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Vertigo

It is a very common problem that many people suffer from, it is a subject that ear, nose, throat physicians deal with. People do not know this unfortunately. Therefore before admitting to ent physicians they admit to many other branches and mostly unnecessary tests are done for them.


Dizziness and vertigo

What is dizziness?

It is a feeling of unbalance like a drunk, lightheadedness feeling without a real vertigo (turning of yourself or the subjects). Some disesase of ear can cause dizziness.

What is vertigo?

People say that they turn or subjects turn around themselves. Most of the vertigos are caused by inner ear problems.
Balance anatomy: Vertigo and dizziness are related with balance systems. People are conscious about position, movement and acceleration of their bodies.
It is a mixed of following mechanisms:

1-Inner ear fix the direction of the movement like front-back, side to side, up and down.
2-Eyes see position of the body and the direction of the movement.
3-Tissue receptors know which part of the body touches to the ground.
4-Muscle and joint receptors knows which part of the body is moving.
5-Central nervous system (brain and spinal cord) evaluates all the coming information from these places and correlate them.

If the central nervous system takes mixed information from these centers then person feels dizziness or vertigo.
If youy have one sided inner ear problem, then this ear sends different messages to the brain and brain is confused. This results dizziness and vertigo sensation in that person.

Which medical problems cause dizziness?

1-Blood circulation: If not enough blood comes to your brain you feel dizzy. Everybody can feel it if they stand up from lying or sitting position suddenly. But some people feel it persistantly. They probably have systemic diseases.
Nicotin and alcohol also decrease blood flow to the brain. Dietary excess salt intake, psychologic stres and anxiety can cause it by producing spasm in the veins.
Inner ear is a very delicate organ for circulation. If there is a circulatory deficiency in inner ear “vertigo” can occur.
2-Trauma: Any trauma effecting inner ear can cause severe vertigo.
3-Infection: Viruses can effect nerves going to inner ear and brain. That may cause vertigo but mostly hearing stays normal. If bacteria that causing middle ear infection enters to the inner ear causes severe vertigo and hearing loss.
4-Allergy: Some patients can feel dizziness and vertigo because of their allergy.
5-Neurologic disorders: Multiple sclerosis, syphilis, tumors can cause unbalance.

What can your doctor do for dizziness?

Your doctor will take a detailed history of the symptoms. What triggers it, drugs you use, trauma, infection all should be eliminated. Some x-rays and tests can be asked.

How can you diminish dizziness feeling?

1-Prevent sudden stand up while lying down.
2-Prevent sudden head movements.
3-Avoid alcohol, smoking and caffeine.
4-Try to get rid of stress if possible.
5-Avoid dangerous activities when you are dizzy like driving, climbing up stairs, swimming.

Exercises that can help:

Exercises can be done in bed:
Eye movements: Start slowly and made faster movements later. Move your eyes up and down, side to side. Put your finger in front of your head and get it closer and further while fixing your eyes on it (30-90 cm).
Head movements: First start slowly and eyes open, then do it faster and at the end do it while eyes are closed.

While in sitting position:
*Move your shoulders like making a circle. Bend and try to hold a subject on the floor.
While standing:
Sit and stand up while eyes both open and closed. Try to hold a ball from one hand to other in the level of your eyes. Try the same movement at the level of knee. Squat down and up, turn around yourself.

While moving:
*Walk in the room with eyes open and later closed. Try to climb the stairs while eyes open and closed. Try to play basketball or bowling that includes all these movements.


Positional vertigo

It is the most frequent cause of vertigo caused by inner ear. It is believed to be a result of calcium and inner ear cells precipitation. The precipitates move with head movements and cause vertigo. It could be occured by itself or triggering events.
Vertigo is observed by head movements in this disease mostly related with nause with or without vomitting. There is no fullness and tinnitus in the ear. No hearing loss is observed.
To treat this problem we perform some maneuvers, drugs are not efficient.

Meniere’s disease

The problem of inner ear fluid pressure. The exact reason is not known.
Inner ear is related with hearing and balance. It is a capsule filled with liquid. Pressure of this liquid increases in Meniere’s disease. This pressure causes hearing loss, vertigo, tinnitus, fullness in the ear.
It is characterised with vertigo, changing in hearing, tinnitus. Nausea, vomitting, dizziness, sweating and diarrhea may accompany.
Attacks are mostly sudden onset and may continue from 20 minutes to 24 hours. The frequency of attacks differ.
Rarely vertigo can be seen alone. Also sometimes hearing loss, fullness and tinnitus can be seen without vertigo.
Meniere's disease mostly effect one ear, 15 % both ears are effected.

Vestibular neuronitis

Balance part of nerves in the inner ear are swelled in this disease. Mostly they have an upper respiratoıry infection before onset of symptoms.
Sudden onset of vertigo, dizziness, nausea and vomitting is seen. Hearing is normal. Symptoms are intense at the beginnig, they become less time by time. This annoying feeling may continue as long as even one year.
Mostly drugs are used in teartment, by time as the disease gets better drugs are stopped.

Perilymph fistula

This disease occur because of sudden pressure changes like quick landing, diving, head trauma. Because of sudden pressure change, membrane between middle and inner ear ruptures and inner ear fluid comes out to middle ear.
Vertigo and dizziness occur with head movements. Hearing loss, fullness in the ear or tinnitus may accompany to the symptoms.
This perforation heals itself without any teratment. Rarely operation is needed.

Acoustic neuroma

It is a benign tumor of vestibular nerve. It grows very slowly therefore without any symptom it can stay silent many years.
We do not see vertigo because compensatory mechanims of the brain and the other ear. Dizziness is common. Tinnitus may be the other first symptom. If the tumor grows more, hearing part of the nerve can be effected so hearing difficulties may occur.
Diagnois is mostly with MR (magnetic resonance imaging).
Treatment is to take out the tumor.

Vertigo due to aging

With aging sudden movements cannot be compensated by ears, therefore dizziness and vertigo are common in old people.
Visual problems are added. Eye problems should be treated in aged people also.
Muscular reflexes are other causes of dizziness in old people. Diabetes, rheumatoid problems, nerve aging add extra problems.
Symptoms of vertigo related to aging:

1-Dizziness and vertigo in sudden movements.
2-Like a drunk while walking
How to decrease the symptoms?

No drugs but some advices.

1-In the morning instead of getting up from the bed suddenly, sit a few minutes first.
2-Move more slowly while turning, sometimes carry something that helps your balance.
3-Hold something while looking up and down.
4-Never walk in the dark, try to walk in well enlighted places.
5-You may use cane.
6-Take care of diabetes, hypertension, rheumatic diseases if present.

My persistent symptoms 31 May, 2013 - 12:14

I am writing to you from St. John's, Newfoundland (Canada). I have a sinus problem started in Nov 2008 upon working for more than a month in a gas plant. I did not have sinus problems prior to this date.

At that time, I may have been exposed to airborne asbestos and other irritants. In the place where I lived at that time, the Winter is so harsh. Temperature during Winter is normally at least 25 Cecilius below zero.

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