Treatment
Treatment of dizziness due to changes in circulation
consists of antidizziness medications to suppress the symptoms. They
also stimulate the circulation and enhance the effectiveness
of the brain centers in controlling the symptoms. An individual
with this type of dizziness should avoid drugs that constrict
the blood vessels, such as caffeine (coffee) and nicotine (tobacco). Emotional
stress, anxiety and excessive fatigue should be avoided
as much as possible. Often, increased exercise will aid
in the suppression of dizziness in many patients by stimulating
the remaining function to be more effective.
Benign Positional Vertigo (Postural or Positional Dizziness)
Postural or positional dizziness is a common form of balance
disturbance due to circulatory changes or to loose calcium
deposits in the inner ear. It is characterized by sudden,
brief episodes of imbalance when moving or changing head
position. Commonly it is noticed when lying down or arising
or when turning over in bed. This type of dizziness is
rarely progressive and usually responds to treatment, but
it may recur. Treatment usually consists of exercises
designed to provoke the dizziness until it fatigues. This
type of exercise may be recommended by your physician
to cause the positional dizziness to run its course more
quickly. Occasionally, postural dizziness may be permanent
and surgery may be required.
Semont Maneuver
The Semont Maneuver is performed as follows:
You are seated, and the doctor, audiologist, or vestibular
clinician turns your head 45 degrees horizontally toward
the affected ear.
The professional tilts you 45 degrees so that you are lying
on the side of the affected ear with your head hanging and
your nose pointed upward. You remain in this position for
4 minutes. The debris should move to the apex of the canal.
The professional then moves you quickly through a seated
position, holding your head in place, until you are lying
on the side of the affected ear with your nose pointing
to the ground. You remain in this position for 4 minutes.
The debris should move toward the exit of the canal.
The professional then slowly moves you back to the seated
position. The debris should fall into the utricle of the
canal, where it will not cause vertigo.
The professional will then place a neck brace on you to
prevent you from moving your head for 24 hours. You can
look up and down with your eyes but should refrain from
moving your head to look up at the ceiling or down at the
floor.
Most people are cured of vertigo with BPPV with one or two
treatments of the Semont maneuver. There are no significant
risks of this procedure.
Imbalance related to Aging
Some individuals develop imbalance as a result of the
aging process. In many cases this is due to circulatory
changes in the very small blood vessels supplying the inner
ear and balance nerve mechanism. Fortunately, these disturbances,
although they may persist, rarely become worse.
Postural or positional vertigo is the most common balance
disturbance of aging. This may develop in younger individuals
as a result of head injuries or circulatory disturbances.
Dizziness on change of head position is a distressing symptom
which is often helped by vestibular exercises.
Temporary unsteadiness upon arising from bed in the morning
is not uncommon for older individuals. At times this feeling
of imbalance may persist for an hour or two. Arising from
bed slowly usually minimizes the disturbance. Again vestibular
exercises may be useful to these individuals.
Unsteadiness when walking, particularly on stepping up or
down, or walking on uneven surfaces, develops in some individuals
as they progress in age. Using a cane and learning
to use the eyes to help the balance is often helpful.
Imbalance due to Infection
Imbalance due to ear infection is usually insidious
and mild in onset. Such imbalance may occur with or without
hearing impairment. As the infection gets closer to the
vital balance mechanism in the inner ear, the dizziness
becomes more constant and severe in nature, and is often
associated with nausea and vomiting.
Treatment
Control of an ear infection is imperative in this type
of dizziness in order to prevent spread of infection directly
into the balance center of the inner ear. Should this develop,
serious complications including total loss of hearing in
the involved ear may result. If the infection cannot be
eliminated by medical treatment, surgery is indicated to
remove the infection.
Neuritis
Neuritis is a physiological change which occurs in the
nerve after injury or trauma, a virus, autoimmune disease,
or vascular compression. When this occurs, the balance
function is impaired, resulting in a severe, and at times
prolonged, episode of dizziness, often followed by some
unsteadiness or motion for weeks to years. Fortunately,
this balance disturbance usually subsides in time and usually
does not recur in the majority of cases. It may be, however,
very chronic at a moderate to mild level.
Medical treatment is helpful in eliminating symptoms until
the central nervous system can compensate for the injured
nerve. This usually consists of dizziness-suppressing drugs.
On occasion, the central nervous system cannot compensate
and surgery may be necessary.
Metabolic Disturbances
Occasionally metabolic disturbances produce dizziness
with or without associated hearing loss by interfering with
the function of the inner ear or the central nervous system.
Occasionally hearing loss may occur without the presence
of dizziness.
A change of thyroid function or abnormalities in the blood
sugar are the most common metabolic disturbances resulting
in dizziness. Rarely, fat metabolism abnormalities may
also cause problems resulting in hearing loss and/or dizziness.
Thyroid dysfunction is diagnosed by blood tests and treatment
consists of taking a thyroid hormone. Abnormalities in
the blood sugar are diagnosed, again by blood studies, and
treatment usually consists of diet control and/or drug therapy.
Fat matabolism problems are diagnosed by studies of the fatty
acids and cholesterol in the blood. Treatment of these
may consist of diet control with or without drug therapy.
Allergies
Rarely, allergies may cause dizziness and/or vertigo.
Allergies are usually diagnosed by obtaining a careful history
and occasionally performing a series of skin tests with
inhalants and food, and/or blood tests. Treatment usually
consists of elimination of the offending agents when possible,
or, if this is not possible, by allergy shots to stimulate
an immunity.
Injury
Injury to the head occasionally results in dizziness
of longstanding origin. If the trauma is severe, it is
usually due to the combined damage to the inner ear, balance
nerve, and central nervous system. Lesser injury may damage
any one, or a combination of these components. The unsteadiness
is at times prolonged, and may or may not be associated
with hearing loss and head noise as well as other symptoms.
Treatment consists of anti-dizziness medications, sedatives
and occasionally medication to improve blood circulation.
Symptoms will usually clear in a few months, but occasionally
surgery is required to stop the symptoms, and in a few instances
no treatment will entirely eliminate the dizziness.
Fistula
A fistula is an abnormal opening in some part of the
body. Relatively minor closed head injuries may cause a
fistula in the inner ear. The fistula occurs at either
the oval window (window where the stapes bone fits) or the
round window membrane (an opening from the cochlea to the
middle ear). Fistulas change the pressure in the inner
ear and lead to a variety of symptoms, some of which can
be incapacitating. A persistent daily low grade dizziness
is often associated with fistulas, but the patient may also
experience severe episodes of vertigo similar to those seen
in Meniere’s disease. Surgery is usually required to close
a fistula and stop the symptoms. If the fistula is large,
or has been present for some time, there may be permanent
damage to the inner ear and symptoms may persists even after
closure of the fistula. In these cases a vestibular nerve
section is necessary to stop the persistent dizziness.
Dizziness: Medical Treatment
The treatment of each individual patient varies according
to the cause, magnitude, and frequency of symptoms. In
addition, it depends upon the status of the hearing in the
ear and lifestyle of the individual.
Medical treatment is aimed at improving the metabolic status
of the inner ear. Several types of drugs are used depending
upon the disease and the status of the patient. Most often
the patient will have to take several drugs in combination,
one of which is usually an anti-dizziness medication (labyrinthine
suppressant). Sometimes drugs which dilate blood vessels
are used, as well as drugs (diuretics) which decrease the
amount of fluid in the inner ear. Changes in diet, thyroid
medication, medication to control sugar metabolism, or other
measures may be needed. Vasconstricting
substances should be avoided to allow the inner ear to have
maximum circulation. Such substances are caffeine (coffee)
and nicotine (cigarettes). Very rarely allergic treatments
may be necessary to control dizziness.
