A 76-year-old man went to the hospital complaining that he had experienced
vertigo for three years and that it had gotten worse in the last two to
three months. What he meant by vertigo, he explained, was a sensation of
"things in the house spinning," along with nausea lasting less than a
minute. He felt fine if he stayed in bed and did not move. He did not have
slurred speech, weakness of extremities or any other symptoms that might
point to a neurological or brain problem.
He was first diagnosed with Meniere's syndrome, a mysterious disorder that
causes severe vertigo, hearing loss and a ringing or other sensation in the
ears. He was treated with the drug Diazide. After that, everything had been
fine until the past few months, when he had several new attacks of the same
symptoms, but with more severe nausea and vomiting. He was now afraid that
he was about to have another attack.
A series of tests revealed that instead of Meniere's Disease, the man was
actually suffering from another illness called Benign Paroxysmal Positional
Vertigo, or BPPV. Meniere's Disease and BPPV are the two most common causes
of vertigo. While one can be mistaken for the other, as in this example,
they are different diseases with different symptoms and different
treatments.
What Is Vertigo?
Vertigo is not a disease in itself, but rather a symptom that can have any
number of causes. The famous Alfred Hitchcock film notwithstanding, a fear
of heights is not normally one of them. Vertigo is defined in Webster's
dictionary as a feeling "in which the external world seems to revolve around
the individual or in which the individual seems to revolve in space."2
Occurring without warning, it comes and goes unpredictably and is often
accompanied by nausea, vomiting and problems with equilibrium. Mild episodes
may feel more like a rocking sensation or mere light-headedness.
Common Causes of Vertigo
Benign Paroxysmal Positional Vertigo
Benign paroxysmal positional vertigo (BPPV), the kind that was mistaken for
Meniere's Disease in the above example, is one of the most common types of
vertigo. It has many causes, not all of which are well understood. The most
popular current theory is that it is usually caused by free-floating calcium
carbonate crystals in an area of the inner ear called the posterior
semicircular canal, which is part of the vestibular system.
The vestibular system, located in and around the ear, is responsible for
integrating what we see, hear and feel with head and body movement. In
short, it controls our body's sense of equilibrium. More specifically, the
vestibular system works by monitoring head movement and then sending this
information to organs inside the ear, which then relay the information to
the brain.
Our ears play an essential part in this process. The inner ear contains an
area called the labyrinth, in which are found three semicircular canals;
these canals are surrounded by a special fluid. The canals' function is to
transmit information about head movement to the vestibular nerve. This nerve
passes the information along to the areas of the brain that control bodily
coordination.
People with BPPV feel lightheaded. The lightheadedness is is often
accompanied by nausea, vomiting, sweating and a skin pallor. It usually
comes on suddenly and goes away in less than 30 seconds.
BPPV can be brought on by a sudden change in body position, such as turning
over in bed or getting in and out of bed. Many people have only a single
passing bout of BPPV but, for some, BPPV returns unexpectedly.
Meniere's Syndrome
Meniere's syndrome is another common cause of vertigo. Characterized by
deafness, ringing in the ears and occasional vertigo, its cause is unknown.
People with Meniere's get a feeling of fullness or pressure in the ear,
followed by hearing loss in one ear, which is soon followed by vertigo. The
vertigo builds in intensity over several hours and is sometimes accompanied
by nausea and vomiting. The hearing loss gradually becomes total, at which
point the vertigo begins to go away until it finally disappears.
Less Common Causes
There are many less common causes of vertigo. These include stroke, brain
tumors, low blood pressure, heart arrhythmias, multiple sclerosis and
migraine headache. Many prescription and non-prescription drugs can cause
dizziness or vertigo. In some susceptible people, cold and flu medicines,
painkillers, as well as treatments for high blood pressure, diabetes,
thyroid disease, depression and anxiety can produce lightheadedness and
dizziness.
Non-Surgical Treatments for BPPV
The most reliable treatment for BPPV is a fairly simple, non-surgical
procedure called canalith repositioning. This is done by changing the
patient's head and body position in a series of steps that are thought to
dislodge the calcium crystals within the vestibular labyrinth that caused
the problem.
Canalith repositioning is usually done under expert supervision, but it is
easy enough that doctors often teach it to BPPV sufferers and their
families.
Many doctors also prescribe drugs called vestibular suppressants. Because of
unwanted side effects, such as lethargy and impaired balance, they are given
sparingly and only for more severe and long-lasting attacks. The elderly are
particularly sensitive to these side effects.
Another concern about these drugs is that they may slow or prevent the
central nervous system from adjusting to a problem in the vestibular system.
While vetibular suppressants often help lessen symptoms, especially in the
short term, surgery is the ultimate answer for the unlucky few with severe
BPPV-related vertigo that does not respond to the canalith repositioning
procedure.
Treating Meniere's
The treatments for Meniere's disease are generally not as effective as those
for BPPV. Severe attacks are treated with vestibular suppressant drugs; in
between, Meniere's symptoms are often controlled by reducing salt intake and
by taking diuretic drugs, which reduce the amount of fluids in the body.
For similar reasons, people with Meniere's should avoid alcohol, coffee,
chocolate and other foods that are high in sugar or salt. As with BPPV,
surgery is a last resort.
Conclusion
Vertigo is not a disease but a symptom that can have many causes. The most
common are benign paroxysmal positional vertigo (BPPV) and Meniere's
disease, which for most people can be treated and controlled without
surgery. The best treatment for BPPV, a simple, non-surgical procedure
called canalith repositioning, is easy to perform; both sufferers and their
families can be trained to do it. Another option, vestibular suppressants
drugs, has serious side effects and should be used very cautiously.
When should you seek medical help?
The answer is that anyone with recurring or severe dizziness or vertigo
should see a doctor. Most of the time, the most serious cause will be BPPV
or Meniere's, both of which can be treated and controlled with drugs and
other non-surgical therapy. It is particularly urgent, however, to seek
medical treatment if the dizziness or vertigo occurs together with one or
more of the following symptoms, which can be a sign of a more serious
underlying heath problem:
Severe or "different" headache
Blurred vision
Hearing loss
Speech problems
Weakness in a leg or arm
Fainting
Problems walking
Numbness or tingling
Chest pain or changes in heart rate
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