Dizziness and
Vertigo
Dizziness
is a very common problem, especially
for patients over the age of 65
years. It is estimated that perhaps
25% of seniors experience some form
of dizziness. Dizziness is the most
common complaint of senior citizens
to their primary care physician.
Dizziness
is a word that is applied to a
variety of different symptoms.
These symptoms can range from
feeling lightheaded or drunk to
feeling a swimming sensation in the
head. A very specific type of
dizziness is the sensation of
spinning, whether one feels himself
to be spinning or that the room
around him is spinning. This
sensation of spinning is called
vertigo.
Along with
sensations of dizziness is
imbalance. Not all patients with
imbalance have dizziness, however.
Yet, imbalance in its own right can
be a severe problem. Consider the
patient over the age of 65 with
imbalance and with a high potential
to fall. If this patient fell, a
resultant hip fracture could carry a
mortality rate (chance of dying) of
as high as 20%.
Dizziness,
vertigo and imbalance are complex
problems. The doctors at MCENTA
have special interest and training
in diagnosing these disorders and
their treatment. Please look over
the following pages to learn more
about a few disorders that produce
dizziness, vertigo and imbalance.
To schedule an appointment for an
evaluation, please call (713)
795-0111.
Understanding Balance
Maintaining
balance is an incredibly complex
action. Imagine walking down a
grocery aisle, moving your head from
side to side, while your eyes scan
the shelves for the item you want.
We take such actions for granted
everyday while we have normal
balance. Yet, if there is a
disorder in any of the systems that
help to maintain balance, such
action can become impossible.
On a very
basic level, your brain takes input
from three organ systems, processes
this sensory information, and then
sends signals to the necessary
muscles to allow an upright posture,
walking, jumping, or whatever
movement desired. These three input
systems include vision, the position
sense we get from our extremities,
and the inner ear balance organs.
We readily
recognize the importance of vision
in maintaining balance. Stand up
and close your eyes. Quickly you
will feel your body sway. At some
point this sway becomes disturbing,
and you will open your eyes to
prevent yourself from falling. This
is common, and shows the normal role
that vision plays in maintaining
balance. In fact, for most adults,
vision is the primary determinant of
balance.
Understanding the position sense we
get from our extremities is a little
bit harder to recognize. But, try
this exercise. Close your eyes,
extend your arms out from your
sides, then touch the tip of your
nose with each index finger. If you
have normal position sense (and
haven't been drinking alcohol), you
should pass this test with flying
colors. This position sense is
called proprioception. Sensors in
muscles, tendons and joints send
signals to the brain regarding the
position of your arms, legs, trunk,
neck, and head. Problems anywhere
along this signal line will cause
problems with proprioception and
might be manifest as imbalance.
Lastly, the
third input system for balance is
the inner ear balance organs, also
called the vestibular system. Each
ear contains three semicircular
canals that perceived changes in
rotation (angular velocity) and two
otolithic organs (the saccule and
utricle) that perceive gravitational
changes. These sensory structures
send signals via the vestibular
nerve into the brainstem and
cerebellum to join up with input
from vision and proprioceptive
structures listed above.
The sudden
loss of input from any one of these
systems will produce imbalance. The
good news is that the brain can
compensate for this loss over time,
given the proper rehabilitative
training. Impairment of two of
these systems is much more difficult
overcome.
Since
balance is a complex task, its
evaluation and treatment are usually
complex as well. Otologists and
neurotologist specialize in
understanding the inner ear
structures. Ophthalmologist
specialize in understanding vision.
Neurologist specialize in
understanding the central and
peripheral nervous systems.
Audiologists specialize in measuring
hearing. Vestibular therapists
specialize in balance retraining
therapy. Oftentimes, a team effort
is required to evaluate and treat
balance disorders.
Paroxysmal Positional Vertigo
WHAT IS
BENIGN PAROXYSMAL POSITIONAL
VERTIGO?
Benign
Paroxysmal Positional Vertigo (BPPV)
is one of the most common forms of
vertigo. The name is a descriptive
diagnosis. “Benign” means that the
disease is self-limited and that it
might go away on its own.
“Paroxysmal” means that the symptoms
come on in bursts or spasms.
“Positional” means that certain
positions cause the symptoms.
“Vertigo” is a very specific form of
dizziness; it is the sensation of
spinning.
SIGNS AND
SYMPTOMS
The
typical symptoms of BPPV are a
sensation of spinning when putting
the head into a certain position.
Often vertigo occurs when the
patient lies down in bed and turns
to one side. It may also occur when
reaching for an object above head
level, thus it’s other name
“top-shelf vertigo.” This movement
can produce a severe, but brief
(usually less than one minute)
spinning sensation. Sometimes the
vertigo produces nausea. Many times
the sensation is severe and patients
learn to avoid getting into
positions that cause the vertigo.
Your physician can tell if you are
having this condition by watching
your eye movements when placing your
head and body into certain
positions.
CAUSES
Benign
Paroxysmal Positional Vertigo (BPPV)
is a mechanical problem in the inner
ear that is caused by calcium
particles or crystals in one of the
loops of the canals that sense head
motion. Calcium carbonate crystals
are found normally in a part of the
inner called the saccule and the
utricle. Occasionally, the
crystals break off in a large number
and float in the fluid of the inner
ear. This dumping of crystals can
occur as a result of head trauma,
viral illness, surgery or the aging
process. The crystals drop down
into the posterior canal and produce
stimulation of this canal with
certain head positions. This
movement in the canal is perceived
by the brain as head-turning and it
produces the sensation of vertigo
and involuntary movement of the eyes
called “nystagmus.”
TREATMENT
Canalith
repositioning is an effective form a
treatment for this disorder. In
this painless, bloodless procedure
performed in the doctor's office,
the patient is moved in certain ways
to put the crystals back into a part
of the inner ear where they will not
cause episodes of vertigo. This
procedure lasts about 10 minutes.
You will be seen two weeks after the
procedure to assess its success or
failure. If the first procedure has
not solved the problem, a second one
will be performed. Usually 9 out of
10 patients will experience relief
of their symptoms with this type of
therapy.
SUCCESS
OF TREATMENT
The
treatment results in a high success
rate; however, more than one
treatment session may be required.
Overall, about nine out of ten
patients have no more vertigo
following this treatment. Rare side
effects of treatment include:
-
Post-treatment
vertigo.
-
Minor neck pain
associated with the treatment
CANALITH
REPOSITIONING INSTRUCTIONS
It is very
important not to eat before this
procedure since the vertigo can
cause nausea. If you must eat
beforehand, eat lightly.
Dress in
comfortable clothing.
If you do
this in the office or in the
physical therapist's office, it is
recommended that you bring someone
with you in case you are unable to
drive, since the procedure may make
you feel dizzy and/or nauseated.
POST
PROCEDURE INSTRUCTIONS
-
Sleep in a recliner
or sleep with several pillows
under you so that you are at an
angle of 45 degrees for the
first 48 hours.
-
Avoid sleeping on the
affected side for the first week
after the treatment.
-
Refrain from picking
up objects from the floor or
bending over for the first week
following the treatment.
-
Schedule an
appointment to see your
physician two weeks following
the treatment.
Viral Vestibular Neuronitis
Viral
vestibular neuronitis is one of the
most common causes of acute
vertigo. This disorder usually
presents with a sudden onset of
vertigo or spinning. This spinning
is usually so severe that one cannot
walk or stand up. Additionally, it
is so severe that it produces nausea
and vomiting. Hearing is usually
not affected.
Due to the
severity of symptoms, most patients
are seen by either their primary
care physician or emergency room
physicians the day that symptoms
start. Most patients are started on
medications to suppress their
symptoms. Examples of such
medications are meclizine (Antivert),
prochlorperazine (Compazine), or
promethazine (Phenergan). All of
these medications, not only
alleviate nausea and vomiting, but
also make one sleepy.
The
dizziness will usually resolve over
the next few days, and the patient
will notice his balance returning
over the next few weeks. Most
patients, especially those under the
age of 65, feel near normal within a
month of the onset of symptoms.
As the name
implies, the disorder is caused by a
virus. Most patients will either
have had a cold or have close
contact with someone who has had a
cold or other viral illness.
Pathologic examination of patients
who died after viral vestibular
neuronitis were found to have viral
particles in the vestibular nerve.
The virus causes inflammation of the
vestibular nerve on the affected
side. This blocks the signal from
the balance organs on the same
side. The brain perceives this
signal blockage as if you are
turning. It then sends signals to
the eye muscles so that the eyes
will keep up with the perceived
turning. This involuntary eye
movement is called nystagmus, and
its presence can help to diagnose
this disorder.
Depending
on the degree of infection and
inflammation, the symptoms can be of
varied intensity. By extension, the
duration of symptoms and the length
of recovery will vary. Although
most patients can return to normal
activities within one month, some
cannot. After recovery, most
patients will notice that turning
quickly gives them a momentary sense
of imbalance, usually for less than
2 or 3 seconds. Recovered patients
will also notice that their balance
is worse at the end of the day, or
if they are tired or "under
stress." For those that continue to
have some balance problems after a
month's recovery period, vestibular
rehabilitation helps to eliminate
symptoms and to improve one's
balance.
Click here for information on
Menieres Disease.
