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Ears, Nose, Throat and Health

Vertigo, the room starts to spin

Meniere's Disease Or a Tight Collar?

By Dr. W. Gifford Jones

April 18, 1999

"Am I about to die?" You went to bed in good health. But on awakening you rolled over and suddenly felt the room spinning. It's a terrifying feeling if it's never happened before. The sense of impending doom is vivid. And the feeling you're about to meet your Maker. What causes "vertigo" and how serious is this disorder?

Vertigo may occur suddenly when you stoop over to pick up something. Or the world may start to twirl for no apparent reason. In a second you feel you're on a fast merry-go-round. And it's impossible to stand up without falling down.

How we feel when we move or turn is determined by what happens in the inner ear. There are three canals in each ear, called semicircular canals. These allow motion to be detected in three dimensions.

Each canal is like a bicycle tire with the inner tube filled with a fluid called endolymph. A thin membrane stretches across the inside of the tube and attaches to the inner wall. It's very flexible and easily detects movements of fluid inside the tube. Special hair cells then send signals to the brain.

The mechanics of the inner ear are so fine-tuned that if anything goes haywire, you've got noticeable problems. The result can be like having one drink too many or reeling from the worst alcoholic binge of your life. It's a sensation you never forget.

Several diseases can trigger vertigo. Prosper Meniere, a French physician, first identified Meniere's Disease in 1861.

We're still not certain what causes this disorder. But it's thought to be due to excessive amounts of lymph in the semicircular canals.

Meniere's Disease is a frustrating problem for those afflicted with it. The spinning sensation can strike at any time. Patients have no way of predicting the frequency of attacks. Unlucky ones may be stricken several times a month. Other patients once a year.

Attacks may last from a few minutes to several hours. The symptoms may be increased by a change in position and eased by staying still. Fortunately for some patients symptoms disappear spontaneously but others suffer for years. Patients suffering from an attack of Meniere's Disease usually complain of ringing in the ears and partial loss of hearing.

The hearing loss is usually restricted to one ear and can be severe. In about 15 percent of cases both ears may be affected. Other patients complain of a "fullness" or discomfort in the ear.

Drugs such as Gravol and tranquilizers like Valium can decrease symptoms. And a diuretic (water pill) to control the buildup of lymph can also be helpful.

At times surgery is needed to control attacks. A shunt operation to drain part of the inner ear can ease endolymph pressure. Or surgeons may cut the vestibular part of the eight nerve. These procedures ease the vertigo without affecting hearing.

There are several other causes for vertigo. Vestibular Neuronitis is associated with the sudden onset of vertigo and often vomiting. The only way to ease the spinning is to lay perfectly still.

This attack may last several hours or days leaving the victim still unsteady on his or her feet. And in some cases it may take several months before normal balance returns.

Unlike Meniere's Disease Vestibular Neuronitis involves no hearing loss. Half of those affected reveal further attacks over a period of months to years. The cause is unknown, but doctors suspect infection, since Vestibular Neuronitis often follows a virus infection.

Some people suffer from what is called "Positional Vertigo". The spinning sensation usually occurs when getting out of bed, lasts for a minute or two, and disappears. It occurs only now and then and most authorities agree it requires no treatment.

Men who suffer from vertigo should check the size of their shirt collar! Most men purchase shirts that are too small. Tight collars can cause pressure on the carotid sinus situated in the neck. The result may be either dizziness or black out.

Antibiotics can damage the inner ear, particularly when taken for long periods of time. Streptomycin is the primary antibiotic linked to this problem.

The symptoms are loss of hearing, ringing in the ears or unsteadiness when walking. Further injury to the ear can be stopped by discontinuing the antibiotic.

Repeated infections of the eardrum can stimulate cells to grow into the inner ear. These growths, known as (a cholesteatoma) cause balance problems and can be surgically removed.

Normally, when you're not moving and your world starts spinning it's not a life-threatening problem. But always see your doctor. On occasion vertigo may be due to a brain tumour or other rare conditions.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod