22 Oct Treating torsional vertigo: Tips, tricks and therapy

Posted at 08:30h in ENT practice, Dizziness by Dr Thomas Fischer

Rotational vertigo can occur suddenly and without warning, often accompanied by a feeling of loss of control. Sufferers experience an apparent movement of their surroundings - and this can be not only uncomfortable but also frightening. Many people do not realise that there are effective ways to treat this form of vertigo and alleviate the symptoms. This article will provide you with helpful information on causes, tips and proven therapeutic approaches to help you regain stability and confidence in your everyday life.

What is rotary vertigo?

Rotational vertigo is a special form of vertigo in which those affected have the feeling that their surroundings or they themselves are spinning on their own axis. This sensation is usually very intense and is often accompanied by a strong feeling of insecurity. For many people, it is as if they are on a merry-go-round, even though they are not moving. This illusion of rotation can occur both horizontally and vertically.

In addition to the perception of dizziness, it is often accompanied by symptoms such as nausea, vomiting, sweating or a feeling of light-headedness. The intensity and duration of an attack of vertigo vary greatly: some sufferers experience short attacks that only last a few seconds, while others can be affected for hours.

Rotational vertigo also frequently occurs in certain situations, such as when standing up quickly, turning your head or after a sudden change of position.

What are the causes of rotary vertigo?

The unpleasant feeling can have various causes. The most common causes include

Benign paroxysmal positional vertigo (BPLS)

Benign paroxysmal positional vertigo is the most common cause of rotatory vertigo and affects the inner ear, which is responsible for balance.
This is where the organ of balance is located, which consists of several interconnected semicircular canals. They are each filled with fluid. The semicircular canals contain small sensory cells that register movements of the head and transmit this information to the brain to control balance.

In BPLS, tiny calcium crystals (otoliths or statoliths) detach from their original location in the utricle (part of the vestibular system) and enter the semicircular canals. These crystals then start to move with certain head movements and irritate the sensory cells, which then send false signals to the brain. These signals create the impression that the body or the environment is rotating, although this is not the case.

The main symptom of BPLS is therefore an intense rotatory vertigo that occurs suddenly with certain head or body movements.
The dizziness usually lasts only a few seconds, but can be very severe and is often accompanied by nausea or severe discomfort. The attacks usually occur repeatedly.

Meniere's disease

This is a disease of the inner ear, typically characterised by recurrent attacks of vertigo, hearing loss and ringing in the ears (Tinnitus). These symptoms are caused by a disturbance of the organ of balance and the auditory system in the inner ear, which can lead to considerable impairment in everyday life.

The exact cause of Meniere's disease is not fully understood. However, it is assumed that an accumulation of fluid in the inner ear, particularly in the so-called endolymph, plays a central role. This fluid is important for the transmission of sound and balance information to the brain. In Meniere's disease, however, there is an imbalance or overproduction of this fluid, which increases the pressure in the inner ear. This pressure damages the fine structures responsible for hearing and balance function.

Typical symptoms of Meniere's disease are

Seizures of severe spinning vertigo that can last from several minutes to hours
Balance disorders
Nausea and vomiting
Temporary and later permanent hearing loss in one ear
Recurrent or constant ringing in the ears
Unpleasant feeling of pressure in the affected ear, which often occurs before or during an attack

Vestibular neuronitis

This is an acute inflammation of the vestibular nerve, which is responsible for transmitting information from the vestibular organ in the inner ear to the brain. This inflammation leads to sudden and severe vertigo without affecting hearing.

Scientists assume that the inflammation can be caused by a viral infection. However, circulatory disorders or bacterial infections may also be associated with it.

The characteristic symptoms of vestibular neuronitis are

a sudden and severe spinning vertigo
Difficulty walking straight (unsteady gait)
Nausea and vomiting
No hearing impairment (no tinnitus or hearing loss)
Spontaneous nystagmus (uncontrolled, rhythmic eye movements)

Labyrinthitis

Labyrinthitis is an inflammation of the entire inner ear, including the organ of balance and the cochlea. The inflammation can be caused by viruses or bacteria. In contrast to vestibular neuronitis, in which only the vestibular nerve is affected, those affected by labyrinthitis suffer from severe spinning vertigo as well as hearing loss and sometimes tinnitus.

Perilymph fistula

A perilymph fistula is an injury in which fluid (perilymph) leaks from the inner ear into the middle ear. This can be caused by an injury to the round or oval window of the inner ear, which is a delicate partition between the inner ear and the middle ear. This injury can occur as a result of trauma, intense pressure, sudden changes in air pressure (e.g. when diving or flying) or sometimes spontaneously.

Typical symptoms are

Rotational vertigo, which often occurs with certain movements
Hearing loss, usually on one side
Feeling of pressure in the ear or tinnitus

Acoustic neuroma (vestibular schwannoma)

This benign tumour grows on the vestibular nerve. It develops slowly and can exert pressure on the nerve. This can lead to dizziness, hearing loss and balance problems. Rotational vertigo does not usually occur suddenly, but develops over a longer period of time.

Trauma of the inner ear

Direct trauma to the inner ear, e.g. from a blow to the head, can damage the organ of balance and cause spinning vertigo. Fractures of the temporal bone surrounding the inner ear in particular can lead to severe attacks of vertigo.

Ototoxicity (damage to the inner ear caused by medication)

Certain medications and chemicals can damage the inner ear and cause dizziness, balance problems or hearing loss.

Migraine-associated dizziness (vestibular migraine)

In some people, rotational vertigo occurs as part of a migraine attack, even if the typical headache is not always present. This is known as a vestibular migraine.

Circulatory disorders in the brain

In particular, disorders in the cerebellum or brain stem caused by a stroke or a temporary circulatory disorder can cause symptoms of dizziness.

Cervical spine problems (cervicogenic dizziness)

Tension or misalignments in the cervical spine can affect balance and cause dizziness.

Diagnostics for rotary vertigo: examinations at your ENT clinic in Frankfurt

In order to treat torsional vertigo, thorough examinations are required to identify the cause of the symptoms. In our ENT clinic in Frankfurt we use a combination of questioning (anamnesis), physical examination and special tests.

Medical history

The first step is to take a detailed medical history, during which we ask you about your vertigo symptoms and possible triggers. Typical questions include

When do the dizziness attacks occur? (sudden, slowly developing)
How long do the dizzy spells last?
Is the dizziness triggered by certain movements or situations? (e.g. when turning the head, when standing up)
Are there accompanying symptoms such as nausea, vomiting, hearing loss, tinnitus or headaches?
Have you recently had any infections (e.g. respiratory tract infections) or head injuries?

Clinical examination

The medical history is followed by a physical examination focussing on the vestibular system, eye movements and hearing. The most important examinations include

Examination of eye movements (nystagmus)
We check whether there are uncontrolled, rhythmic eye movements that indicate a disorder of the balance system. Nystagmus often occurs with rotational vertigo and indicates whether the inner ear or the central nervous system is affected.
Balance test
We then carry out balance tests. For example, you have to stand still with your eyes closed or stand on the spot. This allows us to determine whether there are any fluctuations or instability. We also put you in a special position to specifically provoke the dizziness. If rotational vertigo occurs together with nystagmus during this movement, this is an indication of BPLS.
Hearing tests (audiometry)
If you notice hearing loss or tinnitus, we will close Hearing tests on. This allows us to determine the extent of the hearing loss. This may indicate Menière's disease or labyrinthitis, for example.
Video electronystagmography (Video-ENG)
We measure your eye movements using cameras and electrodes. They help to determine whether the dizziness is caused by a disorder of the inner ear or the vestibular nerve.
Calorific test
Another diagnostic option is to introduce air into the inner ear to induce nystagmus. This helps to determine whether both inner ears react normally to stimuli. If there are deviations, this is an indication of a disorder of the balance system.
Ear canal test
With this examination, we measure the pressure in your middle ear and check the mobility of your eardrum. This allows us to check for middle ear diseases.
Imaging procedures
In certain cases, especially if we cannot clearly assign the dizziness to a specific cause or if other neurological symptoms are present, further examinations are useful. An MRI scan, for example, can detect tumours and other structural problems in the brain or inner ear. A CT scan can be used, for example, to detect fractures of the temporal bone or other injuries to the skull that can cause rotational vertigo.

Treating torsional vertigo: Options at our ENT clinic in Frankfurt

We are at your side to treat your spinning vertigo. The therapy depends on the underlying cause. The treatment aims to alleviate the symptoms, eliminate the triggers and improve your quality of life in the long term. Here are the most important treatment approaches:

Drug therapy

In the case of acute attacks of vertigo or chronic vertigo, we can prescribe medication to alleviate the symptoms. These include, for example

Antivertiginosa
Medications with active ingredients such as dimenhydrinate or betahistine act on the vestibular system and can help to control dizziness.
Antiemetics
Agents such as metoclopramide can treat nausea and vomiting, which are often accompanied by spinning dizziness.
Corticosteroids
For certain conditions such as vestibular neuronitis, we can prescribe cortisone. The medication can reduce the inflammation of the vestibular nerve and speed up recovery.

Positioning therapy for benign paroxysmal positional vertigo

The main treatment method for BPLS, a common cause of rotary vertigo, is so-called positional therapy. The aim is to move the dissolved calcium crystals (otoliths), which are located in the semicircular canals of the inner ear, back into the utricle (the Organ of equilibrium). To do this, we use special manoeuvres that put you in certain positions to move the crystals by gravity.

These positioning manoeuvres are very effective and often lead to immediate relief from the symptoms of dizziness.

Treatment of Menière's disease

There are several treatment options available for Meniere's disease:

Diuretics
Dehydration medication can help to reduce the fluid pressure in the inner ear. This can reduce the frequency of vertigo attacks.
Betahistine
This medication can improve blood circulation in the inner ear.
Gentamicin injections
In severe cases, we can inject gentamicin into the middle ear to reduce the function of the vestibular organ on the affected side. This will control the vertigo attacks, but with the risk of Hearing loss on the treated side.

Treatment of vestibular neuronitis

If the vestibular nerve is inflamed, corticosteroids can help to reduce the inflammation and speed up recovery in the early phase. Vestibular neuroticism can also be treated with antivertiginous drugs. These drugs can alleviate the acute symptoms of vertigo.

Treatment of perilymphatic fistulas

The therapy depends on the severity of the fistula:

Conservative treatment
In mild cases, we recommend rest and avoiding physical exertion to support the healing of the fistula.
Surgical treatment
In severe cases, where the fistula does not close by itself, surgery may be necessary.

Treatment of migraine-associated dizziness

Beta blockers, antiepileptic drugs or antidepressants can help to reduce the frequency of migraine attacks and the associated dizziness.

Treating rotary vertigo: General tips

There are some general tips and measures that you can take yourself to reduce the frequency and intensity of seizures or to deal with them better.

Keep calm and sit or lie down

If a dizzy spell occurs suddenly, it is important that you sit or lie down immediately to minimise the risk of falling. A calm, stable place helps to control symptoms and avoid injury from tripping or falling. Focus on a fixed point in your surroundings to keep your bearings.

Avoid head-conscious movements

Certain head movements can accelerate dizziness. To avoid dizziness attacks, you should avoid fast or jerky head movements. - Turn over carefully in bed and always stand up slowly.

Treat rotary vertigo with a low-salt diet and sufficient fluid intake

A low-salt diet can help to reduce the pressure in the inner ear. Also make sure you drink enough fluids to promote balance in the body.

Reduce stress

Stress and pressure can trigger or worsen dizziness attacks in many people. It is therefore important to integrate stress management techniques into everyday life. Yoga, meditation or breathing exercises can reduce stress and control the symptoms of dizziness. Other approaches to reducing stress include progressive muscle relaxation and autogenic training.

Balance exercises (vestibular rehabilitation)

Regular training can help to strengthen the balance system and enable the brain to better compensate for symptoms of dizziness. In medical training therapy (MTT) or physiotherapy, for example, you will receive targeted exercises that are specifically tailored to your situation.

Treating rotational vertigo with eye and head movement exercises

By gently moving your head in different directions while fixing your eyes on a fixed point, you can train your balance system.

Walking and balance exercises

They can help you to improve your stability when walking and standing - especially if the dizziness lasts longer.

Sleep hygiene and posture

Make sure you sleep well and avoid unhealthy postures. This can also help to alleviate or even prevent dizzy spells. Sleep on a flat pillow to keep your neck in a neutral position. Also avoid sleeping on the side of the affected ear if you have rotatory vertigo, e.g. due to Meniere's disease or BPLS.

Increase safety in everyday life

As spinning dizziness often leads to balance problems, you should make sure that your surroundings are safe in order to minimise the risk of falling. Therefore, remove tripping hazards such as loose carpets or cables. Use non-slip mats in the bathroom and install grab rails in critical areas, e.g. in the shower or on stairs.

Avoidance of alcohol and nicotine

"Everyday drugs" such as alcohol and nicotine can put additional strain on the vestibular system and worsen symptoms of dizziness. Avoid or reduce the consumption of these substances.

Regular check-ups at our ENT clinic in Frankfurt

If you suffer from recurrent vertigo, it is important to seek regular medical advice. We can determine the cause of the dizziness and develop customised treatment strategies for you.

Treating torsional vertigo in Frankfurt

Rotational vertigo can have a major impact on life, but can be effectively alleviated with targeted treatments such as positioning manoeuvres, medication and balance exercises.

We are your experienced contact partners for a comprehensive Vertigo diagnostics and individual Dizziness therapy. With state-of-the-art procedures and customised treatment plans, we help you to sustainably improve your vertigo symptoms and restore your quality of life.

Simply contact us to arrange an appointment!

Do you have any questions on this topic or would you like to arrange a consultation?

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ENT Frankfurt: Dr Thomas Fischer & Dr Albrecht Linke

Your specialists for ear, nose and throat medicine, who will provide you with professional and individualised advice, examinations and treatment in all matters relating to ENT medicine, functional plastic surgery and the aesthetic treatment of changes to the facial skin.

Our news articles are prepared for you to the best of our knowledge and belief and are intended for general education. They are in no way a substitute for medical advice, diagnosis and treatment and are not intended to encourage self-diagnosis or self-treatment. Please always contact your ENT specialist in Frankfurt directly if you have any health complaints!

© "Blured photo of a woman suffering from vertigo or dizziness or other health problem of brain or inner ear." by Tunatura, stock.adobe.com | "Iron deficiency anemia. Sad woman with dizziness sitting on floor. Unhappy girl suffers from vertigo and headache and needs medical help. Low hemoglobin. Vector illustration in flat cartoon style." by KeronnArt, stock.adobe.com

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