Dizziness (Vertigo)

The sensation of moving when we are not actually moving is called dizziness, or medically vertigo. Dizziness is a perception disorder, a conflict between standing still and feeling that you are spinning or moving. This sense of motion may feel as if we ourselves are spinning or as if the objects around us are spinning.

Vertigo is a Latin word. It is not the name of a disease but a symptom that occurs in many different conditions. It is often accompanied by nausea, vomiting, imbalance, ringing in the ears (tinnitus), a feeling of fullness in the ear, hearing loss, sweating and involuntary eye movements. Depending on where it originates, it is mainly classified as central or peripheral vertigo.

Evaluation of a patient with dizziness (vertigo):

The most important step in diagnosis is taking a detailed history from the patient. A physical examination is then performed. Hearing tests, blood tests and imaging (CT, MRI) to examine the middle and inner ear structures in detail can help with diagnosis. Doppler ultrasound measurements may be requested to assess the adequacy of the vessels carrying blood from the heart to the brain. When necessary, evaluation by neurology, cardiology, internal medicine, ophthalmology and psychiatry specialists may be requested.

CENTRAL VERTIGO:

This occurs in diseases of the brain, cerebellum and brainstem. It can be seen in conditions such as vascular occlusion, hemorrhage, tumors, multiple sclerosis (MS) and migraine affecting these areas. It is a less common type of dizziness. The dizziness is generally milder, but it may be accompanied by loss of consciousness, speech disturbances or slurred speech, weakness in the arms and legs, double vision and headache. It falls mainly within the scope of the neurology and neurosurgery departments.

PERIPHERAL VERTIGO:

This occurs when the balance center in the inner ear is affected, or when there are problems in transmitting the signals coming from this center. Most cases of dizziness fall into this group, which is the domain of ENT physicians. The most common causes are benign paroxysmal positional vertigo (BPPV), Ménière's disease and vestibular neuritis.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of all dizziness. It results from particles (crystals) in the balance canals causing excessive signals to be sent to the brain during head movement. It is characterized by brief, recurrent episodes of dizziness triggered by head movement. Although the exact cause is unknown, viral infections and previous head trauma are considered the main factors. It is diagnosed and treated with specially designed maneuvers.

Ménière's Disease (Endolymphatic Hydrops) results from increased pressure of the fluid in the inner ear that is set in motion by the sounds we hear. It is a disease that occurs in attacks, in which dizziness is accompanied by hearing loss, tinnitus, and a feeling of pressure or fullness in the ear. Nausea and vomiting are usually present. These attacks may last for hours or all day. The exact cause is unknown. In treatment, it is important to limit salt intake; avoid smoking, alcohol, carbonated drinks and coffee; avoid stress; and get enough sleep. Depending on the frequency and severity of the attacks, medication and drug applications into the middle ear may be used. Certain surgeries may be performed in patients whose disease cannot be controlled.

Vestibular Neuritis occurs when the balance nerve is affected, usually by viruses. There is sudden-onset severe dizziness, nausea and vomiting. Patients usually cannot stand up without help and have difficulty eating and drinking. Symptoms may last for days or weeks. In the first days of the illness, the patient should be hospitalized if necessary and treated with IV fluids and medication. In the following days, as the patient's condition improves, they should be helped to get up and move around as early as possible. If not treated properly, the balance disorder may last for months or even years.

Our brain has a remarkable ability to adapt. If no specific cause can be identified in a vertigo patient after the necessary investigations, and the treatments applied have not worked, this capacity to adapt can be used to help the body adjust to the new situation. This is called vestibular rehabilitation. Its aim is to restore balance through exercises, improve the patient's affected psychological state and help them regain self-confidence.