When Vertigo Sets You Spinning

Imagine you’re going about your business as usual.  You finish a long day and go to bed, but in the middle of the night you roll over and wake up suddenly feeling like you’ve been strapped into the Whirling Teacups ride at the amusement park!  Nausea, trouble walking and vision problems add to the fun.  Hooray, you have vertigo :-/

A number of patients have come in to the office recently with vertigo.  Vertigo is usually a minor annoyance but rarely it can be a sign of a very serious problem.

Vertigo is actually a symptom, not a medical illness in and of itself.  It is defined as the illusion of movement.  This means you feel like you’re moving but you’re actually not.

Everyone has had vertigo.  Do you remember when you were a kid and spun around in a circle over and over to make yourself dizzy, then fell down on your back to watch the sky whirl around?  That was vertigo.

Vertigo is a problem with the inner ear.  There are delicate fluid-filled tubes in the inner ear called semicircular canals that sense the movement of the head.  When the fluid can’t shift the way it should, or the ear can’t sense the movement properly, the brain gets mixed signals.

Credit wikis.lib.ncsu.edu

Credit wikis.lib.ncsu.edu

Have you ever been seasick or carsick or airsick?  Motion sickness is a problem when the brain gets signals from the eyes and ears that don’t match.  If the ears say you’re moving and the eyes say you’re not (like turbulence in an airplane or trying to read in the car) the brain can’t make the signals match.  Nausea and dizziness are what happens.

You can get vertigo as part of a viral respiratory infection if the virus infects the inner ear.  Swelling will keep the fluid from moving properly and may keep the inner ear from sensing movement properly.  This is called labyrinthitis.

You can also get symptoms if a little bit of debris blocks fluid from moving properly in the canals.  This is called benign positional vertigo and happens with movement and stops when you’re not moving.

There are a few times when this can signal a serious problem.  Vertigo in combination with hearing loss can be a sign of an illness called Meniere’s disease which happens when there’s too much fluid in the inner ear.  The unusual combination of vertigo and hearing loss in just one ear can be a sign of a benign tumor on the acoustic nerve.

Very rarely, vertigo can be a sign of a stroke if it affects the part of the brain related to balance.  This is of course more likely in those who are at risk for strokes.

What can we do to help vertigo?  Well most cases of vertigo are just annoying, not scary or dangerous.  So most of the time we focus on keeping the patient reasonably comfortable while the body heals the problem on its own.  Antihistamines like diphenhydramine and cetirizine are helpful, as are over-the-counter motion sickness medicines like Bonine and Dramamine.

If simple measures don’t work, sometimes steroids are useful to decrease swelling and inflammation in the inner ear.  Other treatments are used based on the cause.

If you develop dizziness and a feeling like you’re moving or spinning or off-balance, please see the doctor if the symptoms don’t subside right away if you sit perfectly still.  Most of the time it’s just an aggravating, temporary problem that feels better with some simple treatments.  However if it keeps up or you’re very uncomfortable or there are signs of a serious cause, more tests may be needed.

QUESTION: Have you ever had vertigo? How was it treated?

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