What are the causes of vertigo?

From the Guidelines

Vertigo is primarily caused by inner ear disorders, including benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, and labyrinthitis, as well as other conditions such as migraines, head or neck injuries, and certain medications. According to the clinical practice guideline on Meniere's disease 1, common causes of vertigo/dizziness and their differentiating features from Meniere's disease include:

• Autoimmune disorders, such as multiple sclerosis, which often present with progressive fluctuating bilateral hearing loss that is steroid responsive
• Benign paroxysmal positional vertigo, characterized by positional vertigo lasting less than a minute
• Infectious diseases, such as Lyme disease, which can lead to complete hearing loss and vestibular crisis events with prolonged vertigo and/or hearing loss
• Otosyphilis, which presents with sudden unilateral or bilateral sensorineural fluctuating hearing loss, tinnitus, and/or vertigo
• Stroke or ischemia, which may cause vertigo lasting for minutes with nausea, vomiting, severe imbalance, and other neurologic symptoms
• Vestibular migraine, which presents with attacks lasting hours but can also present with attacks lasting minutes or 24 hours
• Vestibular schwannoma, which may present with vertigo, chronic imbalance, and asymmetric hearing loss and tinnitus
• Labyrinthitis, which is characterized by sudden severe vertigo with profound hearing loss and prolonged vertigo
• Vestibular neuritis, which is a viral infection of the vestibular system leading to acute prolonged vertigo with prolonged nausea, vomiting, and severe rotational vertigo.

The history and physical examination should evaluate for neurologic, neurotologic/otologic, oncologic, inflammatory, or infectious causes, and the patient's symptoms should be clearly defined to establish a clinical diagnosis 1. A thorough otologic history and medical/surgical history are essential in evaluating a patient with suspected vertigo, and understanding the specific cause is crucial for proper treatment, which may include medication, physical therapy exercises, lifestyle modifications, or in some cases, surgical intervention 1.

From the Research

Vertigo Causes

• Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, and it can be associated with Meniere's disease 2, 3, 4, 5, 6
• Meniere's disease is a disorder of the inner ear that can cause vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear 2, 3, 4, 5, 6
• BPPV associated with Meniere's disease can have different clinical features, such as a higher percentage of female patients, longer duration of symptoms, and more frequent involvement of the horizontal semicircular canal 3, 4, 6
• The treatment outcomes of BPPV associated with Meniere's disease can be different from those of idiopathic BPPV, with a higher rate of recurrence and more therapeutic sessions needed for cure 2, 3, 4, 6
• Lateral canal involvement is more common in BPPV associated with Meniere's disease, and patients with Meniere's disease are more likely to have BPPV in the same ear as Meniere's disease 5, 6

Clinical Features

• The clinical features of BPPV associated with Meniere's disease can include:
  • Unilateral semicircular canal BPPV 2
  • Bilateral BPPV 2
  • Posterior semicircular canal involvement 2
  • Horizontal semicircular canal involvement 3, 4, 6
  • Lateral semicircular canal involvement 5, 6
• The duration of symptoms can be longer in patients with BPPV associated with Meniere's disease 3, 4, 6
• The treatment outcomes can be affected by the presence of Meniere's disease, with a higher rate of recurrence and more therapeutic sessions needed for cure 2, 3, 4, 6

Treatment Outcomes

• The treatment outcomes of BPPV associated with Meniere's disease can be different from those of idiopathic BPPV, with a higher rate of recurrence and more therapeutic sessions needed for cure 2, 3, 4, 6
• The canalith repositioning procedure can be effective in treating BPPV associated with Meniere's disease, but may require more attempts than idiopathic BPPV 2, 3, 4, 6
• The presence of Meniere's disease can affect the treatment outcomes of BPPV, with a higher rate of recurrence and more therapeutic sessions needed for cure 2, 3, 4, 6