Vertigo: A dizzying condition

Vertigo is a type of dizziness in which you feel like you’re moving or spinning. It is different from lightheadedness or the sensation that you are going to faint. The most common type of vertigo is benign paroxysmal positional vertigo. This means it happens suddenly and in relation to the position and movement of your head. Other causes can be more serious, but are much less common.

The inner ear is concerned mainly with hearing and balance. Three circular tubes called semicircular canals are strategically placed in all three planes within each ear. These very small, fluid-filled canals tell our brain which position our head is in. When we move, the fluid moves and stimulates nerves to the brain, telling it we are moving.

Individuals with vertigo get a false sensation of movement when they are at rest. It’s similar to how you feel if you spin around in place several times. When you stop, you feel like you’re still spinning. This is called rotational vertigo. It can occur at any time, but most commonly it starts with a position change, lying down or sitting up from lying down.

Benign positional vertigo is due to tiny calcium debris within the canals. The debris moves within the fluid causing the fluid to stimulate the nerves in the absence of body movement. Lying perfectly still can calm the movement of the calcium debris and the fluid, allowing the sensation to dissipate.

Other causes of vertigo include infection within the inner ear, migraine headaches, inflammation of the nerves (neuronitis), head trauma, Meniere’s disease, multiple sclerosis and, rarely, tumors. Additionally, as we age, our propensity for developing vertigo increases.

Infections within the inner ear that lead to vertigo are called labyrinthitis. They can be due to either viral or bacterial agents. Viral infections are much more common, arising from the same germs that cause the common cold.

Meniere’s disease is a specific inner ear disorder that is associated with three cardinal features: hearing loss, ringing in the ears and vertigo. Individuals with this condition have sudden onset, intense vertigo, usually associated with nausea and vomiting. Meniere’s and other types of severe vertigo can be very debilitating, preventing the individual from performing normal daily activities.

Most cases of vertigo that I see in the office are due to labyrinthitis. Of these, the majority are related to colds, allergies or other inflammation within the inner ear. These cases of vertigo are generally self-limiting, lasting from a few hours to a few days. More severe cases can, however, last for several weeks.

It is advisable to see your doctor if you experience persistent or repeated vertigo. A physical examination will allow your doctor to determine if the symptoms can be simply treated with medications or if further studies are needed to look for a deeper cause.

Medical treatment is aimed at quieting the inner ear. Antihistamines, such as meclizine, or anti-nausea medications are used to treat the symptoms. In more intense cases, anti-inflammatory drugs, diuretics and/or sedatives may be necessary. With benign paroxysmal positional vertigo, head positioning maneuvers and exercises can be performed to settle the calcium debris in the canals.

The content in this column is for informational purposes only. Consult your physician for appropriate individual treatment. Dr. Reynolds practices Family Medicine in Chesterfield.

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