Vertigo: When the World Spins

Everyone has probably been dizzy at one time or another. Perhaps, as a child you might have purposely spun around in circles until you became dizzy and unsteady on your feet. However, when the world spins, and it’s not related to a childish prank, it’s likely you are among the 10% of the population that suffers from vertigo.

Vertigo, or dizziness, affects people in two different forms. It can be either subjective—when a person believes he or she is moving and is not—or objective—when objects appear to move although they are not. When vertigo is present, people find moving, lying down, or even changing position can make them dizzy or any movement makes the condition worse.

Gradual Vertigo

If vertigo gradually occurs, it is likely caused by central vertigo, which means it is something inside the brain and caused by something such as a migraine or a stroke. Central vertigo problems produce the following symptoms:

  • Double vision
  • Headache
  • Impaired consciousness or disorientation
  • Inability to speak due to muscle impairment
  • Nausea and vomiting
  • Physical weakness
  • Poor coordination or a lack of coordination

Central vertigo is often disabling and can frequently cause sufferers to fall. In fact, central vertigo is one of the leading cause of injuries in people over the age of sixty-five. If you experience gradual vertigo symptoms, see your doctor to receive proper diagnosis and treatment.

Sudden Vertigo

If vertigo happens suddenly, it usually indicates another type of vertigo that is often related to an inner ear disturbance. This means it could be an inner ear infection or something else that is minor. The three most common types of vertigo are benign paroxysmal positional vertigo (BPPV), Vestibular Neuronitis (also called vestibular neuritis), or Ménière’s disease.

BPPV

BPPV is the most prevalent cause of vertigo. Although this type of vertigo is bothersome, it’s usually not serious. It is caused by an inner ear infection, aging, or injury. It starts when calcium crystals, which are found in the labyrinth of the inner ear, are dislodged and migrate into one of the semicircular canals (sometimes the may adhere to the semicircular canal cupula but that is rare). When the crystals are present and the head is moved, the semicircular canal experiences abnormal fluid displacement, which then causes the vertigo sensation.

BPPV triggers usually include:

  • Changes in barometric pressure
  • Exposure to moving visual stimuli, such as a car, a dog, or the rain
  • Incongruence between visual stimuli and the inner ear in relation to where a person is located in space
  • Lack of sleep
  • Movement or tilting of the head

When BPPV occurs, sufferers usually complain of blurred vision, dizziness, nausea, lightheadedness, or unsteadiness. BPPV normally lasts for a short time, only a few seconds to a minute or two, and it is an intermittent problem. However, in some sufferers, the condition can persist for many years. According to the Mayo Clinic, although symptoms can sometimes go away all on their own, you should visit your doctor if the condition persists for more than two weeks.

There are effective treatments, one of which is a drug known as Meclizine. In fact, when I first developed BPPV, Meclizine was what my doctor gave me. I was instructed to use it if I felt vertigo coming on, and I found it worked well to prevent vertigo. For me, the problem was not enough rest, and, so once I corrected that problem, my symptoms disappeared.

There are now some new treatments for BPPV. For instance, a doctor performs a series of maneuvers known as either Epley maneuvers or Semont maneuvers (each named for the creator of the specific maneuver). Both maneuvers employ movements to shift the crystals or debris to a less sensitive location in the ear. Each maneuver takes about 15 minutes to complete, and the re-occurence rate for sufferers after these maneuvers is around 30 percent.

Another solution that some doctors recommend is for the sufferer to perform Brandt-Daroff exercises. More information about these exercises is given in the following section. If, however, medications, maneuvers, and exercises are tried and do not help, in severe and persistent cases, doctors perform surgery and reposition the crystals.

Vestibular Neuronitis

If you have Vestibular Neuronitis (also called vestibular neuritis), it appears suddenly. Vestibular Neuronitis can be a single incident, occur in a series of attacks, persist consistently for two weeks, or in rare cases last for months. Beside the main symptom of vertigo, sufferers sometimes experience these other symptoms:

  • Nausea
  • No auditory symptoms
  • Vomiting

Vestibular Neuronitis is caused by an inflamed vestibular nerve, and these nerves run from the inner ear to the brain. Many sufferers report having suffered an upper respiratory tract infection, such as a cold or the flu, prior to Vestibular Neuronitis’s onset, and, in fact, the condition is usually brought on by a viral infection, although doctors aren’t exactly sure which virus causes the infection.

One treatment for Vestibular Neuronitis that I found on the web is provided by Northwestern University. It is known as Brandt-Daroff exercises. However, before you begin the exercises your are advised to keep you head still and rest in bed for two days. After the two day rest period, if the symptoms persist, you should do the Brandt-Daroff exercises as shown. Claims are most people who do these exercises find relief within 3 to 14 days, and if you have a reoccurence within a year, they advise you do these exercises daily.

Ménière’s Disease

Another inner ear disorder is Ménière’s Disease. This disease is usually present in just one ear, and over time hearing loss can occur. When Ménière’s Disease strikes it usually begins with one symptom and over time more symptoms appear. There are four symptoms related to this disease but not all sufferers experience the same symptoms. These symptoms include:

  • Fluctuating hearing loss that leads to deafness usually in lower frequency ranges
  • Periodic abnormal sensation of movement
  • Ringing, roaring, or whooshing noises, known as tinnitus is usually present
  • Sensation of pressure or fullness in the ears

Attacks of Ménière’s Disease usually incapacitate the sufferer and are unpredictable. Attacks can also last anywhere from 20 minutes to 24 hours, although they may last for several days. The tinnitus volume can increase over time, and, although sometimes it improves after an attack, it will worsen again. Some sufferers may experience “drop attacks” where they actually drop to the floor or fall because the vertigo is so severe, and, these attacks may sometimes be accompanied by sweating, nausea, or vomiting.

The exact cause of Ménière’s disease is unknown, although doctors believe it may be related to excess fluid in the ear or perhaps caused by the herpes virus. Sufferers are usually between the age of thirty and sixty, and the disease affects men more frequently than women. To determine if the condition is present your doctor will need to perform an otolaryngological examination and an MRI.

There is some evidence dietary changes can reduce the frequency of Ménière attacks and sufferers are often advised to consume a low-sodium diet. Doctors also often recommend sufferers avoid tobacco, alcohol, and caffeine. Medications to lower the pressure within the ears, such as antihistamines, diuretics, or anticholinergics may be recommended, as are lipoflavonoids or the anti-herpes virus drug, Aciclovir.

For More Information

If you suffer from BPPV, Vestibular Neuronitis, Ménière’s disease, or another dizziness or vertigo problem, you should see your doctor. You should also be aware you will probably deal with these problems off and on for the rest of your life. This has been true for me; however, I have noticed if I get plenty of rest and do my exercises, I can go for years without a reoccurrence.

Another suggestion I have is to exercise and improve your balance because as you age you are at greater risk for falling, even if you don’t suffer from vertigo. To learn how you can improve your balance and strength, refer to my How to Improve Your Balance and Strength article.

If you want to learn more about hearing loss, dizziness, and other ear problems, the Mayo Clinic published a great book in 2003 by Wayne Olsen titled, Mayo Clinic On Hearing: Strategies for Managing Hearing Loss, Dizziness and Other Ear Problems.It gives practical advice about common ear conditions, as well as treatment options for serious ear disorders.

You can also visit the Mayo Clinic’s web site and learn more about BPPV, dizziness, or tinnitus.

3 Comments

  1. Great article, I haven’t heard such details before about the BPPV. This is not a well known disease and it’s hard to find good info on it. Keep up the great work and I will certainly return to your blog soon…

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