“Moons and Junes and ferris wheels that dizzy, dancing way you feel…”

When folk artist Joni Mitchell wrote those lyrics, she was either in love, or she was in touch with her…inner ear.

Severe dizziness, imbalance, nausea, blurred vision, fatigue, headache, heart palpitations, inability to concentrate, sensitivity to bright lights, sweating and lack of coordination are all symptoms of vertigo. It is the physical illusion of a roller coaster ride gone terribly wrong.

Vertigo is that swirling sensation you have after getting off a fast merry-go-round. It’s that feeling that the floor is coming up at you or the ceiling is coming down.  The National Institutes of Health reports that annually 40 percent of Americans experience head-swimming dizziness that is serious enough to go to the doctor.

And though you feel like your brain is turning cartwheels in your head, most common forms of vertigo begin in the structures of your inner ear.

You feel the swirling more profoundly with head movement. This causes a cascade of electrical impulses from the inner ear to the brain. The brain integrates impulses that come in from the ears, eyes and other parts of the body. Theoretically, when there’s a mismatch among these signals, you can feel dizzy or unbalanced.

Types of vertigo

“There are two common causes of vertigo,” explains Arun K. Gadre, M.D., a visiting associate professor in the Department of Otolaryngology – Head and Neck Surgery, at The University of Texas Medical School at Houston.

“The first is a condition called vestibular neuronitis, which is thought to be a viral infection of the inner ear. It often follows something as trivial as a cold or an upper respiratory tract infection. This vertigo will get better on its own. 

“The other, benign paroxysmal positional vertigo, BPPV, can also be associated with airway infections and is sometimes the result of head trauma, even a very minor one.”
 
With BPPV, patients experience a spinning sensation when they are lying down and then roll from one side to the other.  Vertigo is caused by the shifting of crystals—tiny particles of calcium carbonate from one area of the inner ear to another. The particles were probably dislodged during a head injury, even a small one. In most cases, the cause is never found.

The hair cells deep in the semicircular canal get loaded with these particles. An inner ear receptor that is supposed to measure rotation begins instead to measure head position, relative to gravity.

If you suffer from BPPV, there is good news. A simple physical maneuver performed at the doctor’s office can end this discomfort in an overwhelming number of patients, Gadre says. 

Called the Epley Maneuver, the procedure involves placing the patient’s head in different positions for varying lengths of time to reposition the particles and remove them from the inner ear’s semicircular canal.

Many patients have called the result “magic,” Gadre says.
 
 “Although persons of all ages can have vertigo, it is especially harmful for the elderly. The dizziness can cause seniors to fall, especially upon getting out of bed,” warns Gadre, a board-certified otolaryngologist with a special expertise in otology, neurotology and skull-base surgery. 

Other causes

Among the other reasons for vertigo are multiple sclerosis, brain tumors and benign cysts. Some persons can become imbalanced because of visual problems, blood pressure changes and medication side effects.

Vertigo is a classic symptom of Meniere’s disease, a chronic disorder that involves fluctuations of fluid in the inner ear. It is also characterized by recurring episodes of dizziness and intermittent deafness (in one ear only) and tinnitus, an irritating ringing in the ears.

Dizziness is also a symptom of other conditions such as diabetes, hypothyroidism, rheumatoid arthritis, infections and syphilis.

Balance disorders always should be evaluated. Your primary physician may request the opinion of an otolaryngologist (ENT), a physician who specializes in diseases and disorders of the ear, nose, head and neck.

Some of the diagnostic evaluations needed could be a hearing exam or an audiogram, blood tests, an electronystagmogram (ENG), a study of eye movement and imaging studies of the head and brain.

“Almost all causes of vertigo are medically manageable. Surgery should be the last option,” Gadre says.

Managing Vertigo

Vertigo – the sensation of spinning or whirling – is a primary symptom in many health conditions, including inner ear infections, migraines, head injury and allergies.

Medically manageable, vertigo usually occurs after a disturbance in the vestibular system, structures of the inner ear.

In Meniere’s disease, a disorder associated with changes in fluid volume in a portion of the inner ear, drugs in the benzodiazepine group may reduce the severity of the symptoms. These sedatives also are used as muscle relaxants and anti-anxiety medications, says Gadre.

A course of corticosteroids (such as prednisone) may be prescribed initially to reduce inflammation and stabilize hearing.

Antibiotics (gentamicin) may be administered into the middle ear to treat severe vertigo, as in Meniere’s disease.

Prochlorperazine (Compazine), meclizine (Antivert) and dimenhydrinate (Dramamine) are drugs often used to relieve nausea and other symptoms associated with dizziness.

Even after drug treatment for many disorders, patients may still experience vertigo. Vestibular Rehabilitation Therapy (VRT) can be very helpful. The goal is to minimize unpleasant symptoms, improve balance and prevent falls.

VRT is a form of physical therapy using exercises that help the brain to adapt to or compensate for whatever is causing the vertigo.

Conducted by a physical therapist under the watchful eye of a physician, VRT treatment will depend on the patient’s age, cognitive function, coordination and motor skills, overall health and physical strength.  

Other drugs may help relieve certain types of pain in the central nervous system. They may be useful in dizziness caused by multiple sclerosis, an autoimmune disease affecting the brain and spinal cord.  The physician will prescribe what is appropriate for a particular patient.

“Because of drug interactions, a patient needs to tell his or her physician about any other medications they are taking, including over-the-counter drugs,” recommends Gadre. Ask the physician or the pharmacist how each drug will interact with coffee, alcohol and herbal remedies. Even smoking can affect how the body will absorb a medication.

Surgery should be considered when all else fails, Gadre says.

UPDATED: 3-06-2006

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