Vertigo is a spinning sensation which causes loss of balance, and can be accompanied by nausea and vomiting. It is normally associated with a problem with the middle ear balance mechanism, but other factors which can cause an attack of vertigo include migraines, alcohol and infection.

Causes of vertigo

Vertigo is typically caused by infection, damage or disease to the inner ear which is the part of the body that controls balance. Vertigo can also indicate a problem with the brain or with nerves connecting the brain and the middle ear.

Vertigo is not just the dizzy light headed feeling experienced when standing, it can make any movement difficult due to the spinning sensation that affects balance. The common reasons for experiencing vertigo are as follows:

Labyrinthitis – The vestibular labyrinth is a complex system of channels behind the ear drum filled with fluid that sends sound and balance signals to the brain. Viruses, such as a cold or flu, can affect the vestibular labyrinth and is referred to as labyrinthitis. The condition can also be caused by bacterial infections of the inner ear.
Ear infections that result in vertigo will typically have other symptoms such as fever and pain in the ear.

Vestibular Neuritis – This condition causes inflammation to the inner ear and nerve pain causing vertigo attacks lasting hours or days. Viruses can also cause vestibular neuritis and will be accompanied by unbalance, discomfort but will not result in hearing difficulty or tinnitus (ringing sound in the ears).

Benign Paroxysmal Positional Vertigo (BPPV) – Small fragments of calcium crystals can break away from the lining of the labyrinth and travel along the fluid-filled canals brushing against sensitive hairs. This process sends conflicting messages to the brain resulting in vertigo.

These vertigo attacks are often short lived (10-20 seconds) and usually occur when the head is moved suddenly or when you roll onto your side in bed. BPPV can also cause nausea or vomiting.

BPPV is more common among the elderly and usually begins after the age of 40 but young people can be affected.  

Ménière's disease – Severe cases of vertigo may indicate problems with the balance mechanism of the inner ear and this condition is known as Ménière's disease. The condition causes vertigo and is usually accompanied by hearing loss and tinnitus due to problems with pressure within the ear.
Somebody with Ménière’s disease may experience vertigo attacks lasting anywhere from one hour to 24 hours and will also experience nausea, vomiting, unbalance and discomfort.

Injury/Trauma – A sudden blow or injury to the head can result in vertigo.

Migraines – Severe headaches can occasionally lead to vertigo.

Medications – Certain drugs that contain salicylates (e.g. anti-inflammatory), quinine and amino-glycosides can cause vertigo.

Nasopharyngeal Carninoma – Cancer of the canal behind the nose can result in vertigo

Acoustic Neuroma – Benign brain tumour growing on the acoustic nerve can lead to mild symptoms of vertigo.

Otitis Media – A long-term infection of the inner ear can cause vertigo.

Your GP will make an initial diagnosis based on your symptoms, how often they occur and their duration.

To confirm cases of BPPV, a specific manoeuvre test called the Hallpike's manoeuvre will be used to bring on the symptoms of vertigo. You will be asked to sit on a flat surface and the doctor will hold your head while asking you to lie back quickly and rotating your head to one side while keeping your eyes open.

Someone with BPPV will display symptoms of vertigo after 10 seconds or so and lasting for several seconds before stopping. If these symptoms can't be created again for another 10-15 minutes then BPPV will be diagnosed.

If tinnitus is an accompanying symptom with the vertigo your GP may refer you to an ENT specialist where further testing using ear X-rays, balance tests and hearing tests will take place.

Your GP may also recommend an MRI scan or CT scan to rule out any serious underlying problem such as acoustic neuroma.

*Source: GoToSee.co.uk

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