Dizziness and Vertigo
Murray Grossan, MD.
About the author: Dr. Grossan is an otolaryngologist and head and neck surgeon with the Tower Ear, Nose, and Throat Clinic at Cedars-Sinai Medical Center in Los Angeles and the founder of the Web-based Grossan Sinus & Health Institute (https://www.grossaninstitute.com). He is the author of Free Yourself from Sinus and Allergy Problems Permanently.
Dizziness, Vertigo, and their causes dizziness and vertigo are terms that are sometimes used interchangeably by lay persons, but they terms have clearly different meanings for doctors. Vertigo is the sensation of moving – either you feel like you are moving or the room feels like it is moving. This often occurs when the fluid in the inner ear – called the labyrinth – is affected.
Dizziness, on the other hand, is any sensation of unsteadiness, or feeling faint, or difficulty in walking, and can have many causes. Physicians sometimes have to work hard to get the patient to properly convey what they are feeling.
- you can be dizzy from getting up out of bed too fast. Here the blood hasn’t had a chance to catch up with your brain.
- any part of the balance circuit may not be getting enough blood. This can make you dizzy and faint.
- Any blow to the head, even a severe whiplash can cause some swelling in the circuits and make balancing a problem. We can do a test called Electronystagmography and tell if the neck is a causal factor or if it is Benign Positional Vertigo.
BalanceKeeping one’s balance is a highly complex activity.Balance consists of four elements. Your eyes can tell you which way is up. In the inner ear are three water tubes called semicircular canals. (Picture of ear at https://www.teleport.com/~Veda/gallery. html) They go in 3 different directions. Think of them as a carpenter’s ruler with a bubble. The bubble goes up when you tilt your head. One canal or bubble system is for forward and back, one for side to side and one for up and down. There is a left and right system and the brain reads the signals like a pilot reading the dials. When the system is damaged, it learns to recognize that when the left ear says 60 it really means 40 and makes adjustments or compensates.Your neck and back helps tell you that you are leaning to the side. Your feet are important, tells you if you are on an incline. All these are tied together in the brain. If you can’t see clearly, or are in a fun house or given an illusion, you may feel unsteady. New bifocal glasses can also produce a similar effect.Children generally get car sick, as do dogs. After a while, however, they learn to compensate and no longer have this problem. When I teach in China, the first question I am asked is why the native Chinese get train sick and the ÒforeignÓ Chinese from Taiwan, Hong Kong, and USA do not. It is simply that the ÒforeignÓ Chinese have been raised with automobiles and have accommodated and the natives have not had this experience to learn accommodation.
If you get elevator sick, turn your head up so that the elevator motion affects the ear canals having to so with driving, which you are accommodated for.
Seasick? Turn your head so the boat motion is like an automobile stop and go motion. It helps to visualize an actual car ride.
Wearing extra high heels for the first time is a problem because the feet – spine are an important balance system and the high heels are a new way of using these essential muscles so it takes a while to adjust.
The eyes are a part of this system. A flashlight and lights on are important aids to balance.
Treatment and/or AdaptationWe have a wonderfully adaptive system. Anyone can learn to spin on ice skates. You can have major damage to any part of the system and after a short time, especially with training, the body will adapt. A soldier is shot in the ear and loses one of his inner ear balance organs. He is extremely dizzy because he is getting all his input from only one ear. After a few weeks training, you would hardly know he has a problem.This can also make a diagnostic problem for the doctor. If a growth is pressing on the balance nerve slowly, the patient may actually never complain of dizziness because he has learned to accommodate. Likewise, someone is in a serious accident and is no longer complaining of dizziness, but examination shows there is a damaged organ, but he has learned to accommodate. Even though the accommodation is good, I still urge my patients to carry a flashlight so they won’t have a problem in a dark place, wear low shoes and thin socks, and avoid thick rugs. On the other hand, with vestibular rehabilitation training, we train people to walk on thick rugs with thick socks in order to strengthen the whole system. We train patients to balance themselves on a moving platform. We exercise them to move rapidly.For simple dizziness I recommend that the patient turn his head or body so that the dizzy feeling comes on, then do it so slowly that there is no problem, then gradually increase the speed till the symptoms reoccur, then drop the speed again and gradually work the speed up. This allows the body to accommodate.
One of the most important trend in treatment today is to train people’s balance system before they have problems. Falls, especially fractured hips are a significant health problem, especially among the aged. I have been trying to get health providers to offer balance training to everyone. It has been shown that giving this training can significantly reduce the number of injuries. One excellent form of balance training is Tai Chi. Here you practice your balance with various turns and positions. Now when you trip over the rug you can easily keep from being hurt.
Another major advance today is Vestibular Rehabilitation. After the doctor completes his examination and has ruled out and treated pertinent problems, he will refer the patient to a therapist trained in this field. Here the patient is analyzed from a physical therapy viewpoint: is the left leg a little weak? Is the back tilted because of poor muscle tone? Is the neck too stiff? Is the body tilted because one eye is weak? Surprisingly, we are often finding a treatable condition where by strengthening certain muscles the person is no longer dizzy. So today, instead of giving dizzy pills – which sometimes can reduce the patient’s alertness and make him worse – we use these exercise modalities with increasing success.
Benign Positional Vertigo is a condition where some of the stones in the inner ear come loose and rattle around. These stones called otoliths are located like a child’s catch toy on a cup. The symptoms are that when you move a certain direction you feel dizzy and this is reflected in the eye movements called nystagmus. When the stones are off the cup the treatment is to use the Eply Maneuver to get the stone’s back. It is the same principle as getting the ball back in the cup. This condition doesn’t awaken you out of a sound sleep and in not accompanied by tinnitus.
Meniere’s Disease occurs when there is an increase in fluid pressure in the inner ear. Usual symptoms are hearing loss, tinnitus, vertigo, and a feeling of pressure in the ear. It is often episodic, may last a short time and then occur later on. It can awaken you out of a sound sleep. Treatment programs vary because we cannot measure the fluid pressure directly; in my practice I have patients on low salt, high potassium diet drinking distilled water. I usually use a diuretic such as Diamox in the acute stage. There are other successful methods used.
Managing Dizziness and Vertigo people who are dizzy can fall and break their bones. How do you prevent this? Check your blood pressure. Take the medicine your doctor recommends. Take the baby aspirin he may recommend. Be athletic. The more the exercise the less the dizziness will affect you. Do the vestibular exercises. Check with the Vestibular Disorders Association at https://www.teleport.com/~veda/ for more information and join their association. They actively promote patient information re prevention and treatment. They can refer you to local specialists and treatment facilities.Shoes are important. I cringe when I see a senior in high heels. They can fall and fracture a hip. If a senior wears high heels, even if they have perfect balance, they increase their chances of falling or fracture by 10X. Honestly, patients come to see me for dizziness wearing high heels ! That’s like coming to see me for a cough while smoking cigarettes!