Vertigo

Vertigo is a symptom characterised by the sensation of spinning or movement, affecting either the individual or their surroundings. Unlike dizziness, which involves a floating sensation, or imbalance, which reflects unsteadiness, vertigo conveys a distinct sense of motion. While it is not a condition in itself, vertigo often indicates an underlying issue and can range from mild to debilitating, significantly impairing balance and daily activities.

Physiology of vertigo

Physiologically, vertigo is primarily linked to the inner ear and the vestibular system, which is responsible for maintaining balance and spatial orientation. The vestibular apparatus consists of semicircular canals and otolith organs, which detect angular and linear movements, respectively. Dysfunction in these structures, or their neural pathways to the brainstem and cerebellum, can disrupt normal sensory input, causing vertigo. Symptoms (Figure 1) may include a spinning sensation, nausea, vomiting, nystagmus (involuntary eye movements), sweating, and difficulty with balance. Triggers vary widely and may include head movements, changes in position, or even psychological stress. The underlying causes can be peripheral, such as inner ear disorders, or central, involving the brain or central nervous system.

Causes and prevalence

Vertigo is particularly common among middle-aged and older adults, where it presents a considerable risk of falls and associated injuries. This demographic is especially vulnerable due to age-related changes in the vestibular system, such as a decline in vestibular hair cells and neurons, as well as alterations in central pathways. Vestibular disorders are among the most frequent causes of vertigo episodes in the elderly, often contributing to a cycle of psychological distress and physical limitation. Anxiety and depressive syndromes further exacerbate this cycle by increasing fear of attacks and falls, ultimately limiting daily activities and lowering perceived quality of life.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo and is featured in multiple studies within the literature (Figure 2). BPPV is typically triggered by changes in head position, leading to brief episodes of intense vertigo. Despite its prevalence, management can be challenging due to the nonspecific nature of symptoms and the diverse underlying causes.

Polypharmacy, or the use of multiple medications, has also emerged as a significant factor in vertigo among older adults. Prescriptions involving several drugs, particularly antihypertensives and sedative hypnotics, have been linked to an increased likelihood of vertigo. Careful assessment of medication interactions and side effects during medical consultations is therefore essential.

Metabolic disorders, such as diabetes and hypoglycaemia, also contribute to vertigo in some individuals. However, in a portion of cases, the exact cause of vertigo remains unidentified, highlighting the complexity of diagnosis.

Conclusion

As one of the most common and disabling symptoms in the elderly, vertigo requires comprehensive and individualised care. Understanding its underlying physiological mechanisms, as well as recognising the multifactorial influences such as medication use, psychological health, and metabolic disorders, is essential for effective management. By adopting an integrated approach that prioritises accurate diagnosis and targeted interventions, clinicians can improve both symptom control and overall quality of life for individuals affected by vertigo. Further research is needed to enhance treatment strategies and address the remaining gaps in knowledge.

Written by Maria Z Kahloon