Vertigo

DIZZINESS AND IMBALANCE (VERTIGO)

Dizziness and imbalance are concepts different from each other.  They are mostly observed together when different organs become ill.  Concept of vertigo is used to describe mainly dizziness and defines a real rotational spinning (spinning of environment and/or the individual himself/herself).  Generally it is situation arising from internal ear diseases.  Concept of dizziness causes slipping of the floor under the foot of the individual, feeling of imbalance, feeling like a drunk or like being in a boat.  It usually develops because of brain diseases, hormonal diseases, internal diseases, neck diseases.  When real dizziness called vertigo is defined, mostly nausea and vomiting are accompanied.

How is the balance stabilized?  Balancing is a very complex situation which is not completely solved yet and in which many organs have a role.  Brain, spinal cord, internal ear (labyrinth), eyes, joints and muscles can be named among these organs and systems.  A disease affecting these organs may cause dizziness and other indications related with that organ.  Naturally dizziness, as an indication for which so many organs play a role, can not be evaluated only by one branch specialist.  Examination in the departments of eye, internal diseases or physical therapy may be required, in addition to examinations realized by ENT and Neurology physicians at the beginning. 

What kind of complaints is experienced?  Dizziness is described different by each patient. Following explanations are frequently made: Everywhere spins, ground slips under my foot, I am sliding to one side, inside of head pours out, I go black.  All these explanations describe dizziness.  There may be other indications in these patients according to the cause.  Tinnitus, hearing loss, pressure feeling in the ear, nausea-vomiting, ear discharge and abnormal movements of eye (nystagmus) may be observed in the dizziness arising from ear diseases.  Headache, numbness, paralyses, abnormalities in the eyes may be see in the dizziness arising from neurological diseases.  Other complaints that may accompany dizziness can be very variable, however there is only dizziness in most of the patients. 

Basic diseases that cause dizziness and imbalance:

1- Reasons related with ear:

It is the organ responsible for 70% of all real vertigos.  Vertigo attacks may be experienced because of Meniere’s disease, positional vertigo, chronic diseases with ear discharge, ear diseases accompanied by hearing loss, ear diseases arising from damage of equilibrium nerve following a viral infection, less blood flowing to the internal ear of individuals who experience severe vascular occlusion, rupture of membranes in the internal ear without any reason.

2- Traumas:

Extremely restrictive vertigo accompanied with nausea and vomiting may be seen following a fracture in the scull that also influences internal ear.  Patient may experience an apparent dizziness even when he/she turns his/her head.  Recovery may take weeks, even months.  Especially in the position changes, severe dizziness may be experienced for few seconds even after many years. 

3- Infection:

Dizziness arising from ear may be observed especially after severe influenza.  In more serious infections, when cerebral cortex is inflamed, imbalance may be experienced accompanied by nausea and vomiting.

4- Neurological diseases:

Diseases like multiple sclerosis, syphilis, various brain tumors, Parkinson diseases, etc. influence the nervous system and cause imbalance. 

5- Allergic Reasons:

Vertigo attacks may be experienced by individuals with allergic temperament as a response to the allergic medium with pollens especially in spring and autumn.  Only antihistaminic drugs shall be sufficient for the treatment.

6- Cervical reasons:

Most of the dizziness (especially those that are positional) is regarded to be with neck-origin, however neck diseases do not cause dizziness except advanced cervical disc hernia.  What should we do to understand to which organ the complaints of equilibrium system belong?  First of all, dizziness and imbalance diseases necessitate a team work medically.  Most of the time, disease affects several organs.  It is possible to obtain net answers about the place and name of the disease by utilizing various technological instruments in the related centers (audiometric tests, electronystagmography, electroencephalography, electromyography, computerized dynamic posturography, etc.).  Treatment is planned after the reason is determined.

There are precautions to reduce dizziness and they vary in accordance with the type of disease.  For example, patient with Meniere disease should avoid stressful environments, alcohol, caffeine, too salty foods.  Patient who has Benign Paroxysmal Positional Vertigo (BPPV) should avoid sudden head movements (especially near cliff edge, balcony, etc).  The most significant suggestion may be not to drive a car, operate a dangerous instrument or to perform a duty that requires attention when you have dizziness.

What is seen in the examination?

If dizziness is arising from a disease in the internal ear, no problem is seen in the ear examination.  A hole in the tympanic membrane and inflammation in the middle ear are observed, if dizziness occurs when otitis media influences the internal ear.  Abnormal eye movements may be detected in the patient.  Direction of these eye movements may provide information about which ear is inflamed.  Since dizziness can not be seen with eye, information should be obtained as much as possible.  With this aim, your physician will make certain tests while your are standing or lying.

What kind of investigations shall be realized?

Investigations for dizziness shall be planned according to the information obtained at the end of the examination.  If it is concluded that it is not related with ear, your physician shall transfer you to other branches.  However, generally some investigations are made to reach this conclusion.  The most frequently utilized investigation is audiometry test that gives us information about both hearing function and functions of internal ear.  Normal films of ear, computerized tomography or magnetic resonance (MR) investigations can be performed.  Certain blood analyses may be added to these tests.  However, usually nothing is seen in audiometry, computerized tomography or MR in many ear diseases.  These tests are made to eliminate more serious problems.

How is the treatment?

Dizziness itself is not a disease, it is an indication of another disease, so real reason should be treated at first.  However, a net cause may not be established in many patients with dizziness.  Therefore, treatment takes the form to eliminate the dizziness.  Dizziness arising from ear diseases (except tumors) usually disappears in short or long period of time, because other ear compensates the problem of the unwell ear.  This may take 6 months or even 1 year.  When the dizziness is positional vertigo (BPPV), treatment is made by movements called Epley Maneuver, your physician will apply these movements to you on the examination couch.  These movements provide some particles in the internal ear to fall into place.  Drug treatment is applied for other reasons.  Different drugs may be used with this aim, most of them reduce the headache to a certain degree.  It may be required to hospitalize patients who have very severe dizziness.  Treatment of dizziness arising from tumors is the removal of the tumor that is surgery.  Sometimes operation is performed for Meniere’s disease when no response is obtained to drug treatment.

What should I pay attention to?

There are some exercises for patients to reduce their dizziness.  These exercises shall be described to you by your physician or you will be informed by way of brochures. 

Meniere’s Disease

• It is related with equilibrium, adjustment of fluid in the internal ear.  Real reason of the disease is unknown.
• Internal ear is related with hearing and balance, and it consists of a fluid-filled capsule.  Pressure of this fluid increases in Meniere’s disease.  This high pressure causes tinnitus, occlusion feeling in the ear, hearing loss and dizziness.
• Disease is characterized by dizziness, fluctuations in hearing and tinnitus.  Nausea, vomiting, imbalance, perspiration and diarrhea may accompany.
• Attacks generally start suddenly and their duration range between 20 minutes and 24 hours.  In most of the cases, attacks follow each other.  Attacks are frequently repeated and may continue for weeks; then normal life is maintained for weeks, even months.  Hearing loss is because of damage on the auditory nerve.  Hearing loss is observed only during attacks in the first stage of the disease, then hearing returns to normal.  As disease progresses, ability of auditory nerve to recover reduces and permanent hearing loss occurs.
• Rarely, dizziness is seen at intervals, without any hearing loss, ear pressure or tinnitus.  Also, hearing loss, ear pressure, tinnitus may be observed without dizziness. 
• Meniere’s disease is mostly seen in single ear, however two ears may be affected too.
• Drug treatment: Purpose of drug treatment is to reduce the pressure of fluid in the internal ear.  This is provided by eating less salty foods and using diuretic drugs.
• Salt causes the water to stay in the body, so salt is restricted.  Diuretics are also used with the same purpose.  This treatment may be applied for months, even for years in order to keep the disease under control.
• Drugs suppressing balance system may be added to the treatment.  Basically these drugs ensure the brain not to pay attention to the abnormal signals received from ear.
• Surgical treatment: Surgery is performed when drug treatment is not successful and severe dizziness attacks are experienced.  All efforts are exerted to maintain hearing; thus type of operation depends on the degree of hearing loss.  Hearing usually stays the same after the operation, however there is risk of reduction in hearing.  Tinnitus may be improved a little or stays the same.  
• Perfect treatment of dizziness is possible according to the type of operation.  Attacks of dizziness may be experienced in the form of drowsiness for about one year, then this situation disappears when brain and other ear take the charge.