Heather Ainsley
ECB Publishing, Inc.
When you're a kid, spinning around and around in circles can be one of the greatest ways to pass the time on a dull afternoon of boredom. Even as an adult, the occasional ride full of tilts and twists can make us feel delightfully queasy as we fight to keep down those funnel cakes and amusement park nachos. But aside from the occasional, intentional vertigo, we usually don't want the world around us to spin out of control, especially when it happens out of the blue.
Vertigo refers to a symptom, not a condition. It is described as a sudden internal or external spinning sensation, and can be caused by a number of things ranging from serious to minor in severity. Anything from an underlying medical condition to simply turning your head too quickly can result in vertigo, and the sensation itself can be mild or extreme. While the feeling of dizziness is uncomfortable, it is rarely a sign of a serious health problem. While some doctors may treat the symptom itself to provide relief to the patient until the cause is known, the most effective way to treat vertigo is to treat whatever is causing it.
There are two different types of vertigo, peripheral vertigo and central vertigo, and figuring out which one ails you is a good step towards finding the source of the symptom, and ultimately, finding effective treatment. People who suffer from vertigo will feel a sensation that themselves or the room is spinning or moving. This sensation is likely to cause nausea and vomiting, but can also cause problems with eye focus, dizziness, loss of hearing in one or both ears, loss of balance or coordination, ringing in the ears, and dehydration due to vomiting.
Peripheral vertigo is caused by a problem in the part of the inner ear called the vestibular labyrinth, which controls balance. This type of vertigo may also involve the vestibular nerve, which is the nerve that is located between the inner ear and the brain stem. This type of vertigo can be caused by Benign paraxysmal positiona vertigo (BPPV); reactions to medications that are toxic to inner ear structures like cisplatin, diuretics, salicylates and some antibiotics; head injury; inflammation, irritation and swelling of the inner ear or vestibular nerve; Meniere disease, or pressure on the nerve caused by a tumor or growth.
Central vertigo is caused by a problem in the brain, usually involving the brain stem or the cerebellum (the back of the brain). The problem could be the result of a blood vessel disease, seizure or stroke, multiple sclerosis, tumors, certain types of migraines, and certain drugs like anticonvulsants, aspirin and alcohol. Symptoms of central vertigo are similar to peripheral vertigo, but may also include difficulty swallowing, slurred speech, weakness in the limbs and body, facial paralysis and trouble with the eyes that can include double vision and involuntary eye movement.
The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV). BPPV is the most common inner ear disorder, and can affect people of all ages, although it is most common in people over the age of 60. Although there are some extreme cases where symptoms can last for years, the good news is that most patients can be effectively treated with physical therapy.
But what happens to cause such a terrible spinning sensation with BPPV?
Within your inner ear, there is a sensory organ called the utricle. This organ is the larger of two fluid-filled cavities that form part of the structure of your inner ear. It contains hair cells and little calcium stones, called otoconia, that send signals to the brain to indicate when you tilt or rotate your head. Occasionally, these tiny crystals, also called ear stones, come loose from their normal location on the utricle and begin to float freely in the fluid-filled space in the inner ear. This causes the fluid to be displaced within the semicircular canals (SCC), which sense the rotation of the head. This fluid displacement stimulates the balance nerve (eighth cranial nerve) and can cause a person with BPPV to experience vertigo and jumping eyes (nystagmus).
These otoconia, or ear stones, are incredibly small in humans, measuring somewhere in between 3 to 30 microns. To put that in perspective, a single human hair is anywhere from 70 to 90 microns around. The width of a single piece of common copy paper is 100 microns. Incredibly, something so small can cause real havoc on the body when it finds its way to where it doesn't belong!
Symptoms of BPPV can be very upsetting, as a person experiencing it may lose balance, fall out of bed or experience extreme nausea and vomiting. It can be difficult to find relief if left untreated. The onset of these symptoms can be very sudden and can be disturbing to people who develop BPPV. Anyone who experiences sudden onset vertigo should contact their doctor right away.
Happily, most common forms of BPPV an be successfully treated with a non-invasive, medicine-free method called the Epley Maneuver. This and other physical therapy maneuvers and exercise regimes can help reposition the crystals by rotating the head in a way that help guide them out of the SCC.
Medications are usually not required to treat BPPV unless the patient has severe nausea and vomiting that keeps them from being able to tolerate repositioning maneuvers. In very rare cases, surgery may be required to block the SCC to prevent stones from entering and shifting around within the canal. Surgery is usually a last resort, as it comes with the risk of losing partial or complete hearing capabilities.
Sometimes spinning can be fun. We love a whirlwind romance, enjoy a rollercoaster loop-de-loop, and relish when everything comes full-circle. But when it feels like the world starts spinning without you, it might be time to go talk to your doctor and get connected with a physical therapist near you.