I KEEP HAVING EPISODES WHERE I FEEL LIKE I’M SPINNING. WHAT’S WRONG WITH ME?
THE EAR, NOSE AND THROAT DOCTOR SAYS…
The feeling of spinning is called vertigo; and it’s a distinct feeling that’s different from feeling off balance or a little unstable. Vertigo is not a diagnosis but a symptom that can arise from a number of conditions.
If vertigo is experienced without other symptoms, it’s likely that it’s resulting from an issue in the ear, where your balance is controlled. Some people experience intense vertigo for several seconds only when they move their head a certain way, like rolling to one side in bed or looking up — this can be a sign of benign paroxysmal positional vertigo (BPPV). Others experience hourslong bouts of vertigo accompanied by hearing loss, which can happen with Meniere’s disease, a disorder of the inner ear. Infections or growths in the ear can also cause vertigo — and sometimes we never actually find what’s causing the problem.
If your vertigo is accompanied by other symptoms, like changes in vision, trouble speaking or swallowing, numbness or weakness, it can indicate that there’s a neurological issue at the root of it, such as a stroke or multiple sclerosis. In that case, a doctor would do further tests to find out what might be the cause.
There are a number of tests that a doctor might perform to find the source of the vertigo. The most common ones look at eye movements that are associated with vestibular (ear-related) problems. Identifying the source of the problem is important to finding the best treatment.
If you have Meniere’s disease, you may be prescribed steroids, while BPPV could require specific exercises from a physical therapist. Even if your doctor can’t determine the cause of the vertigo, they may give you a diuretic, which will help you to excrete sodium, because there’s a theory that vertigo can be caused by a mix-up in how the inner ear handles potassium and sodium.
Taking care of your health in other ways can also help with dizziness. For example, poor sleep could promote dizziness. Drug interactions can also lead to dizziness, so it’s a good idea to talk to your doctor about whether you can reduce your current prescriptions.
Dr. Brian Blakley is a professor in the department of otolaryngology at the University of Manitoba and director of the vestibular lab at the Health Sciences Centre in Winnipeg.
THE PHYSIOTHERAPIST SAYS…
Finding out the cause of vertigo begins with taking a thorough patient history. It would start with questions like: How and when did the vertigo begin? Do you have other symptoms? Has the vertigo progressed? Vertigo that is episodic (it comes and goes) is likely caused by vestibular issues, while dizziness that gets worse over time tends to be caused by neurological problems. Manual neurological tests, which involve things like visual tracking or coordination tests, can detect causes of vertigo that are rooted in the nervous system. Eye movement tests, done with the help of infrared goggles, can help identify vestibular problems. Normally, the eyes reflexively move in a specific pattern when the head moves, but in some people, the eyes will move when the head is still, because a problem in one ear makes the brain think that the head is moving.
The most common ear-related cause of vertigo, BPPV, occurs when calcium carbonate crystals in the inner ear are dislodged and travel through the ear canal. A series of head and body movements can move the crystals back to where they belong. The necessary movements depend on where the crystals are, but the most common solution is the Epley manoeuvre. For this exercise, the patient turns their head 45 degrees to the right and lies on a table on their back, with their head hanging about 20 degrees below the surface. The head is rotated to the left at 45 degrees and the patient is rolled to the left side and asked to sit up on the opposite side of the table.
Most patients with other causes of vertigo can benefit from vestibular rehabilitation therapy, which involves prescribed exercises they can do at home. For example, if a patient is unable to stabilize their vision when their head moves, they could practice moving their head while staring at a certain point on the wall, gradually increasing the speed over time. Exercises like this help the vestibular system calibrate itself and train the brain to compensate for the problem. Some patients improve after just a couple of visits, while others, particularly those with chronic or degenerative conditions, need treatment for longer.
Finally, neck problems can also compound vertigo. Those with chronic vertigo can develop tense neck muscles because they’ve changed their head movements to avoid dizziness. It’s important to address these issues with muscles and joints and treat the vertigo so that it doesn’t lead to further issueswith the neck.
Joon Nah is a certified vestibular physiotherapist and founder of the Cornerstone Dizziness Clinic in Toronto.