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Dizziness and Vertigo
by Norman J. Harris, MD
Affiliated Ear, Nose and Throat of Orange county
reprinted with permission from 

We generally use one word - DIZZY- for two very different sensations. These sensations have very different causes. We need to be clear on which sensation we mean before we can figure out causes and treatments. 

One sensation is a light headed, kind of fainting, passing out sensation. It’s the what we feel after we breathe in and out rapidly (hyperventilation) ten or twenty times. This we call “little d” dizziness.

The other sensation is the merry-go-round, “I’m spinning”, “ the room is spinning”, on a boat kind of sea sick feeling. This feeling is called vertigo. 

Dizzy with a small "d"

The British call this sensation "giddy". This sensation just about never comes from the ear. 

Two basic origins for this experience are : 

Metabolic...meaning a change in blood chemistry. In addition to hyperventilation, such changes can occur as a result of sedative medications, or hormonal changes. Occasionally, such sensations are caused by a hyperventilation response to emotional stress. 

Circulatory...occurring when the reflexes adjusting blood flow to the brain don’t keep up with the brain’s need. One example is the “head rush” of standing up too quickly after sitting for hours. Other causes include medication effects or blood vessel diseases 

The complete evaluation of this complaint falls within the usual practice of family or internal medicine. ear problem 

With few exceptions, this sensation arises in the inner ear. The inner ear is the part of the ear buried deep in the ( temporal) bone on the side of the head including the organ of hearing...the cochlea, and the organ of balance.....the vestibular apparatus. Vertigo occurs when one ear malfunctions compared to the other. When both ears malfunction to the same degree, vertigo is rare, but severe difficulty walking and standing up are the result. 

Hydrops of the ear is the term for fluid imbalances of the inner ear. Malfunctions in this system cause balance problems, severe dizziness (vertigo), accompanied by hearing loss and distortion, ear ringing (tinnitus), sensations of plugged ear, and ear pain from loud noises. Hydrops of the ear takes many many forms. Often incorrectly applied to any kind of dizziness, the name "Meniere's Disease" refers to a special form of hydrops. 

When the fluid imbalance affects only the cochlea, the symptoms can include periodic blockage sensations, ringing in the ear, and/or distortion or loss of hearing. When just the vestibular apparatus is involved, spinning, rocking , and moving sensations are experienced. The off balance and motion sensations can be so intense, they can cause nausea and vomiting....just like motion sickness. The cochlear and balance symptoms may occur together. 

Hydrops usually comes in clusters of hour long spells. A cluster of spells can last months, then vanish. After many years, just when it seems the disease has gone permanently, another cluster occurs. The chance that any cluster will eventually end by itself is 95% to
97%. The more often the spells occur, the milder they become, because the brain 'learns' how to suppress them. Unfortunately, the longer the interval between clusters, the more intense the first spell will be, for the same reason. 

Many theories have been devised to explain this affliction. Every theory includes a treatment. Abnormal fluid production in the fluid compartments of the inner ear is one popular explanation. This idea supports the use of salt or sugar restriction, or prescribing fluid pills (diuretics). Clogged drainage of the inner ear spaces as a theory has led to surgery intended to drain the inner ear spaces into the membranes of the brain. Some have suggested the blood flow to the ear is poor, and prescribe blood thinners and vasodilators. Allergies, either to the something in the environment or to the ear itself has been blamed. Steroids and allergy shots are said to be helpful. It's not clear that any of these treatments actually result in cures at all, since the data of the trials gives the same 95% success rate as no treatment at all. 

Uncertainty about the cause of hydrops doesn't mean no help is available! The dizzy spells respond well to oral medications like valium or zofran tablets, and tigan suppositories. The best long term strategy is to include a spinning exercise into your regular activities. Square dancing, waltzing, etc. all, when done regularly, help prepare the nervous system to clamp down on the vertigo of a next attack. The latest hearing aids help more complicated hearing losses. 

All dizziness isn’t hydrops. Re-examination on at least an annual basis is advisable for all hydrops patients. If the spells increase in strength, or any part of the body goes weak or numb, other serious... fortunately rare... conditions need to be considered. 

Copyright 2000 Norman J. Harris, MD

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