When Your Head Spins

Vertigo has many causes, so diagnosis takes real sleuthing

Children often delight in the swimming sensation they get after a spin on a merry-go-round. But when that same whirling, swirling feeling comes over you for no apparent reason, it's no joy ride. Vertigo is frightening and difficult to ignore, which is why it's one of the top reasons people seek medical attention. The National Institutes of Health estimates that more than 5 million people visit a doctor complaining of dizziness every year. Yet all too often, patients don't find relief.

One reason is that figuring out vertigo's underlying cause -- the key to prescribing the right therapy -- requires real sleuthing on the part of the physician, says Dr. Lloyd Minor, professor of otolaryngology at Johns Hopkins Medical School in Baltimore. It's easier to give dizzy patients a motion-sickness medication such as Antivert or a sedative like Valium and tell them to wait it out.

Most often, vertigo signals a problem in the inner ear, where a series of semicircular canals and sacs known as the vestibular system senses your body's rotational and vertical movement. Your best bet is to see a balance specialist -- usually an otoneurologist or otolaryngologist. The Vestibular Disorders Assn. offers referrals at vestibular.org.

Before you see a doctor, make careful notes of when and for how long you feel the dizziness, what provokes it, what makes it worse, and what symptoms accompany it. Expect the doctor to take a detailed history as well as run tests on your hearing and eye movements, which can indicate an inner-ear disturbance. The doctor may also want to do an MRI or CT scan of your head and neck to check for tumors or structural abnormalities. Short of those more severe causes, you might be suffering from one of the following:

-- Benign paroxysmal positional vertigo. One of the most common and correctable forms, BPPV is fleeting and usually occurs when lying down, rolling over in bed, or tipping back your head to look up. It results when calcium carbonate particles detach from an inner ear sac and roll into one of the canals. The granules, loosened by trauma or age, tickle sensory hair follicles to create a false sensation of movement.

Treatment takes about 15 minutes and involves moving your head and body in various positions, known as Epley and Brandt-Daroff maneuvers, to drive the calcium particles out of the canals. A specialist can teach you the moves. Discovered 15 years ago, "it's one of the simplest and most dramatic cures in medicine," says Dr. Robert Baloh, professor of neurology at the University of California at Los Angeles.

-- Meniere's disease. This may be the problem if your vertigo lasts hours at a time and is accompanied by ringing in your ears and hearing loss. Experts figure it has something to do with fluid imbalances in the inner ear and treat it with a diet that avoids salt, sugar, caffeine, and alcohol. They may also prescribe diuretics or injections of the antibiotic Gentamicin into the ear.

-- Inner ear inflammation. Vertigo that comes on suddenly and lasts for days is probably the result of a viral infection. Treatment options include taking an antiviral drug or steroids. Bed rest is appropriate for a few days, but, says Dr. Baloh, "you want to get back to movement so the balance system can readjust."

Other causes are erosion of the bone that covers the inner ear and blocked blood vessels. The former may be corrected surgically by filling in the hole with tissue culled from the skull. Occluded blood vessels in the head and neck are more serious and may also cause headaches, difficulty in speaking, or numbness in a limb. "If this is the case, you need to go to an emergency room immediately," says Dr. Shawn Newlands, associate professor of otolaryngology at the University of Texas Medical Branch in Galveston. Wait, and you risk brain damage. Fortunately, most vertigo isn't so threatening and can be mitigated, if not cured. And you can leave the spinning to kids on carousels.

By Kate Murphy

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