PERIPHERAL VERTIGO: SYMPTOMS, CAUSES AND TREATMENT - GEOGRAFÍA - 2025

The peripheral vertigo is the most common type of vertigo. These are episodes characterized by a feeling of dizziness, loss of balance, and ringing in the ears. The patient may experience as if the environment is moving, spinning around him or as if everything is tilting to one side.

Generally, peripheral vertigo is caused by a problem in the inner ear, which is the one that controls balance. It is important to note that this type of vertigo is not a disease in itself; rather, it is a symptom that reflects some underlying medical condition.

The crises that occur in this condition appear and disappear abruptly. In terms of its duration, it is relatively short (lasting from a few minutes to several hours).

For the diagnosis of peripheral vertigo, eye movements and body oscillations are observed. Normally, a neurological examination is carried out.

Once this condition is diagnosed, treatment is aimed at relieving symptoms with drugs, performing specific exercises for the vestibular system, as well as treating the causes that have produced peripheral vertigo.

Symptoms of peripheral vertigo

Peripheral vertigo is a sensation similar to what you get after riding a fairground ride like a roller coaster. Everything seems to revolve around the patient. This results in nausea, vomiting, cold sweats, low blood pressure, pale skin, or bradycardia (slow heart rate).

These symptoms increase when the head moves, since, as mentioned, there is some involvement of the inner ear. Thus, peripheral vertigo can be accompanied by cochlear symptoms. These symptoms are characterized by:

- Tinnitus: they consist of a perceptual phenomenon in which buzzing or ringing is heard in the ears that do not come from the external environment.

- Hearing loss: this is a decrease in the ability to perceive sounds.

- Sensation of pressure in the ears.

However, these cochlear symptoms are not always present. In contrast, a very defining symptom of peripheral vertigo is nystagmus. These are deficits to focus the gaze, observing rapid movements of the eyes from one side to the other involuntarily.

Other symptoms are headaches, loss of balance, hearing and vision difficulties, and a feeling of being pushed from one side to the other.

Causes

Most cases of peripheral vertigo are caused by some type of condition in the inner ear, which regulates balance. Specifically, some alteration in one of the structures that make up the vestibular system.

The most common causes of inner ear problems associated with peripheral vertigo are benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, Ménière's disease, and labyrinthitis.

Benign paroxysmal positional vertigo (BPPV)

This is the most common cause of peripheral vertigo. In this condition, calcium deposits form in the fluid within a part of the inner ear called the semicircular canals.

Therefore, when the head moves, vertigo appears, since these small crystals stimulate fine "hairs" that cover the inner ear. This causes confusion in the brain, leading to vertigo and dizziness.

Benign paroxysmal positional vertigo can be due to normal aging of the vestibular system, some injury to the inner ear, labyrinthitis, circulation problems in the artery that irrigates this area, medications, migraine, etc.

The first time it was described was in 1921 by the physician Robert Bárány. Apparently, approximately 2.5% of the population suffers from this condition at some point in their life. Mainly during old age. Also, it seems to be more common in women than in men.

Treatment for benign paroxysmal positional vertigo is based on exercises to reposition the crystals of the inner ear. This method is known as the Epley maneuver and can be performed by the patient at home with instructions previously described by their doctor.

However, most of the time, this disorder goes away only in a few days or weeks. However, if it is never treated, it will usually reappear.

Vestibular neuronitis

Neuronitis or vestibular neuritis is caused by an infection that is transmitted in the vestibular nerve. This usually appears after a viral infection, such as a cold or the flu. This condition appears suddenly and can last about two to three weeks. Some of the symptoms are: earache, instability, nausea, even vomiting.

However, in this condition, hearing capacity is preserved, unlike labyrinthitis.

Treatment is focused on reducing the symptoms and the underlying virus. It is often accompanied by vestibular rehabilitation, that is, exercises to control posture or gaze when the position of the head is changed.

Labyrinthitis

This condition is characterized by inflammation of an area of ​​the inner ear called the labyrinth. Normally it appears due to an infection of some virus or bacteria. Therefore, it is common for it to arise after a fever, flu or allergies. It causes peripheral vertigo, earache, and decreased hearing and ringing in the ears.

Treatments are also aimed at alleviating symptoms. It is also recommended to avoid driving vehicles, operating machines, and avoiding bright lights, such as those on television or mobile phones.

Ménière's disease

Ménière's disease begins by affecting one ear. In many patients, over time, the problem spreads to the other ear. It usually occurs in people between 40 to 60 years old, although anyone can suffer it.

The exact cause of this disease is not known, although it is believed that it may be related to a fluid found in the inner ear, called endolymph. Specifically, there seems to be an accumulation of said fluid, causing pressure in the inner ear.

It has been found that there may be factors that trigger it such as salt consumption, caffeine, alcohol or stress.

The episodes of peripheral vertigo in this disease appear abruptly and can last up to 24 hours. Vertigo is usually so severe that it causes nausea and vomiting.

In addition to peripheral vertigo, this disease causes fluctuating hearing loss, ear pain, headache, abdominal pain, or diarrhea.

It is treated with diuretic drugs to remove excess fluid and other drugs to decrease symptoms.

Other causes

Other possible causes of peripheral vertigo include autoimmune inner ear disease, perilymphatic fistula, or superior semicircular canal dehiscence syndrome. In the latter there is a lesion in the bone that covers the semicircular canal of the inner ear.

However, it is important to note that there may be transient episodes of peripheral vertigo caused by motion sickness (when traveling in a car, on a boat or on an airplane), poisoning by certain substances (lead or arsenic), certain drugs, drugs, or from migraines.

Diagnosis

To diagnose peripheral vertigo there are several techniques. A single test is usually not significant, it is best to combine several.

First, the doctor can examine the ears for signs of infection. You can also perform hearing tests, balance tests, or recommend scanner tests such as an MRI. This last test is useful to rule out other causes of vertigo related to the neck or the brain.

Romberg test

One of the most used tests is the Romberg test. To begin, the patient is asked to stand with their feet together. The examiner will check if the person remains upright or has oscillations. He is then asked to close his eyes, although care must be taken, as the patient may move sideways or even fall to the ground.

Lateropulsion

A sign of peripheral vertigo would be lateropulsion. That is, an involuntary tendency to tilt the body to one side.

Unterberger test

Another test is the Unterberger test, which is used to observe if there is a lateral deviation of the body while walking.

Nystagmus

The diagnosis of peripheral vertigo is confirmed by rapid eye movements, that is, nystagmus. Mainly it is observed that the eyes are involuntarily diverted towards the healthy ear.

To explore nystagmus, the patient must be seated. The examiner will place his finger about 50 centimeters from the patient's nose, and the patient must follow the movements made by the examiner with his eyes, who will first move them forward; and then to the right, left, up and down.

Eye movements can also be observed by changing the position of the head or by shaking the head from one side to the other.

Halmagyi test

Another similar test is the Dix-Hallpike maneuver. The patient's head is also moved while changing position, lying down and lifting him up. This test is essential for diagnosing benign paroxysmal positional vertigo. It is used to check the existence of nystagmus, as well as nausea and dizziness.

Treatment

To treat peripheral vertigo, the best option is to intervene in the condition that is causing it. As well as pharmacological treatment of symptoms, physical therapy and patient education to follow certain recommendations in their day to day.

Plaza Mayor, Onrubia and Hernández Carnicero (2009) state that there are 4 components for the treatment of patients with balance disorders and vertigo:

- Inform and reassure the patient.

- Medication for the symptoms of vertigo, for nausea or vomiting.

- Treatment to intervene on the factors causing vertigo.

- Vestibular rehabilitation.

Treatment must be individualized for each case according to the cause of vertigo and the development of the disease. As vertigo is a very annoying symptom, which usually causes anxiety and concern, it is important to reassure and inform the patient, as well as give a brief explanation of their condition and the functioning of the vestibular system.

Anti-inflammatory drugs

Anti-inflammatory medications can sometimes be helpful to relieve symptoms. Especially if the causes are vestibular neuronitis, labyrinthitis or Ménière's disease.

Pharmacological treatments are usually to relieve symptoms, mainly manifestations such as nausea and vomiting. However, they do not eliminate the problem. That is why it is important to avoid these drugs as much as possible, as they can create dependency.

The most widely used drugs are vestibular sedatives that decrease the activity of neurons in the vestibular nuclei of the ear. Within this group are antihistamines, antidopaminergic neuroleptics or benzodiazepines.

Other drugs are antiemetics, which also have a vestibular sedative effect.

Drug treatment will also vary depending on the underlying cause of the peripheral vertigo. In this way, if there is an ear infection, antibiotics can be prescribed.

For patients with Ménière's disease, a drug called betahistine may be prescribed. This drug helps reduce the pressure that causes fluid to build up in the ear.

Repose

When peripheral vertigo is very intense, it is necessary for the patient to rest in bed and administer intravenous fluid therapy.

Vestibular rehabilitation

On the other hand, vestibular rehabilitation consists of a series of exercises that help the person maintain postural and visual stability. The doctor will recommend and explain the best exercises for each case, although generally these consist of vestibular habituation (performing movements that produce vertigo two or three times a day until the symptoms diminish).

Other exercises and therapies

Other exercises are based on focusing your gaze on a specific point, while moving your head from one side to the other.

Physical therapy with a physical therapist is sometimes recommended to improve balance. In this way, the brain would learn to compensate for problems in the inner ear.

Surgery

In severe and persistent cases where all of the above techniques have been tried, surgery may be recommended. This consists of removing part or all of the inner ear.

References

1. García de Hombre, AM (2006). Vertigo patient, frustrating situation for doctor and patient. In Annals of Internal Medicine. 23, 6: 299-299.
2. How to Manage Peripheral Vertigo. (2016, April 26). Obtained from Verywell: verywell.com.
3. I Feel Dizzy: Peripheral Vertigo. (2015, October 29). Obtained from Healthline: healthline.com.
4. Mayor, GP, & Onrubia, T. (2009). Diagnosis and treatment of peripheral vertigo. Jano: Medicine and Humanities, (1749), 46.
5. Superior Canal Dehiscence Syndrome. (sf). Retrieved on January 31, 2017, from the Cleveland Clinic: clevelandclinic.org.
6. Types of Vertigo. (sf). Retrieved on January 31, 2017, from Webmd: webmd.com.
7. Peripheral vertigo (sf). Retrieved on January 31, 2017, from Montpellier: montpellier.com.ar.