The world keeps spinning round: vertigo facts

Column by Dr. Tim Moser

Dr. Tim Moser, Denver House Calls in Denver
Posted

It was 6:30 a.m. on a Monday, and Lydia's alarm clock was buzzing fiercely. She awoke from a deep sleep and immediately wanted to hit the snooze button. As Lydia rolled over, the room suddenly started spinning. Confused, she closed her eyes tightly, without effect. Now she was doing "bed rolls" as she instinctively clutched her blankets in an attempt to steady the ride. Nausea was developing as she became motion sick. Slowly over the next several minutes, the spinning sensation slowly improved, as long as she remained perfectly still. Every attempt to turn her head to the side was met with a new wave of debilitating vertigo.

Vertigo is a very common condition that can affect adults suddenly and without warning. Often, the symptoms appear in the morning, when the innocent victim is tying to get out of bed. Although vertigo can be associated with head trauma, drugs, or alcohol the symptoms of Benign Paroxysmal Positional Vertigo are associated with none of these.

The mysteries of the inner ear - revealed!

The ear serves several functions to include hearing the sounds of the world around us. The hearing portion of the ear is in the middle ear. This is where those troublesome ear infections of youth occur and is also the place where the annoying ear "popping" with altitude changes comes from when driving in the mountains or flying in an airplane.

A lesser known portion is the inner ear, where the function is all about balance. The inner ear loves communication - nerves travel from this portion of the ear to the brain and the eye. As the head is turned, the eyes will automatically get the signal to follow the action. The brain registers the fact the head is turning, so a good sense of balance is maintained.

Here is where things get a little complicated. The inner ear has three connected semicircular canals that are filled with fluid. As the head turns, the fluid sloshes around in the canals. Nerves in the semicircular canals sense the motion of the fluid, and use this information to communicate with the brain and the eyes about balance and body position. In total, this is known as the vestibular system. It is an elegant system that works remarkably well. Athletes and dancers have an especially well developed sense of balance, thanks to their inner ears and vestibular systems.

The scourge of vertigo

Vertigo is a severe form of dizziness that makes the room spin. The most common form of vertigo is called Benign Paroxysmal Positional Vertigo. Translated into English, this means the dizziness is completely harmless and is not being caused by a brain tumor or other calamity. Further, the vertigo is caused by changing head position (especially rolling over or turning the head to one side). The onset is usually in the morning, and has no warning signs. One morning you wake up, and can't get out of bed - literally.

Benign positional vertigo is caused by a malfunction of the semicircular canals. One leading theory of the cause of vertigo states a very small crystal becomes dislodged in the inner ear. As this crystal (called an otolith or ear stone) rolls around in one of the semi circular canals, it wreaks havoc in its path. The well controlled signals sent to the brain and eyes suddenly become greatly exaggerated. A slight turn of the head in the right direction causes the otolith to move. The result is a cascade of nerve signals to the brain and eyes telling both you are spinning out of control. The eyes respond by rapidly twitching from side to side, thus making the room appear to rotate. Over several seconds to minutes, the signals from the inner ear slow down, and the vertigo improves.

Treatment

If there can be a good thing about Benign Vertigo, it is the fact the symptoms usually go away after a few days. Rarely, the dizziness can last for weeks. Prescription medication is not usually needed. An over the counter medication called Meclizine can help reduce the dizziness. A common side effect is drowsiness, so many patients take it before bed. Scopolamine is a prescription medication used to treat motion sickness. It may be useful for vertigo, also. The strongest prescription medication used to treat vertigo is Valium. Like Meclizine, it can be sedating.

A very effective treatment for vertigo that does not involve drugs are the Brandt-Daroff Exercises. These can be performed several times per day, and can significantly shorten the course of vertigo. A good link that demonstrates these exercises can be found on YouTube at:

http://www.youtube.com/watch?v=jhkqFGxJthc.

Very rarely, surgery may be offered to patients with persistent vertigo. The nerve responsible for communicating balance information to the brain may be cut. Another permanent solution to vertigo involves the injection of an antibiotic to the nerve, which causes permanent damage and prevents the nerve from communicating with the brain.

Want more information about vertigo?

http://www.mayoclinic.com/health/vertigo/DS00534

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002393/