When I spoke with Aaron G. Benson, MD, an otolaryngologist (ear, nose and throat doctor) and neurotologist (inner-ear specialist), he strongly recommended, “If you experience dizziness, take it seriously — call your doctor without delay. Dizziness has many possible causes, so be specific in describing your symptoms. Do you feel faint? Like you’re on a boat? Do you have vertigo (the sensation that you or your surroundings are spinning)? This information helps the doctor make a correct diagnosis.”
If your doctor suspects a vestibular disorder, ask for a referral to an otolaryngologist or neurotologist… or find one through the American Academy of Otolaryngology-Head and Neck Surgery. Here’s what you should know about four common vestibular problems…
Benign paroxysmal positional vertigo (BPPV). The labyrinth of the inner ear includes three fluid-filled semicircular canals and two small sacs containing tiny calcium particles that detect motion. BPPV occurs when those calcium particles break loose and find their way into a canal… then, whenever you move your head, these particles send false signals of movement to the brain and trigger brief but severe vertigo.
BPPV treatment involves a series of specific head movements called the Epley maneuver. A doctor or physical therapist can guide you through the sequence, which takes about 45 minutes. Caution: Dr. Benson warns against trying to do the Epley maneuver yourself, since a wrong movement can worsen your condition. With proper instruction, however, many patients can continue this or other exercises at home. If the condition recurs, as it does in some cases, treatment can be repeated.
Vestibular migraine. For some migraine sufferers, the main symptom is not pain, but rather dizziness that can last for minutes or hours. “Since patients do not necessarily experience a headache with these spells, this is an easy diagnosis to miss,” Dr. Benson cautioned. So alert your doctor to any other symptoms you may have, such as sensitivity to light or sound and/or wavy lines or blinking lights in your field of vision.
Vestibular migraine episodes can be minimized by avoiding food triggers (such as caffeine, cheese, chocolate and red wine)… guarding against low blood sugar… and reducing stress. Migraine medications can also help prevent attacks.
Labyrinthitis and vestibular neuritis. These occur when an infection (usually viral) leads to inflammation — either of the labyrinth (in the case of labyrinthitis)… or of a nerve connecting the inner ear to the brain (in vestibular neuritis). The resulting severe dizziness typically comes on suddenly and may be accompanied by nausea, vomiting, and hearing or vision problems. Dr. Benson said, “Steroid and antinausea medications can help a patient through the first few days, which are always the worst.” After that — even though recovery is gradual and may take weeks or months — it is important to avoid vestibular suppressant medications (drugs that ease dizziness), Dr. Benson advised, because these prevent the body from adapting to the condition.
Ménière’s disease. This refers to a constellation of symptoms that includes sudden episodes of intense dizziness or vertigo that can last for minutes or hours… plus pressure and/or ringing in the ear and fluctuating hearing loss. It develops when (for unknown reasons) fluid builds up in the inner ear. Stress can bring on an episode of symptoms.
There is no cure, but symptoms often can be managed by avoiding caffeine, alcohol, salt and tobacco. In severe cases, draining the fluid in the ear, surgery or medication injected through the eardrum can bring relief.
Important: Dizziness has many possible causes other than vestibular problems — for instance, low blood pressure, medication side effects, whiplash, cervical stenosis (narrowing of the spinal canal in the neck area), diabetes, thyroid disease, heart attack or stroke. Bottom line: Dizziness that is severe, persistent or recurrent should never be ignored.