This article is actually my response to a health reporter query on vertigo to be published soon. That's why it differs from my usual writing style as I am actually answering the reporters questions.
-What are the causes of vertigo in seniors? Is this a
condition that commonly develops with age? Is it lifestyle-related, hereditary
or a combination of the two?
Vertigo is a sensation of whirling and loss of balance,
associated particularly with looking down from a great height, or caused by
disease affecting the inner ear or the vestibular nerve. Patients have different experiences and
symptoms. Some say, they feel
unsteady, someone else would explain it in visual terms like they are spinning.
Both dizziness and vertigo can be
caused by a wide variety of things including being sick, blood pressure
disorders, or blocked ears.(1)
Dizziness is common in elderly people; 30% of people older
than 65 years experience dizziness in some form,[1–4] increasing to 50% in the
very old (older than 85 years).
It can be caused by a wide range of benign or serious conditions.[5,6]
In 20% to 40% of dizzy patients in primary care, the underlying cause remains
Symptoms of a sense of lightheadedness or disorientation
(dizziness) and/or a mild to violent spinning sensation (vertigo) can have a variety
of causes: vestibular (inner ear) disorders, central nervous system disorders
(such as stroke), cardiac problems (including low or high blood pressure), low
blood sugar, infection, hyper-ventilation associated with anxiety attacks,
medication side effects or interactions between drugs, or an inadequate or
poorly balanced diet. A thorough evaluation by a physician is usually necessary
to help sort out these different possible causes and arrive at a correct
diagnosis. This task can be even more complicated when multiple problems are
present. In such cases, the trouble in any one system may not be severe, but
the combined effects may be enough to cause a serious problem with balance. For
example, an elderly individual with arthritis in the ankle joints and a mild
degeneration in vestibular function may be able to balance adequately until
under-going an operation to remove cataracts. The disturbance in vision during
the healing process and the adjustment to the new glasses or contacts may then
be sufficient to result in imbalance and falls.
Specific vestibular disorders in older adults
Of all vestibular disorders, benign paroxysmal positional
vertigo (BPPV) is one of the most common in older adults. BPPV causes vertigo,
dizziness, and other symptoms due to debris that has collected within a part of
the inner ear. This debris, called otoconia, is made up of small crystals of
calcium carbonate (sometimes referred to colloquially as “ear rocks”). With
head movement, the displaced otoconia shift, sending false signals to the brain
and causing dizziness or vertigo.
Symptoms of BPPV are almost always precipitated by a change
in head position. Getting out of bed and rolling over in bed are two common
“problem” motions. Some people feel dizzy and unsteady when they tip their
heads back to look up.
Ménière’s disease is another vestibular disorder that causes
dizziness. Ménière’s disease produces a recurring set of symptoms as a result
of abnormally large amounts of a fluid called endolymph collecting in the inner
ear. These symptoms typically include spontaneous, violent vertigo, fluctuating
hearing loss, ear fullness, and/or tinnitus. The incidence of Ménière’s disease
is generally known to increase with age.
Other vestibular disorders that may occur in older adults
include vestibular neuritis (inflammation of the vestibular branch of the
vestibulo-cochlear nerve, resulting in dizziness or vertigo but no change in
hearing) and ototoxicity (exposure to certain chemicals that damage the inner
ear or the vestibulo-cochlear nerve, which sends balance and hearing
information from the inner ear to the brain). Ototoxicity can result in
temporary or permanent disturbances of hearing, balance, or both
Most people are familiar with the problems associated with
the aging of senses such as vision and hearing. However, the vestibular system
is another sensory system that can also begin to function poorly with age,
leading to a diminished quality of life.
The vestibular system is a complex structure of fluid-filled
tubes and chambers that constitutes part of the inner ear. Specialized nerve
endings inside these structures detect the position and movement of the head
and also detect the direction of gravity. The signals sent from the nerves of
the vestibular system are critically important to the brain’s ability to
control balance in standing and walking and also to control certain types of
reflexive eye movements that make it possible to see clearly while walking or
-What are the main dangers of vertigo, particularly for
the aging population? Is vertigo the kind of ailment that, if severe enough,
would force someone to move into some type of assisted living situation?
-Likewise, what are some harm-mitigating steps for people
who already have vertigo?Is the condition progressive, and can its progression
be slowed through certain healthy habits?
One of the leading health concerns for people over the age
of 60 is falling, which is often related to balance problems. Because, balance
is a complex function, there is often no single identifiable cause of falls in
an elderly person. However, older people with chronic dizziness or imbalance
are two to three times more likely to fall in comparison with older people who
do not experience these problems. Each year, between 20 and 40 percent of adults over 65 who
live at home fall. The consequences of falls can be disastrous; between 12 and
67 percent of elderly adults who fracture a hip die within one year. As a
result, major scientific efforts are devoted to determining the causes of
falling in older adults in an attempt to reduce this significant health hazard.
Balance in walking and standing is dependent on many
factors. Good balance requires reliable sensory input from the individual’s
vision, vestibular system (the balance system of the inner ear), and
proprioceptors (sensors of position and movement in the feet and legs). The
elderly are prone to a variety of diseases that affect these systems, including
cataracts, glaucoma, diabetic retinopathy, and macular degeneration, which all
affect vision; diabetic peripheral neuropathy, which affects position sense in
the feet and legs; and degeneration of the vestibular system.
Balance is also dependent on good muscle strength and joint
mobility. A sedentary lifestyle and arthritis or diseases of bones and muscles
can compromise strength and mobility.
-What are some preventative steps seniors and even
pre-retirees can take to prevent the onset of vertigo?
Although the problem of imbalance in older persons can be
complex, there are a few simple precautions that everyone can follow to help
ensure an active old age. Balance in standing and walking is at least partly a
skill that older adults can learn to maintain and/or improve, and it is
dependent on good general physical condition. Therefore, sound nutritional and
health habits—including regular exercise can go a long way toward preventing
In older people, a regular physical examination by a doctor
familiar with the problems of aging can help identify and correct potential
problems before a serious fall. In addition, making sure that the elderly
person’s environment is safe (with good lighting, secure footing, clear
walkways, handrails and anti-skid devices in bathrooms, etc.) can help prevent
falls and their attendant injuries.
The elderly have a higher risk of contracting many different
kinds of diseases. As a result, the average elderly person is more likely to
have a disease that interferes with balance than a younger person. A tendency
to fall and symptoms of dizziness should not be dismissed as unavoidable
consequences of aging but may be important signs of a disease that might be
cured or controlled. The vestibular system should not be ruled out as a source
of these symptoms.
The ability to move about freely is an important factor in
the quality of life for both younger and older people, and a healthy vestibular
system is vitally important to freedom of movement.
- See more at:
Vestibular Neuritis and Labyrinthitis Treated?
Acutely, vestibular neuritis is usually treated
symptomatically, meaning that medications are given for nausea (anti-emetics)
and to reduce dizziness (vestibular suppressants). Typical medications used are
"Antivert (meclizine)", "Ativan (lorazepam) ",
"Phenergan", "Compazine", and "Valium (diazepam)
". When a herpes virus infection is strongly suspected, a medication called "Acyclovir" or a
relative may be used. When a circulation disturbance is suspected, an agent
that reduces the likelihood of stroke may be used.
Acute labyrinthitis is treated with the same medications as
as vestibular neuritis, plus an antibiotic such as amoxicillin if there is
evidence for a middle ear infection (otitis media), such as ear pain and an
abnormal ear examination suggesting fluid, redness or pus behind the ear drum.
Occasionally, especially for persons whose nausea and vomiting cannot be
controlled, an admission to the hospital is made to treat dehydration with
intravenous fluids. Generally admission is brief, just long enough to rehydrate
the patient and start them on an effective medication to prevent vomiting.
It usually takes 3 weeks to recover from vestibular neuritis
or labyrinthitis. Recovery happens due to a combination of the body fighting
off the infection, and the brain getting used to the vestibular imbalance
(compensation). Some persons experience persistent vertigo or discomfort on
head motion even after 3 weeks have gone by. After two-three months, testing
(i.e. an ENG, audiogram, VEMP, and others) is indicated to be certain that this
is indeed the correct diagnosis and a referral to a vestibular rehabilitation
program, may help speed full recovery via compensation.
(prednisone, methylprednisolone or decadron) were previously suggested. Strupp
and others (2004) reported that steroids (methylprednisolone for 3 weeks)
significantly improved the recovery of peripheral vestibular function in
patients with vestibular neuritis, while valacyclovir did not. However, a
meta-analysis of 4 similar studies concluded that all studies suggesting
improvement had significant methodological bias, and that there is currently
insufficient evidence to recommend use of steroids for treatment of vestibular
neuritis (Fishman et al, 2011).
How might vestibular neuritis affect my life ?
You will probably be unable to work for one or two weeks.
You may be left with some minor sensitivity to head motion which will persist
for several years, and may reduce your ability to perform athletic activities
such as racquetball, volleyball and similar activities. After the acute phase
is over, for a moderate deficit, falls are no more likely than in persons of
your age without vestibular deficit (Herdman et al, 2000). Persons in certain
occupations, such as pilots, may have a greater long term impact (Shupak et al,
You may also have mild problems with your thinking. Even in
persons who are well compensated, sensory integration seems to require more
attention in persons with vestibular lesions than normal subjects (Redfern et
Recurrent vestibular neuritis -- Benign recurrent vertigo
Fortunately, in the great majority of
cases (at least 95%) vestibular neuritis it is a one-time experience. Rarely
(5%) the syndrome is recurrent, coming back at least once, and sometimes year
after year. When it is recurrent, the symptom complex often goes under other names.
These include benign paroxysmal vertigo in children (Basser, 1964), benign
recurrent vertigo (Slater 1979, Moretti et al, 1980), or vestibular Meniere's
syndrome (Rassekh and Harker, 1992). Many authors attribute this syndrome to
migraine associated vertigo. There is often a familial pattern (Oh et al,
2001), and it may instead be an entity by itself (Lee et al, 2006) but lacking
any clear diagnostic findings that distinguish it from recurrent vestibular
neuritis or acephalgic migraine.
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