Vertigo: An Unwelcome Roller Coaster in Your Head

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As a youth, I recall having a friend grab my wrist and spin me around a few times then stop suddenly and the world would spin. This was great fun as a child. Fast forward to age 70 when I awakened with the room spinning accompanied by nausea, this was no fun as I was unable to stand up. I thought I might be having a stroke. This experience of your environment spinning out of control is called vertigo.
Vertigo is often caused by an inner ear problem. I went to see my ear doctor and he diagnosed benign paroxysmal positional vertigo. That’s medical vernacular for the doctor to say it’s not serious and the doctors don’t know what caused the condition.  There are tiny little crystals of calcium located in the inner ear that gets loose when the head changes position. The inner ear sends signals to the brain of the position of the head and body and results in the disorientation that causes vertigo.
Other symptoms that may accompany vertigo include nausea, vomiting, abnormal or jerking eye movements, headaches, sweating, hearing loss and ringing in the ears. Symptoms can last a few minutes to a few hours or more and may come and go.
Meniere’s disease is an inner ear disorder thought to be caused by a buildup of fluid in the inner ear and changing pressure within the ear. Meniere’s disease can cause sudden episodes of vertigo along with ringing in the ears and hearing loss.
Labyrinthitis is an inner ear problem usually related to a viral infection around the nerves that are important for helping the body sense balance.
Less often vertigo may be associated with head or neck injury, brain problems such as stroke or tumor, certain medications that cause ear damage or migraine headaches.
Treatment for Vertigo
In many cases, vertigo goes away without any treatment. This is because your brain is able to adapt and compensate, at least in part, to the inner ear changes, relying on other mechanisms to maintain balance.
Other treatments include vestibular rehabilitation, which is a type of physical therapy aimed at helping strengthen the inner ear system. The function of the vestibular system is to send signals to the brain about head and body movements relative to gravity. Vestibular rehab may be recommended if you have recurrent bouts of vertigo. It helps train your other senses particularly your eyes and visual acuity, to compensate for vertigo.
Canaliths, the tiny calcium crystals in the inner ear, can be repositioned by maneuvers that move the calcium deposits out of the canal into an inner ear chamber so they can be absorbed by the body. You may actually experience vertigo symptoms during the procedure as the canaliths move. A doctor or physical therapist can guide you through the movements. The movements are safe and often effective.
In some cases, medication may be given to relieve symptoms such as nausea or motion sickness associated with vertigo. If vertigo is caused by an infection or inflammation, antibiotics or steroids may reduce swelling and cure the infection. If the diagnosis is Meniere’s disease, diuretics (water pills) may be prescribed to reduce pressure from fluid buildup. In a few cases, surgery may be needed for vertigo.
Bottom Line: If you have recurring, disabling vertigo, then it is important to see your ear, nose and throat doctor to identify the cause, start an effective treatment and put the spinning to a stop!
By the way, I went to the doctor and was assured it was benign paroxysmal positional vertigo and would subside, which it did, without treatment.

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Dr. Neil Baum is a Professor of Clinical Urology at Tulane Medical School.

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