Vertigo assessment
There are many causes of vertigo, the most frequent of which are related to an inner-ear problem, and more specifically to the vestibule, the organ that helps maintain body and head stability. This is known as vertigo of peripheral or vestibular origin. A clinical assessment by an ENT doctor is recommended in cases of vertigo. He or she will ascertain whether or not your vertigo is vestibular in origin, and will either treat you or refer you to another specialty (cardiology, neurology, etc.). Vertigo can also have a cerebral cause, in which case we speak of vertigo of central origin.
The most common cause of vestibular vertigo is benign paroxysmal positional vertigo, or BPPV. It is triggered by a change of position, such as standing up, lying down, leaning forward or turning over in bed. It is of mechanical origin, due to a calculus or otolith that detaches itself from its normal physiological attachment zone (utricle or saccule), where it participates in the perception of body acceleration, and moves to another part of the vestibule where it shouldn’t be (semicircular canal). The calculus then entracts the flow of liquid, creating erroneous information on the position and movements of the head, which is sent to the brain. Treatment is also mechanical, using a release maneuver to move the stone, and does not require medication.
Vestibular neuritis, Meniere’s disease and acoustic neuroma are classic vertiginous pathologies that also fall within the remit of ENT.
Why?
- If you have the sensation that your body or head is rotating in space, or that objects are spinning around you.
- If you have a sensation of spinning for a short time when you move your head in a certain position.
- Nausea or vomiting.
- If you can’t stand upright.
- If you deviate to one side when walking.
- If your vision is blurred.
- If you have the sensation that the ground is sinking under your feet or becoming vertical, or that you are walking on absorbent cotton.
- If you feel that your body is shifting or falling backwards all the time, even when you’re lying down.
- A hearing assessment carried out by an ENT specialist will enable us to accurately identify the degree and type of hearing loss, and propose an appropriate solution.
For whom?
ADULTS: Vertigo can affect people of all ages, and the 2 most common causes are BPPV or benign paroxysmal positional vertigo, and vestibular neuritis. Ménière’s disease, although very well known, is fairly rare, and its diagnosis is sometimes wrongly attributed by non-ENT doctors.
CHILDREN: Children are very rarely affected by vertigo, and it is essential to rule out non-ENTL (so-called central) causes. On the other hand, their recovery is often very impressive, thanks to their great cerebral plasticity.
Where and how?
Vertigo assessment can involve several stages:
- The ENT doctor carries out a specific clinical examination,The ENT doctor carries out a specific clinical examination, using manoeuvres adapted to each case. He will also look for involuntary movements of the eyeballs, whether spontaneous, sensitized or provoked. These movements are very rapid jerks, called nystagmus. He will examine the eyes for nystagmus using a mask with a minicamera (Videonystagmoscopy or VNS).
- A hearing test (audiogram)
- A test to evaluate the response of the semicircular canals to rapid head movements imparted by the doctor (Video Head impulse test ou VHIT)
- Another test to evaluate more specifically the lateral semicircular canal using stimulating hot water irrigation at 44°c or inhibiting cold water irrigation at 30°c.(Video nystagmography caloric test or VNG)
- A test to evaluate the eyes’ ability to follow a point of light (Video Nystagmography or VNG)
- Other, rarer tests may also be requested (subjective vertical, otolith evoked potentials, rotatory test, equitest…).
Complimentary assessment
In addition to the assessment described above, your ENT specialist may decide to perform
- a CT scan of the roches (the roches are the bones that surround the inner and middle ear and contain the ossicles).
- an MRI of the acoustic-facial bundles (the acoustic-facial bundle corresponds to the cochleovestibular and facial nerves, which are anantomically very close).
- A blood biology test that varies according to the medical context.
ENT consultation for a dizziness check-up in La Roche-sur-Yon, Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about vertigo assessments. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.