Vertigo Explained with Dr. Mina Le

A common misconception about vertigo is that it’s a disease. Vertigo is actually a symptom of a condition, not a diagnosis itself. Vertigo can be brought on by several conditions including middle ear fluid, benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis and vestibular migraine.

To get a better understanding of vertigo and how to handle it, we asked Mountainside Medical Group’s otolaryngologist-head and neck surgeon, Mina Le, M.D.

“The first step to treating your vertigo is to figure out what’s causing it,” Dr. Le said. “Some cases of vertigo originate in the inner or middle ear. The more common culprits include middle ear effusion and BPPV. The rarer ones include Meniere’s disease and vestibular neuritis. Other times, vertigo originates from the brain. The most common culprit here is vestibular migraine.”

It may be difficult to narrow down what’s causing your vertigo without medical evaluation, but there are a few signs that may help to identify the specific underlying condition.

“If your vertigo is from middle ear fluid, you likely have trouble hearing and it may sound like you’re underwater,” Dr. Le said. “You may have pain or pressure in the affected ear. The problem commonly begins after a head cold. A physician can look at your eardrum to confirm this diagnosis. You will get antibiotics if it’s an acute infection, and decongestants and nasal balloon therapy if it’s chronic.”

If you’re experiencing short bouts of dizziness, Dr. Le warns you may be suffering from benign paroxysmal positional vertigo (BPPV).

“If your vertigo only lasts for a few seconds at a time, and if it is brought on by turning your head or rolling over in bed, you most likely have BPPV, in which the crystals in your inner ear are dislodged,” Dr. Le said. “A physician can confirm this diagnosis with a Dix-Hallpike test. You will be treated with a method called the Epley maneuver, designed to reset your inner ear crystals. Working with a physical therapist can help.”

Crippling episodes of vertigo that often interfere with daily tasks may indicate Meniere’s disease.

“Meniere’s disease is characterized by distinct episodes of spinning vertigo, usually with nausea and vomiting, that are accompanied by a roaring sound, a fullness in your ears and hearing loss,” Dr. Le said. “Episodes tend to last for hours and are disabling. Treatment begins with a low-salt diet, reduction of caffeine and diuretic pills to decompress the inner ear. Migraines are a common concurrent diagnosis that Meniere’s patients need to address in managing the disease.”

Another condition that may bring on vertigo is vestibular neuritis. This condition, an inflammation of your vestibular nerve, tends to overwhelm you for a couple of days.

“Vestibular neuritis is a self-limited illness in which you are essentially confined to bed with severe vertigo that causes nausea and vomiting, but it improves in a few days and is gone in a few weeks,” Dr. Le said. “This is most likely the result of a viral infection, so the treatment is rest and time. An over-the-counter medication called Antivert, a brand of meclizine, can help with the symptoms.”

If none of the descriptions listed above are reflective of what you’re experiencing, a vestibular migraine may be the cause of your vertigo.

“Migraine is an inherited problem with the ion channels in your brain, which can manifest in dizziness or vertigo rather than with the typical headaches,” Dr. Le said. “If your vertigo doesn’t fit one of the four descriptions above, and if it lasts for minutes to days but happens over and over, it’s most likely from migraine. The first step is to identify and remove common migraine triggers such as stress, poor sleep, sensory overload and food elements such as MSG, preservatives, alcohol and caffeine. If that’s not enough, you may be started on a preventative medication.”

If you’re experiencing signs of vertigo or unexplained dizziness, schedule an appointment with your physician to figure out the cause.

Mina Le, M.D. is an otolaryngologist-head and neck surgeon with Mountainside Medical Group. She sees patients in the Mountainside Medical Office Building located at 311 Bay Avenue, Suite 300, in Glen Ridge, NJ. New patients are welcome and may visit www.mountainsidemedicalgroup.com to request an appointment.