Expert Offers Help for Vertigo Sufferers

Article ID: 509005

Released: 23-Dec-2004 12:00 AM EST

Source Newsroom: Michigan Medicine - University of Michigan

Newswise — We've all had that dizzy feeling once in a while. Maybe you felt it when you suddenly stood up after sitting down for a long time. Or when you were looking up to search for something on a top shelf.

Now, imagine what it would be like to feel that dizzy and off-balance for minutes, hours, days — or even years. This kind of serious dizziness, called vertigo, makes life miserable for millions of people each year, and keeps some from driving or working. It starts without warning for no apparent reason, and comes and goes.

Many people with vertigo and related balance problems never get effective treatment, or even a firm diagnosis. They may not even seek a doctor's help.

But a University of Michigan Health System expert explains that it doesn't have to be this way. Doctors today understand far more about what causes balance problems, and can offer specialized testing and treatment to help. Anyone who experiences dizziness, especially more than a few times, should see their doctor about it.

"Balance problems are very, very common. Almost everyone in their life will have a balance issue, be it mild or severe," says Hussam El-Kashlan, M.D., medical director of a special U-M center devoted to diagnosing and treating balance disorders. In fact, the Centers for Disease Control and Prevention estimate that 7.4 million people each year visit a doctor's office or emergency room for vertigo or dizziness.

"For some people, vertigo can be very debilitating," El-Kashlan explains. "During the acute attack, the person is totally incapacitated. They can't do anything for themselves and they're basically bedridden or lying on the ground until the attack passes. Often it's accompanied by other symptoms such as nausea and vomiting."

Why does this happen? There are actually many reasons — in fact, it's better to think of vertigo as a symptom of a problem, rather than a disease itself, says El-Kashlan.

For instance, high blood pressure, caffeine, alcohol and nicotine can all cause a fleeting sense of dizziness when someone moves suddenly. Sudden loss of balance can also be a symptom of low blood flow to part of the brain.

Most physicians blame the inner ear for most types of dizziness. That's why doctors who specialize in ear, nose and throat disorders, like El-Kashlan, often treat people with prolonged or severe vertigo.

"People should really seek medical attention for any persisting balance problem," he advises. "If it's a problem of significant magnitude, if they feel that they're falling, if they can't function, or even if they have a minor problem that they didn't have before and that persists for a couple of weeks, they should talk with their primary doctor. And if it persists for longer, they should seek specialized help."

In such cases, a place like the U-M's Vestibular Testing Center, of which El-Kashlan is medical director, can perform advanced diagnostic tests and make a treatment plan that's individualized to each person's vertigo. Medications, physical therapy, at-home techniques and surgery can help.

To understand dizziness, vertigo, and other balance problems, it helps to understand how our bodies keep us balanced in the first place.

Deep inside each of our ears are tiny fluid-filled tubes called balance canals, which are part of an area called the vestibular labyrinth. As we move, the fluid moves — stimulating a nerve that feeds information to the brain about our movement and position. These tubes are especially sensitive to rotational movement — for example, moving your head from side to side or turning around. The brain should receive equal signals from the two inner ears when we're at rest, and under normal circumstances the balance between the signals changes when we move. This is how the brain knows we moved.

The brain combines those signals from both inner ears with information from our eyes, and our skin and muscles, and directs the body to keep us stable while we stand, sit, move or lie down. Together, these three components are referred to as the balance system.

But if anything disturbs the labyrinth, and affects the signal from one inner ear, thus altering the balanced input from the two sides, the brain gets confused. It assumes that the head is moving. And that's what makes us feel like the room is spinning, or like we're going to fall down when really we aren't, during a dizzy spell.

One of the more common things that can disturb this delicate balance system and cause vertigo is "ear rocks" " tiny crystals that are normally present in a certain area of the inner ear. If they break loose (due to age or head trauma) and get into the balance canals, their motion due to gravity can move the fluid in the balance canals. This fools the brain into thinking that we're moving more than we are. And that can create a sensation of vertigo.

Some people only experience vertigo when they move their heads into certain positions, and in many cases doctors believe this may be related to the movement of these tiny crystals. This form of vertigo is called benign positional vertigo, or BPV, and it's the most common, says El-Kashlan.

"At least half the population at one time in their life will experience it, and as the name implies, it's benign," or not caused by anything harmful, he explains. "Thankfully, it can be treated quite effectively by very simple head maneuvers that are aimed at repositioning those little crystals from the balance canals to other parts of the inner ear where they do not cause symptoms."

Just one or two sessions of head maneuvers with a trained therapist can cure more than 90 percent of BPV cases, El-Kashlan says. And if the crystals get loose again and enter the balance canals, causing more vertigo, it's easy to repeat the maneuvers at home. In more severe cases of BPV, where head maneuvers aren't enough, surgery to block the offending balance canal is an option

People over 50 are more prone to this form of BPV. High blood pressure, which also causes dizziness, is also more common in older people. But younger people can also develop vertigo. For instance, it may come on after a head trauma — the crystals can be knocked loose and enter the balance canal after a severe blow to the head, or an injury to the skull or face, often from a car crash, sporting accident, violence, or a fall.

Another common cause of vertigo, and one that El-Kashlan says is under-recognized by doctors and patients alike, is migraine. "Most people think migraine just means headache, but that's not true," he says. "Headache is just one aspect of migraine. It's a primary nervous system problem, and can present in different ways, including vertigo and balance problems." And since migraine is so common — an estimated 18 percent of adult women and smaller proportion of men suffer from migraine headaches — many cases of vertigo that seem to have no cause may be due to migraine.

Infections in the inner ear can also cause vertigo, if bacteria or viruses inflame the labyrinth or inner-ear nerves. This can cause a dizzy spell that can last for a day or two — and if a severe bacterial infection sets in, it can destroy a person's hearing.

Vertigo is also one of the main symptoms of Meniere's disease, an inner-ear disorder that affects an estimated 2.6 million people in the United States and Europe. People with Meniere's disease also experience hearing loss, a feeling of pressure in their ears, and ringing in their ears. Their vertigo attacks come on without warning and last between 20 minutes and a full day, causing nausea and vomiting and debilitating patients for days at a time. A low-salt diet, medications, surgery and special ear-pressure devices can help ease their symptoms.

Fortunately, El-Kashlan says, the brain itself can also help people who experience vertigo for any reason. Over time, if an inner ear problem is stable, the brain adjusts how it responds to the signals coming from that ear, and compensates for the incorrect signals so a person can balance again.

But for many people, appropriate attention to spells of dizziness or vertigo can lessen the impact on their life, and reduce the chance that they'll suffer repeated attacks in the future. Even people who have lived with dizziness for years without seeking medical help should talk with their doctors about whether they might to get evaluated to find out the cause and perhaps find treatment. Whether it's at the U-M or elsewhere, special attention might just help keep vertigo from spinning out of control.

Facts about vertigo, dizziness and balance problems:"¢ Vertigo is a catch-all term for episodes of dizziness or loss of balance that can last anywhere from seconds to days, and can be mere nuisances or completely disabling."¢ Most vertigo is caused by problems in the inner ear, which helps control balance. Infections, tiny crystals in the ear, and trauma can all affect the inner ear and cause vertigo. "¢ People who suffer from migraines, or who have high blood pressure, may also have vertigo. More serious illnesses like stroke, tumors and Meniere's disease can also cause vertigo."¢ Many more diagnostic tests and treatments are now available to help vertigo sufferers find out what's causing their dizzy spells and relieve their problem. "¢ People who suffer dizziness or loss of balance regularly for more than a couple of weeks should ask their doctor for advice. A visit to a balance-disorders specialist may be needed.

For more information, visit these web sites: U-M Vestibular Testing Center: Health Topics A to Z:Dizziness: Positional Vertigo: (inner ear infection)'s disease: American Academy of Otolaryngology: Disorders Association: http://www.vestibular.orgBalance disorders, National Institutes of Health:


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