What is the etiology of vertigo?

From the Guidelines

Vertigo is most commonly caused by benign paroxysmal positional vertigo (BPPV), which occurs when calcium crystals in the inner ear become dislodged, as well as Meniere's disease, characterized by fluid buildup in the inner ear. The etiology of vertigo can be complex and multifactorial, involving various conditions that affect the inner ear or brain. According to the clinical practice guideline on BPPV 1, BPPV is a disorder of the inner ear characterized by repeated episodes of positional vertigo, and it is most commonly encountered as posterior canal BPPV or lateral canal BPPV. The guideline also notes that BPPV is thought to be due to canalithiasis, wherein fragmented otolith particles (otoconia) entering the posterior canal become displaced, causing inertial changes to the cupula in the posterior canal, and thereby resulting in abnormal nystagmus and vertigo.

Other causes of vertigo include vestibular neuritis or labyrinthitis, typically from viral infections; acoustic neuroma, a noncancerous tumor on the vestibular nerve; migraines; multiple sclerosis; head or neck injuries; and certain medications that damage the inner ear. Central causes involve the brain stem or cerebellum and include strokes, tumors, or multiple sclerosis. Peripheral causes originate in the inner ear and include BPPV, Meniere's disease, and vestibular neuritis. The clinical practice guideline on Meniere's disease 1 notes that Meniere's disease is an ongoing inner ear disorder, diagnosed by symptoms of two or more episodes of vertigo that last between 20 minutes to 24 hours, and is believed to be caused by too much fluid within the inner ear.

The sensation of spinning or movement occurs because these conditions disrupt the vestibular system, which maintains balance by coordinating information from the eyes, inner ear, and proprioceptors throughout the body. When this system receives conflicting signals, the brain interprets this as movement, resulting in vertigo. Key points to consider in the diagnosis and management of vertigo include:

• The clinical presentation and history of the patient
• The results of physical examination and diagnostic testing, such as audiograms and videonystagmography
• The presence of underlying conditions, such as Meniere's disease or BPPV
• The potential for central causes of vertigo, such as stroke or multiple sclerosis.

Overall, the diagnosis and management of vertigo require a comprehensive approach that takes into account the complex and multifactorial nature of the condition.

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1). The etiology of vertigo is related to diseases affecting the vestibular system in adults, as indicated by the use of meclizine for treatment 2.

• Key words: vertigo, vestibular system, meclizine.

From the Research

Vertigo Etiology

• Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease, characterized by sudden, brief episodes of vertigo precipitated by specific head movements 3.
• The pathophysiology of BPPV is mainly speculative, but it is thought to be caused by a mechanical stimulation of the vestibular receptors within the semicircular canals 4.
• BPPV can be associated with other conditions, such as Meniere's disease, which can affect the treatment success rate and recurrence rate 5.
• Vestibular neuritis is another condition that can cause BPPV, and patients with secondary BPPV due to vestibular neuritis tend to be younger and have symptoms of only posterior semicircular canal involvement 6.
• Several risk factors have been identified as contributing to the recurrence of BPPV, including:
  • Meniere's disease 5, 7
  • Head trauma 7
  • Diabetes mellitus 7
  • Migraine headaches 7
  • Female gender 7
  • Advanced age 7
  • Osteoporosis 7
  • Vitamin D deficiency 7
  • Hypertension 7

BPPV Subtypes

• Posterior semicircular canal BPPV is the most common variant, and can be effectively treated with the particle repositioning maneuver 3.
• Other subtypes of BPPV include anterior and horizontal canal BPPV, which can be diagnosed using different diagnostic maneuvers, such as the Dix-Hallpike maneuver or supine roll test 3.