The types of vertigo

If you ever feel dizzy or unsteady, and you’ve not just stepped off a rollercoaster, then you may be one of the 10% of people in the world who experience vertigo each year. In most cases the symptoms are harmless, but they can be unpleasant and interfere with your daily life.

Vertigo is the sensation of rotation, either that the patient is rotating or they feel that the room is rotating. This feeling can vary from being mild and barely noticeable to much more severe and stop you from doing your usual everyday tasks. You may find your hearing is affected, too. While vertigo is not actually a condition in itself, it is a symptom of a medical condition.

If you find yourself feeling off balance, then you should book a consultation with your doctor or licensed hearing care professional as you may have one of the two most common forms of vertigo: peripheral and central. They will be able to determine the type of vertigo you have and provide you with more information on hearing loss and the best treatment for your symptoms.

Central vertigo is generally caused by a disease or injury to the brain such as:

• Head injuries
• Migraines
• Illness or infection
• Multiple sclerosis
• Strokes
• Mini strokes (transient ischemic attacks)
• Brain tumors

Symptoms of central vertigo often come on suddenly and tend to be last longer than peripheral vertigo. They include:

• Nausea and vomiting
• Headaches
• Uncontrollable eye movement that lasts for a long period and doesn’t go away when you focus on a fixed point
• Weakness
• Trouble swallowing

The only way to effectively manage central vertigo is to find the root cause of it. If migraines are found to be the cause, appropriate medication and reducing your stress can help. For other ongoing conditions, such as certain tumors or multiple sclerosis, treatment may focus on managing the symptoms. For instance, medication to reduce nausea or the sensation of movement.

If you have vertigo, then it’s likely you have peripheral vertigo, the most common type of vertigo, and is caused by a problem in the inner ear. While the inner ear controls your balance, it can become damaged by:

• Benign paroxysmal positional vertigo (BPPV), a condition that causes small crystals to get loose and start to float in the fluid of your inner ear. The fluid and movement of the crystals can make you feel dizzy
• Vestibular neuritis, which causes severe dizziness that can start suddenly and last for up to three weeks. It may have been caused by a virus
• Ménière's disease, a condition that combines occasional hearing loss with dizziness.
• Perilymph fistula, often as a result of a sudden pressure change or head injury
• Superior semi-circular canal dehiscence syndrome (SSCDS) caused by a breakdown of the temporal bone that separates the inner ear from the brain.

Peripheral vertigo can cause symptoms of:

• Nausea and vomiting
• Sweating
• Ear problems
• Pain or a feeling of fullness in your ear, caused by an inner ear infection or disease
• Hearing loss and tinnitus (ringing in the ears) in one or both ears

Peripheral vertigo can start without warning and stop just as quickly. Your eyes may also move without your control. This movement may go away when you try to focus on a fixed point. This generally happens during the first few days of your symptoms and then will disappear.

Treatments for peripheral vertigo focus on managing the condition that causes it.

• BPPV can be treated with special exercises that help return the crystals to the correct place in your inner ear
• Anti-inflammatory drugs can help relieve symptoms if labyrinthitis, vestibular neuritis or Ménière's disease has caused your peripheral vertigo
• Cutting down on salt, caffeine and alcohol can help vertigo caused by Ménière's disease
• Surgery to correct problems in your inner ear for conditions such as SSCDS or perilymph fistula
• A combination of balance exercises, lifestyle changes, and medication

Vertigo can sometimes be just a once-off episode that comes and goes relatively quickly. However, if you find that you have repeated episodes of hearing loss and dizziness, then it’s time to see a doctor or licensed hearing care professional for evaluation and treatment. Dizziness can sometimes be a symptom of something more serious so it’s important to get checked out as soon as possible.

Simone Biles' twisties incident at the Olympics brought significant attention to the challenges of proprioception and vertigo in gymnastics. The twisties, a condition where gymnasts lose their sense of spatial awareness during aerial maneuvers, can be perilous, causing disorientation and increasing the risk of injury. During the Tokyo 2020 Olympics, Simone Biles experienced the twisties, a phenomenon that significantly impacted her performance and safety. Proprioception, the body's ability to perceive its position and movement in space, is crucial for gymnasts performing complex routines. Biles' twisties incident underscored the importance of mental and physical well-being in sports, highlighting how proprioception and vertigo can profoundly affect even the most elite athletes.