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Vertigo

Dizziness doesn’t feel the same to all people, so it’s helpful if your physician knows exactly what you are experiencing when you report dizziness. For some people, it’s lightheadedness. Some feel faint. Some feel as if they are moving when they’re not. To some, it feels as if the world is spinning all around them, while others feel as if they are doing the spinning. Both of these forms of dizziness are called vertigo. Some people simply can’t maintain their balance, but have no other unusual sensations at all.

Dizziness and Balance

Dizziness is more common than most people think. In fact,

it’s the second most common complaint people bring to their doctors. It’s estimated that as many as 40% of all adults experience dizziness severe enough to warrant reporting it

to their doctors. Fortunately, most causes of dizziness are detectable and treatable.

Balance (equilibrium) problems can affect almost anyone for reasons such as inner ear infections, medications, trauma,

and neurological problems. Many cases are caused by crystals

(otoliths or “ear rocks”) floating around the wrong part of

the inner ear causing positional vertigo (benign paroxysmal positional vertigo or BPPV). Poor balance can be responsible for dangerous falls or erode confidence to lead an active lifestyle. Fall prevention is an important aspect of the

management of these problems.

Dizziness often occurs along with other symptoms like nausea, anxiety, hearing loss, pressure or fullness in the head or ears, or a ringing in the ears. Once again, it’s important that your doctor knows if these or any other problems accompany your dizziness.

BPPV (Benign Paroxysmal Positional Vertigo)

Cause:

Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia. In patients with BPPV, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris within the affected semicircular canal causes abnormal (pathological) fluid endolymph displacement and a resultant sensation of vertigo. This more common condition

is known as canalithiasis.

Any action which stimulates the posterior semi-circular

canal which may be:

• Tilting the head

• Rolling over in bed

• Looking up or under

• Sudden head motion

Diagnosis:

The condition is diagnosed from patient history (feeling of vertigo with sudden changes in positions); and by performing the Dix-Hallpike maneuver which is diagnostic for the condition. The test involves a reorientation of the head to align the posterior canal (at its entrance to the ampulla) with the direction of gravity. This test stimulus is effective in provoking the symptoms in subjects suffering from archetypal BPPV. These symptoms are typically a short lived vertigo,

and observed nystagmus. In some patients, the vertigo can persist for years.

Treatment:

The treatment of choice for this condition is the Epley canalith repositional maneuver which is effective in approximately 80-95% of patients. The treatment employs gravity to move the calcium build-up that causes the condition. The maneuver is relatively simple but few general health practitioners know how to perform it.

Meclizine is a commonly prescribed medication, but is ultimately ineffective for this condition, other than masking the dizziness. Other sedative medications help mask the symptoms associated with BPPV but do not affect the disease process or resolution rate. Particle repositioning remains the current gold standard treatment for most cases of BPPV.

Surgical treatments, such as a semi-circular canal occlusion, do exist for BPPV but carry the same risk as any neurosurgical procedure. Surgery is reserved for severe and persistent cases which fail particle repositioning and medical therapy.

The Ear: Hearing, Balance and Equilibrium

Hearing:

The sense of hearing is the ability to detect the mechanical vibrations we call sound. Sound waves pass down the

auditory canal of the outer ear strike the eardrum (tympanic membrane) causing it to vibrate these vibrations are transmitted across the middle ear by three tiny, linked bones, the ossicles:

• hammer (malleus)

• anvil (incus)

• stirrup (stapes)

The ossicles also magnify the amplitude of the vibrations.

The middle ear is filled with air and is connected to the outside air by the eustachian tube, which opens into the nasopharynx. Opening of the tube — during swallowing or yawning — equalizes the air pressure on either side of the eardrum.

Allergies or a head cold may inflame the walls of the eustachian tubes making them less easily opened. Rapid changes in pressure at such times — such as descending in an aircraft or during a SCUBA dive, may be quite painful because of the unequal pressure against the eardrums.

Balance and Equilibrium:

The inner ear also detects:

• the position of the body with respect to gravity.

• the motion of the body.

Just above the cochlea are two interconnecting chambers filled with endolymph, the sacculus and utriculus. On their inner surface are patches of hair cells to which are attached thousands of tiny spheres of calcium carbonate (CaCO3). Gravity pulls these downward. As the head is oriented in different directions, these ear stones or otoliths shift their position. The action potentials initiated in the hair cells are sent back to the brain.

Motion of the body is detected in the three semicircular canals at the top of each inner ear, each one oriented in a different plane. There is a small chamber at one end of each canal containing hair cells. Whenever the head is moved, the fluid within the canals lags in its motion so that there is relative motion between the walls and the endolymph. This stimulates the hair cells to send impulses back to the brain. When the hair cells send messages that are incongruent with what the eyes are seeing and our body is feeling, as may occur in a boat or aircraft during rough weather, motion sickness can

result.

Hearing Loss

A hearing impairment or hearing loss is a full or partial decrease in the ability to detect or understand sounds. Caused by a wide range of biological and environmental factors, loss of hearing can happen to any organism that perceives sound.

Tinnitus:

Tinnitus is the abnormal perception of a sound that only the patient can hear. It is usually in the form of a high-pitched ringing but it can take on other forms such as a low-pitched hum or buzz. Most often, it is accompanied by some degree

of hearing loss, even if the patient is unaware of it. It is recommended that any new onset of tinnitus be investigated for its cause and any associated hearing loss.

Fall Prevention

Falls are a leading cause of fatal and non-fatal injuries in people ages 65 and older in the United States. The cost of these injuries among older people is enormous, due to the high death toll, as well as the disabling conditions, requiring recovery in hospitals and rehabilitation institutions. Research has proven that there is a pattern to falls among the elderly…the fear of falling and an actual fall are the major reasons that people lose their independence and need to be relocated to a nursing or assisted living home.