I KEEP HAV­ING EPISODES WHERE I FEEL LIKE I’M SPIN­NING. WHAT’S WRONG WITH ME?

Best Health - - ADVICE -

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.

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