Health

Everything revolves around you? It's vertigo. It's probably benign. A few points of reference are useful to understand its origin, its treatment and the steps to take if you feel it.

WHO SHOULD I CONTACT?

You should consult your doctor. He will carry out an initial examination and, most often, he will make a diagnosis by asking you questions and examining you.
He will possibly prescribe additional tests and, if necessary, refer you to a specialist, ENT or neurologist, depending on the results of the initial assessment.

VERTIGO: WHAT IS IT?

Vertigo is an illusion of movement that gives the sensation that the environment is rotating around you or that you are spinning in space.
Vertigo is a common cause for consultation.
They are a warning signal that most often indicates a malfunction of the inner ear, an organ that participates, along with sight and body movements, in the perception of movement and displacements (speed, direction, etc.).
They are classified according to their duration: from a few seconds to several days.

WHAT ARE THE POSSIBLE CAUSES?

Vertigo is most often due to a malfunction of the inner ear. Generally benign, it can have many origins. Among the 150 types of vertigo recorded, three are the most common:

• Benign paroxysmal positional vertigo: this is the most common. It is caused by the presence of small crystals (otoliths) in the inner ear. It is an intense and brief vertigo that occurs when turning the head, getting up or bending down.
  Often very annoying for the patient, vertigo can be quickly relieved by actions that are easy to perform by your doctor. The purpose of these head movements is to release the otoliths, free floating particles.
• Meniere's disease: its cause is unknown. It could be a reaction to an infection, trauma, allergy or autoimmune disease. Dizziness occurs in repeated attacks. They are longer, lasting from a quarter of an hour to several hours; they can be accompanied by severe unilateral buzzing, nausea and vomiting at the height of the attack. The progression is to progressive deafness and chronic dizziness.
• Vestibular neuritis: it is due to a viral infection. It is a single severe dizziness that lasts several hours to several days with the inability to stand up during the first few days and vomiting.

Other causes, rarer but also more serious, can cause vertigo:

• head trauma,
• stroke,
• tumor (schwannoma or acoustic neuroma).

Finally, vertigo in the elderly is very common. Its origin can be multiple, alteration of the cardiovascular state, psychological state, drug treatments, etc.

WHAT TESTS CAN BE PERFORMED?

The doctor will question you in depth in order to determine precisely the duration of the vertigo, the circumstances of its occurrence (particular position, time, place, etc.), the presence of other symptoms (tinnitus, headaches, etc.), the frequency of attacks.
He will carry out a clinical examination and an otoscopic examination (of the ears).
If he concludes that it is benign paroxysmal positional vertigo, no additional examination is necessary.
If Ménière's disease is suspected, the doctor will refer you to an ENT specialist to confirm the diagnosis, who will perform specific tests during the crisis, including an audiometric assessment.
Additional tests may be offered, such as magnetic resonance imaging (MRI) or a scanner.

WHAT ARE THE POSSIBLE TREATMENTS?

Benign paroxysmal positional vertigo is treated with a therapeutic maneuver. It consists of simple movements performed on the examination table, which allow the otoliths to exit the inner ear.
Ménière's disease is treated with a medication (betahistine hydrochloride) combined with a salt-free diet and a healthy lifestyle.
Vestibular neuritis disappears spontaneously, through a natural compensation phenomenon in the inner ear. Drug treatment is given during the first two days to reduce symptoms and anxiety. So-called "vestibular" rehabilitation can improve the quality of recovery.
In the event of dizziness, consult your doctor. The cause is probably benign, but the doctor may decide to carry out additional tests in order to rule out a more serious cause and decide on appropriate treatment.