The 411 on Vertigo
Meet Kimberly Croteau-Sparks, AuD, with Sentara Hearing & Balance Center on the campus of Sentara Princess Anne in Virginia Beach. Specializing in balance disorders, Dr. Croteau-Sparks has provided some useful tips on vertigo and the steps you can take to seek treatment.
1) Speaking to a patient, how would you explain vertigo?
Vertigo is typically defined as a spinning or whirling sensation, a movement of either yourself or the room. However, some individuals will describe it as a lightheaded, floating, rocking, sensation of being heavily weighed down, or pulled in one direction.
2) What are the symptoms of a balance (vestibular) disorder?
The symptoms of a vestibular disorder are vast. There can be vertigo and/or dizziness, balance/spatial orientation, visual, auditory, cognitive, and psychosocial deficits present.
Common symptoms include, but are not limited to, vertigo, lightheadedness, imbalance, difficulty with coordination, confusion/disorientation, fatigue, trouble focusing or tracking objects with the eyes, blurred or double vision, sudden loss of hearing, tinnitus, difficulty concentrating, anxiety, panic, isolation, nausea, vomiting, motion sickness, and headaches.
3) What can a patient do to decrease the symptoms?
Quick movements often will trigger an increase in vestibular symptoms. Often patients will need to make calculated movements with their heads/bodies during an episode of vertigo. There are also medications which occasionally will help (depending on the balance disorder). Meclizine (also known as Antivert) is an anti-dizziness medication which can be prescribed from a doctor or can be found over the counter. The OTC medication used is any motion sickness relief pill (Dramamine, Bonine, or generic). The OTC has the same active ingredient which is contained in the prescription strength Meclizine.
4) For our referring physicians, what are some sure signs that a patient may be struggling from vertigo vs. a more complicated neurological disorder?
Neurological symptoms of dizziness are more serious and need to be evaluated by a medical doctor, specifically a neurologist. Central symptoms include, but are not limited to, numbness, tingling, weakness in extremities, difficulty with speech/swallowing, and sudden change in mental status.
5) How do you examine a patient to determine if they have vertigo?
The first step is a detailed case history, which will tell us temporal course, circumstances surrounding onset, characteristics of the symptoms, and current hearing status. This will give us clues to a peripheral (inner ear based) vs a central (brain) pathology. If benign positional vertigo (BPV) is suspected, the patient will undergo the Dix-Hallpike maneuver. The patient will lie on a table and lie down quickly with their head turned to the right/left. If the patient has BPV, their eye movements will exhibit rotational nystagmus where the pupils or the eyes begin to rotate. If BPV is present, the appropriate canal is treated so the inner ear otoliths can be repositioned into the membrane where they belong. If BPV is not present, more in-depth testing is scheduled to determine if there is an inner ear cause to the dizziness.