Peripheral Vertigo – Causes, Diagnosis and Treatments

Vertigo is an unanticipated feeling of giddiness. Central and Peripheral Vertigo are two subtypes of Vertigo. Vertigo triggered by the problems in the brain is called Central Vertigo, while those triggered by the troubles in the inner ear are called Peripheral Vertigo. Peripheral Vertigo is more common than Central Vertigo.

What is Peripheral Vertigo? 

Peripheral Vertigo is the Vertigo caused due to the issues of the structures present in the inner ear that is responsible for influencing the body’s balance. This results in dizziness or a whirling sensation.

Causes of Peripheral Vertigo 

Peripheral Vertigo is most often brought about by a benign process, with Benign Paroxysmal Positional Vertigo (BPPV) being the most prevalent cause. 

Few frequent causes of Peripheral Vertigo include:

Benign Paroxysmal Positional Vertigo (BPPV) 

BPPV is an inner ear condition in which slight changes in head position, like tilting the head backwards, cause unexpected Vertigo—the sensation that the room is swirling.  

Dizziness and Vertigo are produced by certain positions in BPPV due to debris that has accumulated within a region of the inner ear. 

BPPV is caused by small calcium crystals called otoconia that come loose from their typical placement on the utricle, an inner ear sensory organ.

Epley manoeuver and Semont manoeuver exercises greatly help people affected with BPPV.

Labyrinthitis 

When the labyrinth in the ear is inflamed because of infection, it results in labyrinthitis.

The infections that lead to labyrinthitis include flu, cold or another virus. Labyrinth is vital owing to its role in balance and sound detection.

Inflammation of the labyrinth can result in a misalignment of signals transmitted to the brain and information received by the brain from the unaffected ears and eyes.

Vertigo is the outcome of the brain’s inability to deal with confusing impulses. Tinnitus, fever, ear pain, hearing loss, nausea and vomiting are all symptoms of labyrinthitis.

Vestibular Neuronitis 

Vestibular Neuronitis or Vestibular Neuritis is caused by inflammation of the vestibular component of the eighth cranial nerve that connects the labyrinth to the brain. The labyrinth itself may be affected in rare circumstances.

Vertigo, nausea and imbalance are common in Vestibular Neuronitis. 

It can last for a few hours or days, but it can last up to six weeks before totally disappearing.

Medications that assist with nausea and dizziness help in alleviating the symptoms of Vestibular Neuronitis along with exercises such as Brandt-Daroff exercise, Epley manoeuver and Semont manoeuver.

Meniere’s disease 

Meniere’s disease is an infrequent inner ear disorder that causes Vertigo, hearing loss, Tinnitus and a sensation of pressure in the ear.

People with Meniere’s disease experience brief Vertigo attacks that last for hours or days. It is possible that it will co-occur with nausea and vomiting.

Although there is no specific treatment for Meniere’s disease, some of the symptoms can be managed with a low-sodium diet. Surgery is occasionally required.

Otosclerosis 

Otosclerosis is a condition that affects the bones of the middle and inner ear.

Hearing loss is frequently caused by Otosclerosis. It is caused by an issue with the tiny bones (ossicles) that carry vibrations across the middle ear, allowing us to hear sound. 

Dizziness, balance problems, hearing sounds from within the body, hearing better in loud surroundings and hearing loss are common symptoms of Otosclerosis.

Hearing aids, fluoride tablets and surgery are the available treatment methods for Otosclerosis.

Certain medications 

Vertigo is a common adverse effect of some drugs. Some Vertigo-inducing medications are also ototoxic (medicines that induce balance or hearing problems).  

Aminoglycosides, phosphodiesterase type-5 inhibitors, anti-inflammatory medicines and furosemide are a few ototoxic medications.

When a patient with Vertigo is using an ototoxic medication, a dose reduction or withdrawal of the medication may be necessary to avoid permanent hearing loss. Therefore, getting prescribed medication after a doctor’s consultation is recommended. 

Head injury 

In the majority of cases, Vertigo develops as a result of a trauma or head injury. Vertigo can be caused by a misalignment of the neck during a head injury.

Otoconia may be displaced from the utricle and move into other areas of the ear after a head injury, causing dizziness.

The treatment is tailored to the diagnosis. Medication, physical therapy and certain lifestyle changes are typically used in treatment. Surgery may be recommended on rare occasions.

Diagnosis of Peripheral Vertigo 

Peripheral Vertigo is usually sporadic and severe. There are plenty of ways to diagnosing Peripheral Vertigo.

Taking a very accurate and complete history, as well as symptomatic/physical findings, are part of the diagnosis and workup. 

The health practitioner may inspect the ears of the patient to look for symptoms of infection and assess the body’s balance through a walk test (By asking the patient to walk in a straight line).

Hearing and balance tests may be done as a part of the diagnosis. To rule out other causes of Vertigo, the doctor may arrange imaging examinations (such as an MRI scan) of the brain and the neck, depending on the symptoms.

The Dix Hallpike test can assist in diagnosing Peripheral Vertigo by exacerbating symptoms and making nystagmus more visible. 

Other important tests include:

• Electro/videonystagmography (ENG)
• Vestibular-evoked myogenic potentials
• Computerised dynamic posturography (CDP)
• The rotating-chair test, also called sinusoidal harmonic acceleration (SHA)

Treatment for Peripheral Vertigo 

Treatment for Peripheral Vertigo depends on its cause. Medications, exercises, surgery and physical therapy are a few options that have proven benefits.

Drugs and medication 

Acute Vertigo can last anywhere from a few hours to several days, and medications can help in treating them.

Since vertiginous episodes usually last less than one minute, they are of limited utility in patients with Benign Paroxysmal Positional Vertigo.

Vertigo that lasts longer than a few days may indicate a persistent vestibular lesion (e.g., a stroke), and drugs should be discontinued to allow the brain to adjust to the new vestibular input.

Peripheral Vertigo can be treated with a variety of medicines, including:

• Antibiotics – to treat infections
• Prochlorperazine – to ease nausea
• Antihistamines – such as meclizine (Antivert)
• Benzodiazepines – anxiety medications that help relieve physical symptoms of Vertigo 

Betahistine is a drug used by people with Meniere’s disease to help lower pressure created by fluid in the inner ear and alleviate symptoms.

Treating hearing loss 

Patients with Meniere’s disease patients may require treatment for hearing loss and ringing in the ears.

Medication and hearing aids can be used to treat the condition. Drugs such as betahistine will serve to help treat Peripheral Vertigo.

Exercises 

Epley manoeuver and Brandt-Daroff exercises are proven to be helpful for individuals with BPPV. Both the exercises require making three or four directed movements with the head.

The Epley manoeuver is usually performed by the doctor because it demands quicker movement and turning of the head. It is not advised for those who have back or neck problems.

Brandt-Daroff exercises can be performed at home. These are the exercises that are mostly used to treat Vertigo. They’re thought to be able to help shift the debris that’s creating the Vertigo.

The following are the steps to perform Brandt-Daroff:

• The patient is advised to sit at the edge of the bed and tilt the head at a 45-degree angle, opposite to the side troubled by Vertigo.
• The body has to be lowered down with the head held in the same position for about 30 seconds or until Vertigo subsides. The person has to return to the upright position after that.
• The procedure is repeated on the other side.
• In a single session, these exercises are repeated 3-5 times.

Physical therapy 

Peripheral Vertigo can also be treated with vestibular rehabilitation therapy. It demands working with a physical therapist to assist the brain in learning to make up for inner ear issues to enhance balance.

If certain treatments fail, surgery can be used to treat severe, frequent episodes of Vertigo. This procedure requires the removal of a portion or all of the inner ear.

Foods to avoid  

The food that we eat has a remarkable impact on our health.

Dietary choices can affect illness progression and patterns. A small change in a Vertigo patient’s diet can either increase or decrease the likelihood of a Vertigo attack and the suffering that comes with it.

Some people become dizzy after consuming certain foods, while others notice an improvement in their Vertigo symptoms after following a Vertigo diet.

Limit Caffeine 

Coffee, chocolate, tea and energy drinks have high caffeine content in them. It may exacerbate the ringing feeling in the ear of a person suffering from Vertigo.

Caffeine has been shown to trigger the depolarisation of cells, making them more excitable. Patients with Meniere’s disease and vestibular migraine should limit their caffeine intake.

Caffeine is impermissible in the diet of people who suffer from vestibular migraines.

Reduce salt intake 

Excess fluid is retained in the body with salt intake, and this influences pressure and fluid balance. The vestibular system’s homeostasis is disrupted by a high salt diet.

Individuals with vestibular migraine and Meniere’s disease are advised to minimise their salt consumption, as this can cause dizziness and worsen symptoms.

Soy sauce, popcorn, chips, pickles, cheese, canned foods and papad are high in sodium and should be restricted. Since sodium is the main cause of Vertigo, one can substitute ordinary salt with low sodium salt.

Alcohol is a No-No​

Alcohol has a negative impact on metabolism, results in dehydration, and its metabolites are hazardous to the inner ear and brain.

In a Vertigo prone person, alcohol can cause migraines, severe Vertigo attacks, nausea and vomiting.

Alcohol may interfere with the brain’s central processing, obstructing vestibular compensation and impairing cognitive functioning, hindering a patient’s recovery.

It may also worsen Vertigo by changing the fluid dynamics of the inner ear. Migraine attacks have been linked to the consumption of wine.

Don’t eat foods that cause inflammation 

Inflammation plays a significant part in the development of many diseases. This is also true for inner ear issues.

It is said that foods that are most likely causing inflammation might make the symptoms of vestibular problems worse over time. These include red meat, bread, pastries, margarine, and fried and processed foods.

Avoid dehydration​ 

Vertigo symptoms can be caused by even minor dehydration. Dizziness and balance problems can be reduced by staying hydrated.

Eight to twelve glasses of water intake is recommended daily. Being calorie and caffeine-free, water is considered to be a great option.

Food in relieving Vertigo 

Anti-inflammatory and detoxifying foods can be included in the Vertigo diet owing to their ability to repair cells, minimise swelling in the inner ear and promote healthy cell regeneration. 

To overcome the negative consequences of inflammation in the body, foods containing vital fats, vitamins and minerals to the body should be consumed, as well as antioxidants that can help to cleanse the toxins in the body.

Omega-3 Fatty Acids 

Omega-3 fatty acids are proven to reduce inflammation. They are suggested for vestibular migraine and other inner ear diseases.

Foods that contain Omega-3 include fish, particularly oily fish and certain vegetables and nuts, especially walnuts. Flaxseeds are one of the best food sources of omega-3 fatty acids.

Foods that contain Antioxidants 

Antioxidant ‘ergothioneine’ is present in shiitake mushrooms. Ergothioneine protects the cell that targets oxidative stress in the body.

Green tea is high in antioxidants and minerals that help to combat inflammation.  Japanese matcha tea is said to possess seven times the antioxidant content of dark chocolate and 17 times the antioxidant content of wild blueberries.

Tomatoes, which are high in potassium, aid in the removal of excess fluid from the body. Being one of the greatest foods for treating dizziness or Vertigo, tomatoes can be included in the diet.

Ginkgo Biloba Supplements 

The supplement, Ginkgo biloba, helps to alleviate Vertigo symptoms by improving blood flow to the brain.

Ginkgo biloba’s efficacy and safety was investigated in a study that compared Ginkgo biloba extract to betahistine, the most commonly used Anti-Vertigo drug. Though both the drugs had equivalent effects on Vertigo patients, Ginkgo biloba showed more noticeable improvement with fewer negative effects.

Foods Containing Vitamin D 

Vitamin D deficiency has been linked to Vertigo symptoms.

According to a study, participants with low vitamin D levels had a 23-fold higher chance of experiencing positional Vertigo than the control group. 

Fortified foods, fatty fish, beef, liver and egg yolks are good sources of vitamin D.

Conclusion

Peripheral Vertigo is caused due to issues in the inner ear. BPPV is the most common cause of Peripheral Vertigo. Tinnitus, fever, ear pain, hearing loss, nausea and vomiting are common symptoms.

Apart from medications, hearing aids, physical therapy and exercises, maintaining a healthy dietary pattern greatly help in treating Peripheral Vertigo.

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