Daily Local News (West Chester, PA)
Vertigo — where no one wants to go
The dizziness associated with this condition can be alarming, but there are steps you can take.
Alfred Hitchcock called his frightening movie “Vertigo” for a reason.
While the 1958 film noir directed by Hitchcock is classified as a psychological thriller, the real, every-day variety of vertigo is horrific.
One minute of vertigo is like one minute of a toothache; you just want it to go away.
“It is scary at first, because you have no idea what’s going on,” said Dr. Leslie Sonday, the Director of Audiology at Berks ENT Surgical Associates Inc. in Wyomissing. “So it’s important to know that help is out there.”
Vertigo is a symptom of a medical condition, not a disease, which doesn’t make it any less alarming.
Imagine having your balance askew, with everything spinning fast and crazily around you; that’s vertigo.
“Vertigo is a sense of motion; that spinning feeling that people sometimes get,” Sonday said.
Vertigo is a visual disturbance caused by the inner ear, she explained.
It’s not generally painful; it’s more insidious, totally disabling as well as disorienting. People suffering from vertigo will be immobile, trying not to move a muscle so the spinning doesn’t recur.
Vertigo could also be a symptom of a more serious event, like a stroke or cardiovascular disease, so it’s important to see a doctor if you have an episode of vertigo.
“With true vertigo, new onset, we need to rule out blood vessel problems,” said Dr. Winifred Kao-Seda of the Berks ENT group.
A blood vessel that’s occluded or blocked needs immediate attention.
If feeling vertiginous, the best course of action would be to have someone drive you to an emergency room or see a neurologist ASAP.
“Use your judgment, make sure you’re not having an impending stroke,” Dr. Kao-Seda said.
When that possibility is ruled out, the next step would be to consult an ENT doctor for further diagnosis and treatment.
After looking for fluid behind the eardrum, changes in the patient’s hearing, and ringing in the ears, if the inner ear is suspect, medications like meclizine or bonine could be prescribed to help with the vertigo.
Causes of vertigo vary, but no matter the reason, little can be done in the way of prevention.
Children don’t seem to be affected as much by vertigo as other age groups; once you hit your 20s, anybody is fair game.
“If one ear is affected by a disease process or inner ear balance disorder, it can cause vertigo and that can happen at any age,” Sonday said.
The inner ear is often the culprit, as this is where the center of the somato-sensory system is located; the workings that help people know where their body is in relation to space.
Feeling lightheaded or faint is not the same as vertigo; being dizzy.
Feeling faint could be caused by getting up too quickly and experiencing a drop in blood pressure.
One of the main causes of vertigo is Benign Positional Paroxysmal Vertigo (BPPV) that results when tiny calcium crystals in the ear get out of place and find their way to an inner ear canal, Sonday said.
The shifting of the inner ear crystals could be the result of a head injury, although that’s not always the case, Sonday said.
Dizziness could be a side effect of some medications, so folks should speak with their family physician if they have questions.
Vertigo seems to become more common as people age, Sonday said.
“It’s a degenerative process; the gel-like membrane that holds these crystals in place degenerates as we get older,” Sonday said.
The dislodging of the crystals could be caused by something as simple as turning over in bed to reach for the alarm clock.
“This type of vertigo (BPPV) only goes away when you stop moving,” Sonday said. “The patients who have that type of vertigo learn really quickly what triggers it.”
To determine if a patient’s vertigo is being caused by BPPV, a physician will use the Epley Maneuver.
“We put the patient’s head in a certain position and let gravity do its work,” Sonday said. “We’ll know a patient has BPPV by watching their eyes.”
If the crystals are out of place, involuntary jerky eye movements will be noticeable.
If that’s the case, a physician can reposition the head to get the problematic crystals out of the ear canal.
Occasionally, vertigo will resolve on it own, Sonday said, although it can also return.
People suffering from vertigo can be referred to a physical therapist for vestibular rehabilitation, a specialized form of therapy that focuses on re-training the brain to maintain its balance.
Vertigo can also be caused by vestibular neuronitis, an inflammation of the balance nerves.
Thought to be caused by a virus, antibiotics won’t help with this kind of inflammation.
While Benign Positional Paroxysmal Vertigo may only last a few minutes or hours, vertigo caused by neuronitis may last a few days.
Meniere’s Disease can also be accompanied by vertigo.
“It’s a more episodic vertigo, typically accompanied by pressure in the ear, nausea, tinnitis (ringing in the ear) and possible hearing loss,” Sonday said.
Meniere’s Disease seems to be related to fluid buildup in the inner ear.
Treatment might include dietary restrictions, such as a low-salt diet, Sonday said.
Dr. Tammy Balatgek of the Center for TMJ and Sleep Disorders, 2433 Morgantown Road, Reading, suggests staying hydrated as a first step in fending off vertigo, since dehydration can be instigate a number of physical maladies.
While inner ear inconsistencies are one of the primary causes of vertigo, a jaw that’s out of alignment may also cause vertigo, Balatgek said, because it can put pressure on the system.
Dental hygienist Bonnie Brown, employed by Balatgek, had bouts of vertigo in the past.
“It was Brown said.
After calling off sick a few months ago, Dr. Balatgek suggested checking the alignment of Brown’s jaw.
An oral appliance was made for Brown and so far, is working well.
“I’m cautiously optimistic that this took care of the problem,” Brown said. “The re-positioning of my jaw took pressure off my ear.”
The jaw joint, a socket joint, connects in front of the ear.
An ear infection or even a congested cold could bring on a bout of vertigo.
People suffering from vertigo will usually see their primary care physician debilitating,” or an ENT doctor first, Balatgek said.
“They come to us when other treatments don’t work,” Balatgek said. “Sometimes we can tell them ‘your jaw is out of alignment ‘ and we can help them.”
Structurally, if the vertigo is coming from the jaw misalignment, Balatgek can outfit the patient with an oral appliance that will keep the jawbone away from the ear.
Grinding or clenching one’s teeth at night could contribute to vertigo, Balatgek said, because the high pressure being exerted can distort the bones in the ear.
She suggested an evaluation if teeth grinding is a problem.
Balatgek might also prescribe anti-nausea medication to lessen vertigo, including Dramamine, the drug of choice for seasickness.
“I like to start conservatively, but if the Epley Maneuver doesn’t take care of it, we’ll try something else,” Balatgek said.
While vertigo can affect almost all ages, the consequences are greater for the elderly, who may be more inclined to fall due to that loss of balance, Balatgek said.
“The jaw joint can be a main cause of vertigo, but that’s not something that will turn up on the Internet,” Balatgek said. “Physical therapy can sometimes help.”
The vertebral artery can get temporarily occluded when you tilt your head way back, as in looking up at the sky, causing a slight dizziness, Balatgek said.
Balatgek advised: Don’t stand up too quickly, get help if you grind your teeth, and don’t spin around on amusement park rides.