Vertigo can be caused by disturbances in the inner ear (peripheral vertigo). 
The feel is the same as it feels to look down from a considerable height. 
Dizziness affects women more than men.

According to Marcelo B Antunes, MD ( Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System ) balance is the result of an integration of information from sensory receptors at the level of:

  • Vestibular apparatus (in the inner ear ),
  • Eyes,
  • Proprioceptive nerve endings (which signal the position of the body in space).

This information is processed:

  • No cerebellum ,
  • No brain stem .

The correct integration of signals from the nerves allows:

  • A straight walk,
  • A correct postur ,
  • Focusing the images on the eyes.

The central vertigo can be caused by:

  • An injury of the cerebral organs of the balance (brain stem and cerebellum),
  • The mismatch of sensory information (at the level of the cerebral cortex).

The vestibular nerve is the nerve of balance. 
Vestibular nerve lesions cause an imbalance that may influence vestibular sensory information. 
However, this can be compensated for by the nerve on the other side and by the vestibular nuclei; therefore, patients never have violent vertigo, but may have a sense of instability.


Notes on the anatomy of the ear and the balance mechanism

The vestibular organs of the ear are:

  • Utricle,
  • Saulo,
  • Three semicircular canals.

The semicircular canals record the rotational movement of the head. 
They are perpendicular to each other and contain a fluid called endolymph.

Each channel has a certain function and records the movements of the head up, down, to one side or the other and the rotations. 
These channels contain ciliated sensory cells that activate with the movement of the endolymphatic fluid. 
By moving the head (for example, by tilting the head to one side), ciliated sensory cells send a nerve impulse to the brain through the auditory nerve. 
The endolymphatic fluid (in the semicircular canal) moves the otoliths . 
These crystals glide over the sensory cilia at the base of the utricle and saccule.

The impulses reach the brain stem and cerebellum area. 
If the otoliths release from sensory hair cells, they travel through the vestibular labyrinth and can cause dizziness and serious problems of balance (benign paroxysmal positional vertigo).


Classification of dizziness

  • In subjective vertigo , the individual has the sensation of being spinning.
  • In objective vertigo , the person feels the body stopped but it is the room that revolves around it.


Types of dizziness based on origin

1) Peripheral vertigo is caused by a labyrinth disorder; the duration is short, but it occurs suddenly. 
Peripheral vestibular disorders are limited:

  • To the eighth cranial nerve,
  • To the inner ear.

Patients may also report a loss of balance .

Often other symptoms occur, such as:

In this case, the vertigo is recurrent or relapsing  for a period and then goes by itself. (Timothy L. Thompson, MD – Department of Otorhinolaryngology – Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA).

Among the diseases that cause peripheral vertigo are:

  1. Ménière’s syndrome
  2. Benign positional paroxysmal vertigo
  3. Neuron vestibular
  4. Labyrinthitis
  5. Schwannoma vestibular (tumor intracraniano)
  6. Perilymphatic fistula (abnormal communication channel between inner ear and perilymphatic space)
  7. Superior Semicircular Canal Dehiscence Syndrome (lack of bone above the superior semicircular canal)
  8. Trauma

2) Vertigo is defined  central if the cause is a disease or injury of the central nervous system . The disease is progressive, but lasts a long time. 
Patients with central vertigo present above all problems of constant balance and coordination, not real vertigo. 
However, this is not always true. 
Often patients can not stand or walk, while patients with peripheral vertigo can walk smoothly. 
Depending on the injury, there may be:

The diseases that can cause this symptom are:

  • Vertebrobasilar ischemic stroke ,
  • Vertebrobasilar insufficiency,
  • Multiple sclerosis .


Causes of dizziness

Many causes are not serious and it is possible to cure the symptoms with simple changes in everyday life. 
Many of the symptoms disappear without the need for treatment. 
The most common causes of vertigo are explained in the list below:

Low Blood Pressure
In orthostatic hypotension, the body’s blood pressure drops:

  • Upon rising quickly,
  • When moving quickly from the sitting position to the lying position.

The body must adapt quickly to these changes of position. 
Some people need a few minutes to regain normal pressure. 
While blood pressure does not stabilize, the individual may have vertigo.

Another cause of sudden dizziness is dehydration . 
When the body does not have enough fluids, the person feels:

  • Stunning,
  • Instability,
  • Blurred or blurred vision.

During exercise, lack of water can cause an imbalance in the body. 
Alcohol consumption causes dehydration. 
When a person has a vomiting , diarrhea , or fever , he may be dizzy.

The symptoms of migraine are as follows:

Also light or noise can cause dizziness. 
Experts think that the changes that occur within the blood vessels of the brain are responsible for the migraine. Many times when the migraine heals, the dizziness disappears. 
To treat vertigo caused by vestibular migraine, your doctor can give you useful advice on:

  • diet ,
  • Stress ,
  • Like sleeping at night,
  • Exercises to do.

Certain medications can prevent vestibular migraine, relieving nausea and vomiting.

Low blood glucose in people taking insulin to treat diabetes can cause dizziness and other symptoms such as:

  • Confusion ,
  • Cold sweat.

Drugs to lower blood pressure may be too effective and may cause the pressure to drop to lower than desired levels, causing dizziness. 
Also sedatives can cause dizziness.

Women may experience dizziness and dizziness during pregnancy . 
They are caused by changes that occur in the woman’s body.

According to Webmd, the pregnancy hormone progesterone causes vasodilation(dilates blood vessels); in addition, more blood goes to the uterus. 
The consequences are:

Also position can make a lot of difference. 
For example, when a pregnant woman is lying on her back, the uterus compresses the inferior vena cava (which carries blood from the lower body to the heart ). 
In this way, it prevents the return of blood to the heart and further decreases blood pressure.

Arrhythmia or other heart problems
The heart is the organ that pumps blood to the body. 
Lack of blood supply to the heart causes pain in the heart muscle. 
Also arrhythmia (irregular heartbeat) may cause dizziness.

Depression and anxiety
Often anxiety and depression cause dizziness. 
Experts associate panic disorder , anxiety , depression , etc. with dizziness. 
People who are depressed or anxious often have dizziness.

Other symptoms of depression are:

  • Anxiety Attacks
  • Panic Attacks
  • Pseudovertigens

The anxiety affects the respiratory system and causes hyperventilation. 
Remember that dizziness is also caused by tablets to treat depression.

Vertigo of cervical origin
Among the causes of dizziness of cervical origin  are:

Ear Problems
Many causes of vertigo are caused by ear disorders. 
Some problems in the inner ear cause:

  • Lack of balance,
  • Vertigo.

The neuronoma of the acoustic nerve is a benign mass in the acoustic nerve. 
This nerve connects the brain to the inside of the ear. This condition causes dizziness. 
The  Meniere’s syndrome also causes the same symptoms. 
When fluid builds up in the region of the inner ear, this disease may occur. 
Acute vestibular neuritis is an inflammation of the vestibular nerve and may cause dizziness for several days. 
The symptoms of this pathology are as follows:

  • Nausea ,
  • Vomiting,
  • Lack of balance .

The labyrinthitis is a disorder of the ear that ignites the maze. Labyrinthine causes severe dizziness and other symptoms, including:

  1. Deafness,
  2. Vomiting,
  3. Tinnitus (or whistling in the ears ).

Temporomandibular joint dysfunction
The jaw bone is attached to the temporal bone (the one containing the ear organs). 
If one bone is poorly positioned or not well aligned with the other, several symptoms may occur, including:

Benign Positional Paroxysmal Vertigo (BPPV)
is a disorder caused by the displacement of otoliths (small calcium carbonate crystals) from the otolithic organs (utricle and saccule) to the semicircular canals of the inner ear. 
Symptoms occur during certain movements, especially in the morning.

At night , if the person sleeps with a pillow, the head is lifted at an angle of about 30 ° to the plane of the bed. 
In this position, the macula of the utricle is located just above the dome of the posterior semicircular canal. 
If the otoliths are released, they may descend into the ampule (the portion of the posterior semicircular canal where the positional receptors are with the stereocyles).

Upon awakening , when the person rises from the bed, the displacement of the endolymph and the otoliths (which should not be there) causes an excessive solicitation of the dome of the semicircular canal. 
The consequence is dizziness. 
Also the lack of otoliths at the level of the macula in the utricle can promote the appearance of vertigo.

It is a benign formation in the middle ear that can extend inwards and can interfere with:

  • The vestibular apparatus,
  • The hearing aid or cochlea.

If the cholesteatoma affects the cochlea, it causes irrecoverable neurosensory deafness (even with the prosthesis ). 
If the vestibular apparatus is invaded, it causes objective vertigo with:

  • Nausea,
  • Vomiting.

There is a special signal that makes diagnosis easier. 
The lateral semicircular canal located in the medial wall of the middle ear is the most affected. 
If this channel is corrupted:

  • Erosion of the bone labyrinth occurs.
  • The consequence is the exposure of the membranous labyrinth (it is no longer protected by the bone).

A labyrinthine fistula forms that connects the labyrinth to the middle ear. 
Pressure (even light) in the duct causes a very violent vertigo. 
It’s the sign of the fistula.

Cardiovascular Problems
The major cardiovascular disorders that cause vertigo are listed below:


Other causes of dizziness

  • Smoking a cigarette; after smoking a lightheadedness lasts for a few seconds
  • The drug
  • Allergy  – can cause blockage of the Eustachian tube and therefore the accumulation of inflammatory fluid in the ear. The consequence is loss of balance because the organs of balance are present in the ear.
  • Influenza  – there are antihistamine drugs for the flu that can cause dizziness, for example diphenhydramine (Difenidrin).
  • Cold
  • Tumor or metastases in the brain
  • Internal bleeding or heavy menstrual bleeding (in case of anemia or low blood pressure)
  • Pre-menstrual syndrome (before the menstrual cycle or during ovulation due to hormonal changes )
  • After eating or when the person is under stress the body takes more blood to the muscles and to the stomach; therefore, the brain receives a smaller amount and this can cause a slight dizziness.


Dizziness in the elderly

Often a patient is fine when getting out of bed, but vertigo appears after a while. 
For example, the patient has no problems at home, but can not shop or walk outdoors. 
In this case, there is talk of instability.

In the elderly patient, the causes are many, for example: 
1) Musculoskeletal stiffness , a rigid body that vibrates at high frequency can be perceived by the vestibular system as instability (for example, Parkinson’s disease ); 
2) The elderly person frequently suffers from presbycusis (progressive age-related hearing loss) and presbytaxis  (progressive degeneration of the vestibular system with reduction of labyrinth reflexes); 
3) Often the patient has disorders that cause low vision ( cataract , maculopathy , etc.); the consequence is that vision can not compensate for the decline of labyrinth function;
4) Among the possibilities there are peripheral neuropathic disorders , such as sensorimotor neuropathy of the lower limbs that causes loss of sensitivity in the sole of the foot. 
In this case, the patient perceives the instability mainly:

  • When you close your eyes,
  • In the evening,
  • When walking on uneven ground.

5) Psychogenic vertigo is considered when the patient:

  • It can not accurately describe the sensation of instability or vertigo,
  • It changes the version of the facts continuously,
  • Uses generic terms.


Dizziness in children

Children may feel unsteady, weak or dizzy. 
Often torture is accompanied by other symptoms:

According to a study by AP CASANI et al. ( Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Italy ), the most frequent causes of vertigo in children are the following:

  1. Vestibular migraine (38%),
  2. Acute labyrinthitis / vestibular neuronitis (16%),
  3. Somatization (16%),
  4. Benign positional paroxysmal vertigo (11%),
  5.  Paroxysmal torticollis (2%),
  6. Path-traumatic: canalicline of the posterior semicircular channel (8%),
  7. Ménière Syndrome (5%),
  8. Idiopathic chronic vertigo (2%).

The hypoglycemia is another cause of dizziness. 
Hypoglycaemia has the following consequences:

  • Low energy,
  • Fatigue ,
  • Confusion ,
  • Dizziness.

In this case, the treatment is simple: a little water and sugar can improve the symptoms.

Also  sunstroke or dehydration can cause dizziness. 
Children who have anemia , cardiac arrhythmia and diabetes are more likely to have vertigo.


Dizziness and blurred vision


  • Tumor cerebral
  • Diabetes
  • Dehydration
  • High / low pressure
  • Multiple sclerosis
  • Migraine
  • Panic attacks.


Sudden dizziness

The main causes of sudden dizziness are as follows:

  • Dehydration,
  • Pseudo-vertigo (psychogenic),
  • Low blood pressure,
  • Stroke .
  • Some medications ( antibiotics , oncology, analgesics, COX-2 inhibitors, cardiovascular, etc.).


Causes of dizziness in the morning

  • Infections of the inner ear,
  • Vestibular problems,
  • Sensory disturbances,
  • Migraine,
  • Multiple sclerosis ,
  • Low blood pressure,
  • Psychogenic or functional drowsiness caused by anxiety (symptoms include increased heart rate, excessive sweating and tremors ),
  • Fast movements,
  • Stroke .


The dizziness when the person gets up is caused by the following reasons:

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