the Eustachian tubes. Another standard element of diagnostics are basic tests of the hearing organ using reeds, indicative speech test, tonal, verbal and impedance audiometry. If necessary, they will be extended to include audiometry of responses evoked from the brainstem or recording of the induced otoacoustic emissions. The doctor will also perform an examination of the balance organs. Posturography or electronystagmography may be helpful, during which a caloric test is performed (measurement ofnystagmus caused by irritation of the tympanic membrane with water of different temperatures) or the Hallpike maneuver (one-sided quick positioning of the patient from a sitting to a lying position with a head tilt for 1 minute).
Often the following consultations will be necessary: ophthalmology, to assess the fundus, visual field and visual acuity, as well as neurological, to assess the neurological status, taking into account focal symptoms. Sometimes diagnostics will be extended to include visits to doctors of other specialties, depending on the suspected cause.
Who should stay in the hospital?
Patients should be admitted to the hospital:
- with dizziness after multiple-organ injuries;
- with dizziness and high blood pressure (especially if it is accompanied by nystagmus);
- after a sudden onset of dizziness with an increasing headache;
- after a sudden onset of dizziness with impaired hearing or the function of any of the cranial nerves.