Dysfunction in more than one of
these systems or in the brain itself may cause loss of balance or
dizziness. The elderly often have dizziness due to poor blood flow
to the brain, hypotension (low blood pressure often from high blood
pressure medications), poor proprioception and poor vision.
Dizziness: There are
many types of dizziness, and only a few of these actually come from the
inner ear. When patients state they are dizzy, they usually are
referring to one of three different types of symptoms:
A loss of control or
staggering like being drunk, but the room orientation is normal. The
patient just cannot control his body.
A light-headedness or fainting.
A sensation of motion or
Of these symptoms, only the
sensation of motion or spinning is characteristic of
disease. This type of dizziness is
called vertigo. A loss of control or staggering with normal room
orientation can be found with some brain tumors and also drug use. A
light-headedness or fainting is usually found in nervous conditions but can
also be a symptom of cardiovascular conditions or even a brain tumor.
patients have a difficult time describing their dizziness. Up to 33% of
patients with nystagmus (eyes spinning or jerking back and forward) use
the terms "swimmy head" and "light-headedness" to
describe vertigo or a spinning sensation. An electronystagmogram is
helpful in determining if a patient has vertigo or dizziness from the
The two most important features
of vertigo is its duration and if it is caused by a change in body
position. Vertigo which is caused by a change in position usually
lasting less than one minute. If
caused by the
inner ear, it may be treated by a particle repositioning maneuver.
The dizziness is felt to be caused by bone debris (otoconia
dislodged from the
macula of the
entering the posterior semicircular canal. A maneuver can be used to
reposition this debris and relieve the patient's symptoms. In
one study 76% of patients with benign positional vertigo improved as
compared to 48% of the untreated group.
The posterior canal is the most dependent, thus, otoconia
usually enter it
and cause the dizziness.
rarely, otoconia can fall into the horizontal canal. If this happens
a different maneuver may have to be performed.
Positional vertigo may also be caused by brain abnormalities or tumors.
This is particularly true if it lasts a long time after the eliciting
Vertigo lasting from 30 min. to
24 hrs. is often caused by
Meniere's Disease. This is a triad of ear
ringing, hearing loss and vertigo. Often there is pressure in the
ear with the spell. It usually affects only one ear but in 5% of
cases may be bilateral. 70% of patients can be controlled with a low
salt diet and diuretic (water pill).
is caused by
too much pressure in the fluids (endolymph) of the
temporal bone anatomy section. There are many
possible causes of
but none are universally
accepted. Theses causes include: Autoimmune,
allergy viral, head trauma and exposure to toxins. There is now
creditable evidence that loud sounds or acoustic trauma does NOT cause
Meniere's disease --
A variety of different
treatments are available for
Meniere's Disease. Initially, a low
salt (Sodium Chloride) diet with avoidance of caffeine alcohol and tobacco
may be tried. If this fails diuretic therapy will help most
patients. Patients who still have severe vertigo despite these
conservative measures, may be offered one of a number of surgical
procedures. Results are hard to judge because any treatment for
even placebo has a 60% chance of improvement. One
of the newer treatments is intratympanic injection of gentamicin. View
Abstract of Review Article In
this procedure an
drug (a drug which damages the
gentamicin, is injected through the eardrum, into the
This treatment has been gaining wider acceptance and can be performed in
the surgeon's office. Complete control of vertigo has been reported
in up to 90% of patients with worsening of hearing in about 25% of
View Abstract Perez et.
al. reported control of vertigo in 83% of patients
and hearing loss (two years after treatment) due to
gentamicin in 15.5% of the treated patients.
View Abstract Intratympanic
) injection of steroids for the treatment of Meniere's disease is
controversial with some studies showing no long term benefit of the
Another technique is the use of transtympanic
micropressure. This is a new techinque which has not been
extensively studied but initial results appear promising (Gates 2004)
Vertigo lasting from 24 hrs. to
one week is often caused by viral labrynthitis. The patient seldom
has hearing loss and recovers slowly over the course of one
week. Although sometimes it may take up to one month to recover.
Vertigo lasting greater than one
week is often caused by a dysfunction in the central nervous system, or a brain condition, such as a tumor.
Caused by Changes in Position
Paroxysmal Positional Vertigo
Many cases of vertigo can be diagnosed by
the above table. However, there are many causes of vertigo
and all can mimic central or a brain condition, many of which are
serious. A consultation with a doctor is important to properly
diagnosis and treat dizziness.
Cocculus Indicus 6CH is a climbing flowering plant which has been purported
to help vertigo. The fruit of the plat produces picrotoxin a
poisonous crystalline plant alkaloid which has a neurotransmitter
stimulatory effect. The only study regarding Cocculus Indicus
6CH on Pub Med (as of 2/1/2008) was a study by Lucertini M et al.
The report was unable to demonstrate in a double-blind study that Cocculus
Indicus helped in reducing flight simulator sickness.
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