10 Things to Know About Vertigo

Ever tilted your head back–and suddenly found the world spinning around you?

You likely had an episode of vertigo, which is a common but frightening experience, especially the first time it strikes. One minute you are fine, and the next you feel scarily out of control, caught in a whirling that won’t stop.

What is vertigo, what can cause it, and what can you do about it? Here are 10 things you need to know.

1. Vertigo is not the same thing as dizziness.

Vertigo is an illusion of motion: You feel like the room is spinning around you or that you are whirling. You also may experience nausea and vomiting.

Dizziness is marked by lightheadedness or loss of balance.

2. Vertigo is common, especially as you get older.

You can get vertigo at any age, but usually not before age 20. As you get older, you are more likely to experience the condition. Among people older than 65, about 30% experience vertigo at some point.

3. Vertigo is usually caused by medical conditions that disrupt our inner ear.

Our sense of balance is directed by our vestibular system, which is located in our inner ears. Sometimes, medical conditions occur that disrupt this system. The result: vertigo.

Medical conditions that cause vertigo include:

• Benign paroxysmal positional vertigo (BPPV): the most common cause of vertigo, typically associated with a sudden change in the position of your head

• Labyrnthitis: an inflammation of the inner ear

• Meniere’s disease: a disorder in which fluid builds up in the inner ear

• Vestibular neuritis: an infection of the nerves connecting the inner ear to the brain

• Vestibular migraines

• Colds

• Stroke

• Multiple sclerosis

• Head injury

4. Riding your bike on a rough trail or doing high-intensity aerobics can bring on vertigo.

Other triggers include having your head in one position for a long time, like at the dentist’s office or hair salon, or while on bed rest.

Some people even get brief episodes of vertigo from playing 3D video games.

5. Vertigo can be either acute or chronic.

Some people experience vertigo once and never again. Other people have chronic, recurring episodes of vertigo.

Often vertigo goes away on its own. If it doesn’t, it can be treated either by your general practitioner or by specialists, such as neurologists or ENT (ear, nose and throat) doctors.

6. Exercises can help treat some types of vertigo.

Benign paroxysmal positional vertigo (BPPV) is caused by tiny calcium crystals breaking free in your inner ear chamber. Doctors can use a series of exercises to move these particles so that they no longer cause problems. About 70 to 80% of BPPV sufferers are cured in a single visit.

Other kinds of exercises can help other types of vertigo. Vestibular rehabilitation exercises help people whose inner ears have been damaged by retraining the brain’s balance system. Common exercises include moving your eyes from side to side and rotating your head. Tai chi also is helpful for people with vestibular disorders.

7. Some types of vertigo can be treated surgically.

Surgery isn’t typically done unless more conservative measures have failed to work. However, it can be effective for some conditions, such as Meniere’s disease.

BPPV also can be addressed surgically for patients who don’t respond to particle positioning exercises. The procedure carries the risk of hearing loss.

8. Medications are generally used for acute, not chronic, cases of vertigo.

Medications can help treat and prevent vertigo, depending on what is causing your symptoms. For example, if your vertigo is caused by vestibular migraine, you may receive medications to prevent the migraine from occurring.

Other kinds of vestibular suppressant drugs can help during sudden, temporary attacks of vertigo, but generally are not used for chronic conditions.

9. Your diet can make a difference.

If you have chronic vertigo, particularly due to vestibular migraine or Meniere’s disease, avoiding caffeine, nicotine, alcohol, salt and sugar can help, as well as eating and drinking regularly throughout the day to maintain a good fluid balance. People who have vestibular migraine also should avoid common migraine triggers (such as foods containing the amino acid tyramine).

10. If vertigo is accompanied by other symptoms, seek ER help.

If your vertigo recurs for more than a week, see your doctor. But if you also have other symptoms, like a severe new headache, fever, vision problems, trouble speaking, hearing loss, leg or arm weakness, or loss of consciousness, seek emergency help.

BPPV & Vertigo Symptoms | When to See a Doctor for Dizziness

Dizziness is a feeling of lightheadedness or even a feeling that you could fall or pass out. Dizziness is often temporary for most people, but in more severe instances, it can be accompanied by nausea, vomiting, clamminess or cold sweat, imbalance, and fainting.

While not a medical condition on its own, dizziness and dizzy spells can be symptoms that result from many factors, ranging from relatively harmless to life threatening. Either way, dizziness—especially when combined with other symptoms—should never be taken lightly.

Common Causes of Dizziness

In many cases, dizziness occurs due to a temporary situation or condition. Once the root cause is treated, the dizziness also goes away. Some common causes of temporary dizziness include:

Many different medications, including antidepressants, high blood pressure medicines, and sedatives also can cause dizziness. If you take medications, look at the drug information label for known side effects, and tell your doctor about the dizziness. Your doctor can help determine if one or more of your medications could be the cause.

If you have been diagnosed with a chronic condition such as anemia or diabetes, tell your doctor about dizzy spells so you can adjust your lifestyle or treatment as needed. If you do not have a current diagnosis and experience dizziness, see your doctor to determine if it’s related to an underlying condition.

Dizziness Treatment at Home

Treating less severe dizziness focuses on stopping the sensation of feeling unbalanced or lightheaded. Some of the following tactics can reduce dizzy spells and help pinpoint the severity of the dizziness:

If dizziness persists or gets worse, or is accompanied by additional symptoms, seek immediate care (call 911).

When Dizziness Could Be Signaling an Emergency

In some cases, dizziness can be caused by more serious, life-threatening conditions like heart attack or stroke. Call 911 immediately if your dizziness is associated with:

In temporary cases of dizziness, your primary care provider can evaluate your symptoms with your medical history to determine if you may have an underlying chronic condition. Depending on your diagnosis, your doctor may refer you to a specialist, such as an ENT (ear, nose, throat) doctor, endocrinologist, cardiologist, or hematologist. In urgent and emergency care situations, such as dizziness with other heart attack or stroke symptoms, an emergency doctor will treat your acute condition, then refer you to an appropriate specialist for further treatment.

Dizzy spells are a common physical experience for many people. By knowing when dizzy spells could signal a chronic or emergency condition, you can take prompt action and find effective—possibly life-saving—treatment.

Antivert vs. Bonine Treatment for Vertigo, Motion Sickness: Differences and Side Effects

All drug information provided on RxList.com is sourced directly from drug monographs published by the U.S. Food and Drug Administration (FDA).

Any drug information published on RxList.com regarding general drug information, drug side effects, drug usage, dosage, and more are sourced from the original drug documentation found in its FDA drug monograph.

Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. The drug comparison information found in this article does not contain any data from clinical trials with human participants or animals performed by any of the drug manufacturers comparing the drugs.

The drug comparisons information provided does not cover every potential use, warning, drug interaction, side effect, or adverse or allergic reaction. RxList.com assumes no responsibility for any healthcare administered to a person based on the information found on this site.

As drug information can and will change at any time, RxList.com makes every effort to update its drug information. Due to the time-sensitive nature of drug information, RxList.com makes no guarantees that the information provided is the most current.

Any missing drug warnings or information does not in any way guarantee the safety, effectiveness, or the lack of adverse effects of any drug. The drug information provided is intended for reference only and should not be used as a substitute for medical advice.

If you have specific questions regarding a drug’s safety, side effects, usage, warnings, etc., you should contact your doctor or pharmacist, or refer to the individual drug monograph details found on the FDA.gov or RxList.com websites for more information.

You may also report negative side effects of prescription drugs to the FDA by visiting the FDA MedWatch website or calling 1-800-FDA-1088.

References

SOURCES:

Dailymed. Antivert Product Information.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4a5d81fc-ad25-4c3f-a91c-93fe334c02e5

Dailymed. Bonine Product Information.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b4b55cd-063e-4d0e-911c-8e03886e15d3&audience=consumer

Dizziness | Beacon Health System

Overview

Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady. Dizziness that creates the false sense that you or your surroundings are spinning or moving is called vertigo.

Dizziness is one of the more common reasons adults visit their doctors. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition.

Treatment of dizziness depends on the cause and your symptoms. It’s usually effective, but the problem may recur.

Symptoms

People experiencing dizziness may describe it as any of a number of sensations, such as:

• A false sense of motion or spinning (vertigo)
• Lightheadedness or feeling faint
• Unsteadiness or a loss of balance
• A feeling of floating, wooziness or heavy-headedness

These feelings may be triggered or worsened by walking, standing up or moving your head. Your dizziness may be accompanied by nausea or be so sudden or severe that you need to sit or lie down. The episode may last seconds or days and may recur.

When to see a doctor

Generally, see your doctor if you experience any recurrent, sudden, severe, or prolonged and unexplained dizziness or vertigo.

Get emergency medical care if you experience new, severe dizziness or vertigo along with any of the following:

• Sudden, severe headache
• Chest pain
• Difficulty breathing
• Numbness or paralysis of arms or legs
• Fainting
• Double vision
• Rapid or irregular heartbeat
• Confusion or slurred speech
• Stumbling or difficulty walking
• Ongoing vomiting
• Seizures
• A sudden change in hearing
• Facial numbness or weakness

Causes

Dizziness has many possible causes, including inner ear disturbance, motion sickness and medication effects. Sometimes it’s caused by an underlying health condition, such as poor circulation, infection or injury.

The way dizziness makes you feel and your triggers provide clues for possible causes. How long the dizziness lasts and any other symptoms you have also help pinpoint the cause.

Inner ear problems that cause dizziness (vertigo)

Your sense of balance depends on the combined input from the various parts of your sensory system. These include your:

• Eyes, which help you determine where your body is in space and how it’s moving
• Sensory nerves, which send messages to your brain about body movements and positions
• Inner ear, which houses sensors that help detect gravity and back-and-forth motion

Vertigo is the false sense that your surroundings are spinning or moving. With inner ear disorders, your brain receives signals from the inner ear that aren’t consistent with what your eyes and sensory nerves are receiving. Vertigo is what results as your brain works to sort out the confusion.

• Benign paroxysmal positional vertigo (BPPV). This condition causes an intense and brief but false sense that you’re spinning or moving. These episodes are triggered by a rapid change in head movement, such as when you turn over in bed, sit up or experience a blow to the head. BPPV is the most common cause of vertigo.
• Infection. A viral infection of the vestibular nerve, called vestibular neuritis, can cause intense, constant vertigo. If you also have sudden hearing loss, you may have labyrinthitis.
• Meniere’s disease. This disease involves the excessive buildup of fluid in your inner ear. It’s characterized by sudden episodes of vertigo lasting as long as several hours. You may also experience fluctuating hearing loss, ringing in the ear and the feeling of a plugged ear.
• Migraine. People who experience migraines may have episodes of vertigo or other types of dizziness even when they’re not having a severe headache. Such vertigo episodes can last minutes to hours and may be associated with headache as well as light and noise sensitivity.

Circulation problems that cause dizziness

You may feel dizzy, faint or off balance if your heart isn’t pumping enough blood to your brain. Causes include:

• Drop in blood pressure. A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in brief lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly. This condition is also called orthostatic hypotension.
• Poor blood circulation. Conditions such as cardiomyopathy, heart attack, heart arrhythmia and transient ischemic attack could cause dizziness. And a decrease in blood volume may cause inadequate blood flow to your brain or inner ear.

Other causes of dizziness

• Neurological conditions. Some neurological disorders — such as Parkinson’s disease and multiple sclerosis — can lead to progressive loss of balance.
• Medications. Dizziness can be a side effect of certain medications — such as anti-seizure drugs, antidepressants, sedatives and tranquilizers. In particular, blood pressure lowering medications may cause faintness if they lower your blood pressure too much.
• Anxiety disorders. Certain anxiety disorders may cause lightheadedness or a woozy feeling often referred to as dizziness. These include panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia).
• Low iron levels (anemia). Other signs and symptoms that may occur along with dizziness if you have anemia include fatigue, weakness and pale skin.
• Low blood sugar (hypoglycemia). This condition generally occurs in people with diabetes who use insulin. Dizziness (lightheadedness) may be accompanied by sweating and anxiety.
• Carbon monoxide poisoning. Symptoms of carbon monoxide poisoning are often described as “flu-like” and include headache, dizziness, weakness, upset stomach, vomiting, chest pain and confusion.
• Overheating and dehydration. If you’re active in hot weather or if you don’t drink enough fluids, you may feel dizzy from overheating (hyperthermia) or from dehydration. This is especially true if you take certain heart medications.

Risk factors

Factors that may increase your risk of getting dizzy include:

• Age. Older adults are more likely to have medical conditions that cause dizziness, especially a sense of imbalance. They’re also more likely to take medications that can cause dizziness.
• A past episode of dizziness. If you’ve experienced dizziness before, you’re more likely to get dizzy in the future.

Complications

Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident. You may also experience long-term consequences if an existing health condition that may be causing your dizziness goes untreated.

Diagnosis

If your doctor suspects you are having or may have had a stroke, are older or suffered a blow to the head, he or she may immediately order an MRI or CT scan.

Most people visiting their doctor because of dizziness will first be asked about their symptoms and medications and then be given a physical examination. During this exam, your doctor will check how you walk and maintain your balance and how the major nerves of your central nervous system are working.

You may also need a hearing test and balance tests, including:

• Eye movement testing. Your doctor may watch the path of your eyes when you track a moving object. And you may be given an eye motion test in which water or air is placed in your ear canal.
• Head movement testing. If your doctor suspects your vertigo is caused by benign paroxysmal positional vertigo, he or she may do a simple head movement test called the Dix-Hallpike maneuver to verify the diagnosis.
• Posturography. This test tells your doctor which parts of the balance system you rely on the most and which parts may be giving you problems. You stand in your bare feet on a platform and try to keep your balance under various conditions.
• Rotary chair testing. During this test you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.

In addition, you may be given blood tests to check for infection and other tests to check heart and blood vessel health.

Treatment

Dizziness often gets better without treatment. Within a couple of weeks, the body usually adapts to whatever is causing it.

If you seek treatment, your doctor will base it on the cause of your condition and your symptoms. It may include medications and balance exercises. Even if no cause is found or if your dizziness persists, prescription drugs and other treatments may make your symptoms more manageable.

Medications

• Water pills. If you have Meniere’s disease, your doctor may prescribe a water pill (diuretic). This along with a low-salt diet may help reduce how often you have dizziness episodes.
• Medications that relieve dizziness and nausea. Your doctor may prescribe drugs to provide immediate relief from vertigo, dizziness and nausea, including prescription antihistamines and anticholinergics. Many of these drugs cause drowsiness.
• Anti-anxiety medications. Diazepam (Valium) and alprazolam (Xanax) are in a class of drugs called benzodiazepines, which may cause addiction. They may also cause drowsiness.
• Preventive medicine for migraine. Certain medicines may help prevent migraine attacks.

Therapy

• Head position maneuvers. A technique called canalith repositioning (or Epley maneuver) usually helps resolve benign paroxysmal positional vertigo more quickly than simply waiting for your dizziness to go away. It can be done by your doctor, an audiologist or a physical therapist and involves maneuvering the position of your head. It’s usually effective after one or two treatments. Before undergoing this procedure, tell your care provider if you have a neck or back condition, a detached retina, or blood vessel problems.
• Balance therapy. You may learn specific exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.
• Psychotherapy. This type of therapy may help people whose dizziness is caused by anxiety disorders.

Surgical or other procedures

• Injections. Your doctor may inject your inner ear with the antibiotic gentamicin to disable the balance function. The unaffected ear takes over that function.
• Removal of the inner ear sense organ. A procedure that’s rarely used is called labyrinthectomy. It disables the vestibular labyrinth in the affected ear. The other ear takes over the balance function. This technique may be used if you have serious hearing loss and your dizziness hasn’t responded to other treatments.

Lifestyle and home remedies

If you tend to experience repeated episodes of dizziness, consider these tips:

• Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
• Avoid moving suddenly and walk with a cane for stability, if needed.
• Fall-proof your home by removing tripping hazards such as area rugs and exposed electrical cords. Use nonslip mats on your bath and shower floors. Use good lighting.
• Sit or lie down immediately when you feel dizzy. Lie still with your eyes closed in a darkened room if you’re experiencing a severe episode of vertigo.
• Avoid driving a car or operating heavy machinery if you experience frequent dizziness without warning.
• Avoid using caffeine, alcohol, salt and tobacco. Excessive use of these substances can worsen your signs and symptoms.
• Drink enough fluids, eat a healthy diet, get enough sleep and avoid stress.
• If your dizziness is caused by a medication, talk with your doctor about discontinuing it or lowering the dose.
• If your dizziness comes with nausea, try an over-the-counter (nonprescription) antihistamine, such as meclizine or dimenhydrinate (Dramamine). These may cause drowsiness. Nondrowsy antihistamines aren’t as effective.
• If your dizziness is caused by overheating or dehydration, rest in a cool place and drink water or a sports drink (Gatorade, Powerade, others).

Preparing for an appointment

Your family doctor or primary care provider will probably be able to diagnose and treat the cause of your dizziness. He or she you may refer you to an ear, nose and throat (ENT) specialist or a doctor who specializes in the brain and nervous system (neurologist).

Here’s some information to help you get ready for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet. If you’re scheduled for vestibular testing, your doctor will provide instructions regarding any medications to withhold the night before and what to eat on the day of testing.
• Be prepared to describe your dizziness in specific terms. When you have an episode of dizziness, do you feel like the room is spinning, or like you are spinning in the room? Do you feel like you might pass out? Your description of these symptoms is crucial to helping your doctor make a diagnosis.
• List any other health conditions or symptoms you have, including any that may seem unrelated to your dizziness. For example, if you have felt depressed or anxious recently, this is important information for your doctor.
• List key personal information, including any major stresses or recent life changes.
• Make a list of all prescription and over-the-counter medications, vitamins or supplements that you’re taking.
• List questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For dizziness, some basic questions to ask your doctor include:

• What’s the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What tests do you recommend?
• Is this problem likely temporary or long lasting?
• Is it possible my symptoms will go away without treatment?
• What treatment options might help?
• Do I need to follow any restrictions? For example, is it safe for me to drive?
• Should I see a specialist?
• Is there a generic alternative to the medicine you’re prescribing?
• Do you have any brochures or other printed material that I can take home with me? What websites do you recommend?

What to expect from your doctor

Your doctor will likely ask you a number of questions about your dizziness, such as:

• Can you describe what you felt the first time you had an episode of dizziness?
• Is your dizziness continuous, or does it occur in spells or episodes?
• If your dizziness occurs in episodes, how long do these episodes last?
• How often do your dizziness episodes occur?
• When do your dizzy spells seem to happen, and what triggers them?
• Does your dizziness cause the room to spin or produce a sensation of motion?
• When you feel dizzy, do you also feel faint or lightheaded?
• Does your dizziness cause you to lose your balance?
• Are your symptoms accompanied by a ringing or fullness in your ears (tinnitus) or trouble hearing?
• Does your vision blur?
• Is your dizziness made worse by moving your head?
• What medications, vitamins or supplements are you taking?

What you can do in the meantime

If you tend to feel lightheaded when you stand up, take your time making changes in posture. If you have had episodes of dizziness while driving, arrange for alternate transportation while you’re waiting to see your doctor.

If your dizziness causes you to feel like you might fall, take steps to reduce your risk. Keep your home well lighted and free of hazards that might cause you to trip. Avoid area rugs and exposed electrical cords. Place furniture where you’re unlikely to bump into it, and use nonslip mats in the bathtub and on shower floors.

Last Updated: October 15th, 2020

Hearing Problems, Dizziness, and Ototoxicity – Managing Side Effects

Includes: Dizziness,
hearing loss,
ototoxicity, tinnitus (ringing
in the ears)

What Is Dizziness?

Dizziness is a term used to describe when you feel “woozy” or “faint.”
Vertigo is a word used to describe the feeling that the room is spinning around
you.

• When people experience dizziness, it may be a sign that the balance mechanism in
  your inner ear is not working properly.
• Some dizziness and hearing loss are due to chemotherapy.
  Many medications, treatments, and diseases can cause dizziness. It may also be a
  result of injury to your ear.
• Some causes of dizziness may include:
  • If you are dehydrated and change positions. This is a result of low blood pressure.
    Your healthcare provider may check your vital signs (including your blood pressure
    and heart rate) while lying down, sitting up, and standing, to help in determining
    this.
  • Stress, tiredness, fever, fatigue, anemia, heart problems, or stroke may cause dizziness.
  • You may feel dizzy if you are depressed, or if you are breathing really hard and
    fast (hyperventilating).
  • Inflammation of your inner ear, caused by infection.
  • Infections in your brain and central nervous system.
  • Meniere’s disease (an inner ear disease). Meniere’s disease is a disorder where
    patients experience dizziness, tinnitus, and hearing loss, sometimes due to chemotherapy.
  • Certain tumors may cause dizziness, such as brain tumors, and a tumor found in the
    auditory (hearing) canal of the ear, called a vestibular schwannoma. A schwannoma
    is a benign tumor. (The word “benign” refers to a medical condition that is not
    immediately life threatening. It may progress and symptoms could become worse).
  • Ototoxicity is something that occurs after you have received medications that have
    caused you to lose your hearing, or feel dizzy. Ototoxicity following the
    use of certain medications may be due to a long-term exposure to damaging drugs.
    Your risk for developing ototoxicity increases as the drug accumulates in your body.
  • Ototoxicity may also come from receiving high doses an ototoxic drug at one time,
    which may damage certain cells in your inner ear. The hearing loss you experience
    as a result of medications may be irreversible.

Dizziness Symptoms:

• Most people notice dizziness when they change positions, or move their heads.
• You might feel like the room is spinning around you, or that you are spinning. Some
  people describe dizziness, as feeling a bit “woozy.” Severe dizziness is the
  fear that you may fall down when you stand up.
• Some people may lose their hearing, or their vision, which may be accompanied by
  dizziness.
• Nausea, ringing in the ears, and vomiting may be associated with dizziness.
• Severe vomiting over a long period of time may cause you to feel dizzy.
• Dizziness may be a symptom or sign of a serious problem. Notify your doctor if you
  experience any of the symptoms mentioned here.

How Is Dizziness Diagnosed?

• Usually, your healthcare provider will first take a complete health history from
  you. They will then examine your neurological system through conducting a physical
  exam in their office. This may include looking in your eyes, watching you stand
  or walk, and testing your strength. He or she will also look inside your ear, to
  see if there is an infection.
• To distinguish vertigo from dizziness, your healthcare provider may turn your head
  in different positions, usually from a sitting position, to a lying position, and
  back again, as they try to elicit the same symptoms that you are describing.
• Your healthcare provider may suggest that you have x-rays, an MRI, or a CAT scan
  of your head. You may also be referred to a Neurologist, who specializes in dizziness
  disorders.
• Your healthcare provider may order some blood work to be drawn. The blood work will
  show many things, including if you have anemia, your blood electrolytes (such as
  sodium, and kidney function) or it may suggest that you are dehydrated, as a cause
  of your dizziness.

Things You Can Do to Minimize or Prevent Dizziness:

• It is important to notify your healthcare provider if you notice any dizziness,
  or any change in the pattern of dizziness you are experiencing. Also, notify
  your healthcare provider if you have any loss of vision, hearing, or if your symptoms
  become more severe, and do not improve.
• Drink 2-3 liters of fluid per day to prevent dehydration. This may include fruit
  juices, water, non-caffeinated sodas and coffee, and non-alcoholic beverages. Alcohol
  and caffeine may cause dehydration, so these should be avoided. Always carry a “sipper”
  cup with you, filled with your favorite drinks.
• Change positions slowly. Allow your body a chance to adapt to the position change.
  For some people, lying down until the dizzy episode passes may be the best solution.
  
  
  * With moderate dizziness, walk slowly and often. Walk with assistance if the dizziness
  is severe.
• If you have vertigo, your doctor or a trained therapist may teach you exercises,
  called “vestibular exercises,” to try to get rid of your dizziness. These exercises
  involve you sitting down, and changing into different positions. This may cause
  you to be dizzier at first, while you are performing these movements, but should
  help to correct the vertigo. You may expect improvement in 2-6 months.
• If you have Meniere’s disease, your doctor or healthcare
  provider may tell you to limit the amount of salt you eat in a day, and prescribe
  anti-nausea or anti-vertigo medications, along with a medication to help your body
  rid itself of salt and fluids (a diuretic). The goal is to decrease the pressure
  of your inner ear, in an effort to control the vertigo.
• Depending on the cause of dizziness, it may last a few days to a few months. It
  is important to follow all the instructions your healthcare provides.
• If your dizziness is a result of medications you have taken in the past, it is important
  to avoid these in the future, if possible. Be sure that you tell each of your health
  care providers about all of the medicines you are taking, including over-the-counter
  medications, vitamins, and herbal remedies. It is important to avoid the use of
  drugs that may cause further damage the cells in your ear.
• Make sure to keep all appointments.
• Do not share your medications with anyone.

Drugs That May Be Prescribed By Your Doctor:

There are many drugs that can be used to treat dizziness. These may include:

• Meclizine (Antivert^®), dimenhydrinate (Dramamine^®), or the scopolamine patch (Transderm-Scop^®).
  These medications may help to decrease the feelings of unsteadiness or imbalance
  that you may be feeling.
• Prochlorperazine (Compazine^®), and promethazine
  (Phenergan^®), may work by preventing a feeling
  of dizziness, or by preventing nausea and vomiting that may cause dizziness.
• These are just some of the most commonly used drugs. Your healthcare provider may
  prescribe others.

If you believe you are suffering from dizziness or hearing loss due to
chemotherapy, the following guidelines suggest when to call your doctor or
health care provider:

• If you develop any sudden severe ear pain.
• If you have a temperature greater than 100.5 F (38 C).
• If you experience vomiting more than 4-5 times in a 24 hour period.
• If you have a sudden loss of vision, or if you lose your hearing.
• If you fall down, or lose consciousness as a result of your dizziness.
• Severe, uncontrolled nausea and vomiting, unrelieved by anti-nausea medications.
• If your symptoms worsen within 3 days of treatment.
• As always, notify your doctor or healthcare provider if you are concerned about
  any of the symptoms you are experiencing.

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

What Is Hearing Loss?

• Hearing loss occurs as a result of many different things. Hearing loss may be associated
  with age, or as a result of certain chemotherapy treatments
  or medications. By the age of 75, many have some sort of hearing loss.
• Many diseases can cause hearing loss. This includes Meniere’s disease, an inner
  ear disease.
• There are many different types of hearing loss. They may include:
  • Presbycusis – This is a word that means “hearing loss.” This is
    the normal loss of hearing and sound detection that comes with age. If you have
    presbycusis, it becomes harder to hear people if there is background noise. High-pitched
    sounds also become “muffled.”
  • Sensory hearing loss – occurs when there is a more central problem.
    Certain diseases, infections, or damage to the cells that help you to hear sounds
    may cause this.
  • Conduction hearing loss – occurs as a result of a blockage in your
    ear. This may be from earwax, infection, a foreign body, or tumor. This can be resolved
    by treating the cause of the hearing loss.

Common Medications That Cause Hearing Loss:

• Cisplatin chemotherapy
• Diuretics or “water pills” such as furosemide (Lasix^®),
  in high doses.
• Antibiotics, such as gentamycin, tobramycin or streptomycin.
• Ototoxicity is something that occurs after you have received medications that have
  caused you to lose your hearing, or feel dizzy. Ototoxicity following the
  use of certain medications may be due to a long-term exposure to these drugs. Your
  risk for developing ototoxicity increases as the drug
  accumulates in your body.
• Ototoxicity may also come from receiving high doses of an ototoxic drug at one time,
  which may damage certain cells in your inner ear. The hearing loss you experience
  as a result of medications may be irreversible.

Hearing Loss Symptoms:

• Most people notice that sounds are muffled or not as loud.
• Most types of hearing loss are progressive, and painless. It may be noticed on one
  side of your head, or both.
• There are some hereditary or family related causes of hearing loss. Know if hearing
  loss runs in your family.
• Some people may experience dizziness with a trouble hearing.
• Nausea, vomiting, dizziness and tinnitus (ringing in the ears), may be associated
  with hearing loss in some diseases.
• Hearing loss may be a symptom or sign of a serious problem. Notify your doctor if
  you experience any of the symptoms mentioned here.

How Is Hearing Loss Diagnosed?

• Your healthcare provider will usually, at first, take a complete health history
  from you. They will conduct a physical exam in their office. They will also look
  inside your inner ear, to see if there is an infection.
• With certain types of hearing loss, your healthcare provider may suggest that you
  see an audiologist, a professional who diagnoses, treats, and manages
  individuals with hearing loss or balance problems.
• A hearing test may be performed, to see if you have problems hearing at different
  levels or pitches (frequencies) of sound. Some people cannot hear high or low-pitched
  sounds, but may hear normal tones without any problem.

Things You Can Do To Minimise Hearing Loss:

• It is important to notify your healthcare provider if you notice any change in the
  hearing loss you are experiencing. Also, notify your healthcare provider if
  you have any loss of vision, dizziness, or if your symptoms become more severe,
  and do not improve.
• If your hearing loss is caused by a build-up of wax, there are many over the counter
  eardrops available for you to use. Discuss this with your healthcare provider.
• Tell people that you have trouble hearing sounds. Discuss ways for them to speak,
  so you can hear them more clearly. Some suggestions include:
  • Tell them to speak slowly, and clearly, and not to shout. Shouting creates high-pitched
    sounds that could make it harder for you to hear what they are saying.
  • Encourage the use of gestures, if you find it helpful.
  • Many people have trouble hearing consonants. Tell them to enunciate, or pronounce
    their words more slowly and clearly.
  • With severe hearing loss, lip reading and sign language may be helpful.
• Depending on the cause of your hearing loss, hearing aids may be useful to better
  your hearing. Hearing aids use an amplifier to pick up sound, and help to make sounds
  clearer. There are many forms of hearing aids available today. Seek assistance from
  a hearing aid specialist, who will help you to select the best kind of hearing aid,
  to suit your needs.
• Even with hearing aids, it may still be difficult for you to understand what people
  are saying to you. If you do not understand someone who is speaking to you, ask
  him or her to clarify what is being said. Tell them what parts of the sentence you
  were able to understand.
• If you have Meniere’s disease, your doctor or healthcare provider may tell you to
  limit the amount of salt you eat in a day, and prescribe anti-nausea or anti-vertigo
  medications, along with a medication to help your body rid itself of salt and fluids.
  The goal is to decrease the pressure of your inner ear, and to control the dizziness
  you may be experiencing, in addition to the hearing loss.
• It is important to follow all the instructions your healthcare provides.
• Make sure to keep all appointments.
• Do not share your medications with anyone.

Drugs That May Be Prescribed By Your Doctor:

• There are few drugs that specifically treat hearing loss, if it is a result of aging,
  or due to damaged hearing cells in your ear. However, if there is a conductive hearing
  loss, antibiotics may be prescribed to treat an infection that may be blocking the
  transmission of sound to your ear.
• If your hearing loss is a result of drugs or medicines that you have received in
  the past, it is important to avoid these in the future, if possible. Be sure that
  you tell each of your health care providers about all of the medicines you are taking,
  including over-the-counter medications, vitamins, and herbal remedies. It is important
  to avoid the use of drugs that may cause further damage the cells in your ear.

If you believe you are suffering from hearing loss due to chemotherapy,
the following guidelines discuss when to call your doctor or health care
provider:

• If you develop any sudden severe ear pain.
• If you have a temperature greater than 100.5 F (38 C).
• If you experience vomiting more than 4-5 times in a 24 hour period.
• If you have a sudden loss of vision, or if you lose your hearing.
• If you fall down, or lose consciousness as a result of dizziness or hearing loss.
• Severe, uncontrolled nausea and vomiting, unrelieved by anti-nausea medications.
• If your symptoms worsen within 3 days of treatment.
• As always, notify your doctor or healthcare provider if you are concerned about
  any of the symptoms you are experiencing.

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

What Is Ototoxicity?

• Ototoxicity occurs most often, after you have received medications that have caused
  you to lose your hearing, or feel dizzy.
• Ototoxic medications are drugs that can cause damage to the inner ear, and result
  in temporary or permanent loss of hearing. It may also cause your loss of hearing
  to become worse.
• Some common medications that cause ototoxicity, if given in high doses may include:
  • Cisplatin, and other types of chemotherapy
  • High doses of salicylates, such as aspirin
  • Non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen sodium
  • Diuretics or “water pills,” such as furosemide (Lasix^®)
  • Antibiotics, such as Erythromycin, Gentamycin, Tobramycin or Streptomycin.
• Ototoxicity following medications may be due to a long-term exposure to these drugs.
  Your risk for developing ototoxicity increases as the
  drug accumulates in your body.
• It may also come from giving high doses of the drug at a time, which may damage
  certain cells in your inner ear. The hearing loss you may experience as a result
  of medications may be irreversible.
• When people experience dizziness as a result of ototoxicity from medications, it
  may be a sign that the balance mechanism in your inner ear is not working properly,
  or has been damaged.
• The first sign of ototoxicity may be dizziness. Some other causes of dizziness
  may include:
  • You may feel dizzy when you are dehydrated, and you change positions. This is a
    result of low blood pressure. Your healthcare provider may check your vital signs
    while lying down, sitting up, and standing, if you are dizzy, and seek medical care.
  • Stress, tiredness, fever, fatigue, anemia, heart problems, or stroke may cause dizziness.
  • You may feel dizzy if you are depressed, or if you are breathing really hard
    and fast (hyperventilating).
  • Inflammation of your inner ear, caused by infection.
  • Infections in your brain and central nervous system.
  • Meniere’s disease, an inner ear disease. Meniere’s disease is a disorder where patients
    experience dizziness, tinnitus, and hearing loss.
  • Certain tumors may cause dizziness, such as brain tumors, and a tumor found in the
    auditory (hearing) canal of the ear, called a vestibular schwannoma. A schwannoma
    is a benign tumor. (The word “benign” refers to a medical condition that is not
    immediately life threatening, and is not likely to become worse).

Ototoxicity Symptoms:

• Ototoxicity may be accompanied by a tinnitus. Tinnitus is a word used to describe
  any ringing, or abnormal sound in your ear or head. Some people may hear roaring,
  hissing, or humming sounds. This may interfere with your ability to rest, or concentrate.
  You may be unable to sleep at night. As your ototoxicity becomes worse, the sounds
  become louder.
• You may feel a pressure or fullness in your head or ears, like you have a cold.
• You may notice a loss of hearing, or your existing hearing loss may become worse.
• You might feel like the room is spinning around you, or that you are spinning. Some
  people describe dizziness, as feeling a bit “woozy.” Severe dizziness is the
  fear that you may fall down when you stand up.
• Nausea and vomiting may be associated with ototoxicity.
• Even if you have been diagnosed with ototoxicity, dizziness may be a symptom or
  sign of a serious problem. Notify your doctor if you experience any of the symptoms
  mentioned here.

How Is Ototoxicity Diagnosed?

• Your healthcare will usually, at first, take a complete health history from you.
  They will then examine your neurologic system by conducting a physical exam in their
  office. This may include looking in your eyes, watching you stand or walk, and testing
  your strength. They will also look inside your inner ear, to see if there is an
  infection.
• If you are dizzy, it is important to distinguish vertigo from dizziness. Your healthcare
  provider may turn your head in different positions, usually from a sitting position,
  to a lying position, and back again, as they try to elicit the same symptoms that
  you are describing.
• Your healthcare provider may suggest that you have x-rays, an MRI, or a CAT scan
  of your head.
• You may also be referred to a specialist, such as an audiologist, otolaryngologist,
  or a Neurologist; depending on the type of symptoms you are experiencing.
  • An otolaryngologist or neurologist will usually perform the complete physical examination,
    and order all the tests. Your healthcare provider may also do this.
  • A Neurologist specializes in dizziness disorders, and tinnitus.
  • You may also be referred to an audiologist, a professional who diagnoses,
    treats, and manages individuals with hearing loss or balance problems.
• Your healthcare provider may order some blood work to be drawn. The blood work will
  show many things, including if you have anemia, low electrolytes, or it may suggest
  that you are dehydrated, as a cause of your dizziness.

Things You Can Do To Minimize Ototoxicity:

• It is important to notify your healthcare provider if you notice any dizziness,
  or any change in the pattern of dizziness, or the ringing in your ears that you
  are experiencing. Also, notify your healthcare provider if you have any loss
  of vision, hearing, or if your symptoms become more severe, and do not improve.
• Drink 2-3 liters of fluid per day to prevent dehydration. This may include fruit
  juices, water, non-caffeinated sodas and coffee, and non-alcoholic beverages. Alcohol
  and caffeine may cause dehydration, which can lead to dizziness, so these should
  be avoided. Always carry a “sipper” cup with you, filled with your favorite drinks.
• Change positions slowly. Allow your body a chance to adapt to the position change.
  For some individuals, lying down until the dizzy episode passes may be the best.
• With moderate dizziness, walk slowly and often. Walk with assistance if the dizziness
  is severe.
• If you have vertigo, your doctor or a trained therapist may teach you exercises,
  called “vestibular exercises” to try to get rid of your dizziness. These exercises
  involve you sitting down, and changing into different positions. This may cause
  you to be dizzier at first, while you are performing these movements, but should
  help to correct the vertigo. You may see some improvement in 2-6 months.
• You may have tinnitus (ringing, humming or any abnormal sound in your ear or head)
  as a result of your ototoxicity. Stress, anxiety and tiredness may cause your tinnitus
  to become worse. If stress and anxiety causes your tinnitus to become worse, relaxations
  techniques may help. You may also be prescribed an anti-anxiety drug.
• Using a quiet radio, television, or any low levels of sound when you are trying
  to rest may help you to ignore the tinnitus, and make it easier to sleep or relax.
• If you have Meniere’s disease, your doctor or healthcare provider may tell you to
  limit the amount of salt you eat in a day, and prescribe anti-nausea or anti-vertigo
  medications, along with a medication to help your body rid itself of salt and fluids.
  The goal is to decrease the pressure of your inner ear, and to control the vertigo.
• Depending on the cause of dizziness, it may last a few days to a few months. It
  is important to follow all the instructions your healthcare provides.
• If your hearing loss is a result of drugs or medicines that you have received in
  the past, it is important to avoid these in the future, if possible. Be sure that
  you tell all of your health care providers about all of the medicines you are taking,
  including over-the-counter medications, vitamins, and herbal remedies. It is important
  to avoid the use of drugs that may cause further damage the cells in your ear.
• Always ask your healthcare provider if they know of your hearing loss, especially
  if it is sensory.
• Make sure to keep all appointments.
• Do not share your medications with anyone.

Drugs That May Be Prescribed By Your Doctor:

• There are no drugs to specifically treat ototoxicity. The treatment is aimed at
  controlling the symptoms.
• Dizziness is a major symptom, and there are many drugs that can be used to treat
  dizziness. These may include:
• Meclizine (Antivert^®, dimenhydrinate (Dramamine^®), or the scopolamine patch (Transderm-Scop^®).
  These medications may help to decrease the feelings of unsteadiness or imbalance
  that you may be feeling.
• Prochlorperazine (Compazine^®), and promethazine
  (Phenergan^®), may work by preventing the feelings
  of dizziness, or by preventing nausea and vomiting that may cause dizziness.
• These are just some of the most commonly used drugs. Your healthcare provider may
  prescribe others.

When to Contact Your Doctor or Health Care Provider:

• If you develop any sudden severe ear pain
• If you have a temperature greater than 100.5 F (38 C).
• If you have nausea that interferes with your ability to eat, or experience vomiting
  more than 4-5 times in a 24 hour period.
• If you have a sudden loss of vision, or if you lose your hearing.
• If you fall down, or lose consciousness as a result of your dizziness.
• Severe, uncontrolled nausea and vomiting, unrelieved by anti-nausea medications.
• If your symptoms worsen within 3 days of treatment.
• As always, notify your doctor or healthcare provider if you are concerned about
  any of the symptoms you are experiencing.

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

What Is Tinnitus?

• Tinnitus is a word used to describe any ringing, or abnormal sound in your ear or
  head. Some people may hear roaring, hissing, or humming sounds. This may interfere
  with your ability to rest, or concentrate. You may be unable to sleep at night.
• Tinnitus may be divided into 2 categories: Objective tinnitus and Subjective tinnitus.
  • Objective tinnitus is when another person, such as a healthcare provider, may hear
    a similar noise as you are hearing. This may be caused by heart valve problems,
    blood vessel abnormalities, or problems with the tubes in your ear (Eustachian tube).
    This form of tinnitus is more rare.
  • Subjective tinnitus, which is far more common, is a result of damaged cells in your
    inner ear. This is when the person can tell other people what they hear – but the
    other persons cannot hear it themselves.

• Although the cause of tinnitus may be unknown, certain things can make your symptoms
  worse. These may include:
  • Anxiety
  • Injury to your ears, head or neck
  • Certain kinds of tumors
  • Infections in your ear or sinuses
  • Wax or any foreign objects in your ear canal
  • Certain diseases, such as Meniere’s disease, heart disease (especially blocked arteries),
    and thyroid disease. Meniere’s disease is a disorder where patients experience dizziness,
    tinnitus, and hearing loss.
  • Heavy smoking, problems with your jaw

• Certain medications that cause tinnitus, may include:
  • Diuretics or water pills, such as Diamox^®
  • Heart and blood pressure medications, such as metoprolol (Lopressor^®)
  • Antibiotics, such as gentamycin
  • Anti-nausea medications, such as promethazine (phenergan^®).
  • Anti-malaria drugs, such as quinine
  • High doses of salicylates (aspirin), if taken for long periods of time.
• Ototoxicity is a word to describe damage to the ear due to many causes. It may be
  due to a long-term exposure to certain drugs, as the drug accumulates in your body.
  It may also come from giving high doses of the drug at a time, which causes damage
  certain cells in your inner ear. The hearing loss you could experience as a result
  of medications may be irreversible.
• If you have experienced ringing in your ears, or tinnitus, it may be on one side
  or both.

Tinnitus Symptoms:

• Many people have a tinnitus that comes and goes. Some have a ringing or abnormal
  noise in the ears at all times. It may or may not be associated with hearing loss
  or dizziness.
• Along with tinnitus, you might feel like the room is spinning around you, or that
  you are spinning. Some people describe a feeling of dizziness with a ringing in
  the ears, and feeling a bit “woozy.” Severe dizziness, and the fear that you
  may fall down when you stand up, should be reported to your healthcare provider.
• Nausea and vomiting may also be associated with tinnitus.
• Severe vomiting over a long period of time may cause you to feel dizzy, or cause
  you to have abnormal sounds in your ear.
• Notify your doctor if you experience any of the symptoms mentioned here.

How Is Tinnitus Diagnosed?

• Your healthcare will usually, at first, take a complete health history from you.
  They will then examine your neurological system through conducting a physical exam
  in their office. This may include looking in your eyes, watching you stand or walk,
  and testing your strength. They will also look inside your inner ear, to see if
  there is an infection.
• If you have dizziness with your tinnitus, they will also perform a few different
  tests. Your healthcare provider may turn your head in different positions, usually
  from a sitting position, to a lying position, and back again, as they try to elicit
  the same symptoms that you are describing.
• Your healthcare provider may suggest a few special tests to diagnose your condition.
  These may include:
  • A hearing test, to see if you have problems hearing different levels or pitches
    (frequencies) of sound. Some people cannot hear high or low-pitched sounds.
  • X-rays of your head
  • Angiography to look at the vessels in your neck
  • MRI, or a CAT scan of your head.

• An otolaryngologist or neurologist will usually perform the complete physical examination,
  and order all the tests. Your healthcare provider may also do this.
• You may also be referred to a Neurologist, who specializes in dizziness disorders,
  and tinnitus.
• You may also be referred to an audiologist, a professional who diagnoses,
  treats, and manages individuals with hearing loss or balance problems.
• Your healthcare provider may order some blood work to be drawn.
• If they are able to find the cause of your tinnitus, it is likely that there are
  some forms of treatment available, especially if it is due to an infection, or a
  blocked tube.

Things You Can Do:

• It is important to notify your healthcare provider if you notice any change in the
  pattern of tinnitus you are experiencing. Also, notify your healthcare provider
  if you have any loss of vision, hearing, or if your symptoms become more severe,
  and do not improve.
• If you have hearing loss with your tinnitus, you may require hearing aids.
• Avoid loud noises.
• It is important to drink 2-3 liters of fluid per day to prevent dehydration. This
  may worsen your symptoms. Things to drink may include fruit juices, water, non-caffeinated
  sodas and coffee, and non-alcoholic beverages. Alcohol and caffeine may cause dehydration,
  so these should be avoided. Always carry a “sipper” cup with you, filled with your
  favorite drinks.
• Stress, anxiety and tiredness may cause your tinnitus to become worse. If stress
  and anxiety causes your tinnitus to become worse, relaxations techniques may help.
  You may also be prescribed an anti-anxiety drug.
• Using a quiet radio, television, or any low levels of sound when you are trying
  to rest may help you to ignore the tinnitus, and make it easier to sleep or relax.
• If your tinnitus is related to jaw abnormalities, you may be referred to a specialist
  for possible surgery to correct the problem.
• If your tinnitus is a result of drugs or medicines that you have received in the
  past, it is important to avoid these in the future, if possible. Be sure that you
  tell all of your health care providers about all of the medicines you are taking,
  including over-the-counter medications, vitamins, and herbal remedies. It is important
  to avoid the use of drugs that may cause further damage the cells in your ear.
• Change positions slowly if your tinnitus is accompanied by dizziness. Allow your
  body a chance to adapt to the position change. For some individuals, lying down
  until the dizzy episode passes may be the best.
• With moderate dizziness, walk slowly and often. Walk with assistance if the dizziness
  is severe.
• If you have vertigo, your doctor may teach you exercises, called “vestibular exercises”
  to try to get rid of your dizziness. These exercises involve you sitting down, and
  changing into different positions. This may cause you to be dizzier at first, while
  you are performing these exercises, but should help to correct the vertigo. For
  these exercises, a trained therapist will teach you. You should expect improvement
  in 2-6 months.
• If you have Meniere’s disease, your doctor or healthcare provider may tell you to
  limit the amount of salt you eat in a day, and prescribe anti-nausea or anti-vertigo
  medications, along with a medication to help your body rid itself of salt and fluids.
  The goal is to decrease the pressure of your inner ear, and to control the dizziness,
  and tinnitus.
• Depending on the cause of tinnitus, it may last a few days to a few months. It also
  may never fully resolve. It is important to follow all the instructions your healthcare
  provides.
• Make sure to keep all appointments.
• Do not share your medications with anyone.

Drugs That May Be Prescribed By Your Doctor:

• There are many drugs that can be used to treat dizziness and tinnitus. These may
  include:
• Antidepressants, such as nortriptyline at bedtime, are often effective in decreasing
  your symptoms.
• Meclizine (Antivert^®), dimenhydrinate (Dramamine^®), or the scopolamine patch (Transderm-Scop^®)
  may also be prescribed. These medications may help to decrease the feelings of unsteadiness
  or imbalance that you may be feeling.
• Prochlorperazine (Compazine^®), and promethazine
  (Phenergan^®), may work by preventing the feelings
  of dizziness, or by preventing nausea and vomiting that may cause dizziness.
• These are just some of the most commonly used drugs. Your healthcare provider may
  prescribe others.

When to Contact Your Doctor or Health Care Provider:

• If you develop any sudden severe ear pain.
• If you have a temperature greater than 100.5 F (38 C).
• If you have nausea that interferes with your ability to eat, or experience vomiting
  more than 4-5 times in a 24 hour period.
• If you have a sudden loss of vision, or if you lose your hearing.
• If you fall down, or lose consciousness as a result of your dizziness or tinnitus.
• Severe, uncontrolled nausea and vomiting, unrelieved by anti-nausea medications.
• If your symptoms worsen within 3 days of treatment.
• As always, notify your doctor or healthcare provider if you are concerned about
  any of the symptoms you are experiencing.

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

Additional resources for hearing problems:

Better Hearing Institute


515 King Street, Suite 420


Alexandria, VA 22314


800-EAR-WELL(327-9355)
http://www.betterhearing.org

The National Association of the Deaf


814 Thayer Ave.


Silver Spring, MD 20910-4500


Voice: 301-587-1788


TTY: 301-587-1789
http://www.nad.org

Self Help for Hard of Hearing People


7910 Woodmont Ave., Suite 1200


Bethesda, MD 20814


Voice: 301-657-2248


TTY: 301-657-2249
http://www.shhh.org

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

What is the treatment for labyrinthitis?

Treating the symptoms associated with labyrinthitis

The following medication can be prescribed to help relieve the symptoms of an inner ear infection:

• Antihistamines – desloratadine (Clarinex), or over-the-counter options such as loratadine (Claritin), diphenhydramine (Benadryl), or fexofenadine (Allegra).
• Meclizine (Antivert) which helps to reduce nausea and dizziness.
• Diazepam as a sedative.
• Prednisone as a corticosteroid (these are used to treat inflammation).
• Motion sickness medication  to aid in the treatment of loss of balance and vertigo.
• Antibiotics will only be prescribed if you have a bacterial infection in the respiratory tract, or if the labyrinthitis is bacterial as antibiotics are not effective in the treatment of viral infections. Blood cultures and swabs of the fluid, if there is fluid available, will detect which bacteria is present and then an antibiotic will be prescribed. 

Treating vertigo associated with an inner ear infection

• Do not move in sudden or quick movements.
• It is better to be in low lighting as this can help if you are feeling dizzy as bright lights are often deemed overwhelming when experiencing vertigo.
• If you are lying in bed and experience vertigo, try to keep your head still and sit up slowly.
• If you are walking and experience vertigo, try to find something to lean on or slowly sit down until it subsides.

PLEASE NOTE:  It is not safe to drive if you are experiencing vertigo on a regular basis.

Home remedies for treating an inner ear infection

• Try to rest in a position that is comfortable for the first few days.
• Keep hydrated and drink a lot of water.
• Try to reduce your sodium and sugar intake as this can affect your vertigo as these foods are known to spike blood sugar levels.
• Avoid chocolate, alcohol and caffeine.
• Do not smoke cigarettes as these can make you feel lightheaded.

Treatment for chronic labyrinthitis

Some people may suffer from vertigo and dizziness associated with an inner ear infection for a number of months or years, experts and doctors will typically refer to this as chronic labyrinthitis (i.e. long-term labyrinthitis).

The symptoms of chronic labyrinthitis are not usually experienced as severely as when one is first diagnosed with an inner ear infection and vertigo and dizziness tend to lessen over time. However, these mild symptoms associated with an inner ear infection may persist and adversely impact one’s daily activities and quality of life.

In order for those suffering from chronic labyrinthitis to seek some form of relief from long-term symptoms, a form of treatment known as VRT (vestibular rehabilitation therapy) is often recommended by doctors.

VRT (vestibular rehabilitation therapy)

This exercise-based form of treatment is designed to help ease the symptoms of a chronic inner ear infection, particularly those of vertigo and dizziness, the exercise program does this by promoting vestibular (i.e. relating to the inner ear) adaptation, as well as substitution. Simply put, VRT aids in retraining the nervous system and brain in order to compensate for any abnormal symptoms and signs stemming from the vestibular system.

VRT is typically supervised by a specialist such as a physiotherapist. A physiotherapist is a qualified expert in treating injury, disease or deformity through utilising physical methods such as exercise, massage and even heat treatment. He or she will make use of a range of different exercises designed to aid in the below ways:

• Improvement of hand-eye co-ordination – enhancing the stability of one’s gaze
• Simulation of dizziness in order to allow the brain to adjust to the specific disruptive signals that are sent to it from the vestibular system and train it to ignore these signals.
• Improvement of walking ability and balance
• Improvement of fitness and strength

Meniere’s Disease Treatment NYC | Mount Sinai

Affecting men and women equally between the ages of 20 and 50 years old, Meniere’s disease is a disorder of the inner ear that causes the following symptoms:

• Dizziness (vertigo) is the most troublesome symptom for most patients. Attacks of vertigo (whirling or spinning) begin unexpectedly. These are often accompanied by nausea and vomiting. A typical spell may last for hours at a time. A sense of fatigue or imbalance can continue long after the vertigo has subsided. The attacks of vertigo can come and go unpredictably.
• Hearing loss usually affects only one ear. In the early stages of Meniere’s disease your hearing loss may be mild or it may fluctuate (getting better and worse on its own). In later stages, hearing loss may become severe and permanent.
• Ringing in the ear (tinnitus) often occurs. In most cases, tinnitus is a by-product of the hearing loss. Many patients also experience pressure or fullness in their ears. Sometimes the pressure increases before or during a dizzy spell.
• Pressure in the ear

Meniere’s disease is caused by an overproduction of fluid within the inner ear. Excessive fluid pressure interferes with the function of the hair cells located in that area. Sudden increases in pressure make the ear feel stopped up and cause vertigo.

Most cases of Meniere’s disease have no known cause. In some cases, it can be associated with head trauma or middle or inner ear infections. Allergies and autoimmune disorders may also bring about the onset of this condition.

At Mount Sinai, our hearing and balance experts have been treating patients suffering from Meniere’s disease for more than 50 years. Our team has vast expertise with all forms of treatment, and we personalize each patient’s treatment plan.

Diagnosis and Treatment for Meniere’s Disease

Abnormal results of a caloric stimulation test of eye reflexes can indicate a sign of Meniere’s disease. An electrocochleography, MRI scan or electronystagmography (ENG) may also be recommended to decipher Meniere’s disease from other forms of vertigo. The vertigo associated with Meniere’s disease can usually be controlled with medications and dietary changes. If those measures do not work, gentamicin injections might give lasting relief. Surgery is an option when other measures fail.

Medications

Medications that are effective for Meniere’s disease include:

• Diuretics are the most commonly prescribed maintenance medications for Meniere’s disease. Diuretics work by restricting the overproduction of fluid in the inner ear. Diuretics are long-term medications. They help reduce the number of vertigo attacks, and in some cases, they help stabilize hearing. Commonly used diuretics are Diamox (acetazolamide) and Dyazide (triamterene/HCTZ).
• Meclizine (Antivert or Bonine) is the most commonly prescribed medication for the control of vertigo. Dramamine, available over-the-counter, is milder but might also be effective.
• Valium in small doses may be helpful when other medications fail to control the vertigo.

Low-salt Diet

Cutting back on salt will help keep the inner ear fluid low and help prevent vertigo. For most patients, 2000 mg of sodium a day is the target value. When symptoms are severe, 1500 mg a day is advisable. A low-salt diet consists of: not adding salt to food, avoiding prepared foods, and tallying the sodium intake by reading food labels.

Injection Therapy for Meniere’s Disease

Gentamicin is an antibiotic that is toxic (poisonous) to the cells of the inner ear. By selectively targeting the specialized cells of the balance organ, gentamicin can reduce the incidence of vertigo while preserving hearing in the ear. The effect of gentamicin injections is permanent—once the balance function (or hearing) is lost in that ear it does not return.

The medication is administered in the office. The injections are performed at monthly intervals until either dizziness, imbalance, or hearing loss occur. Most patients receive between one and three treatments, although the number may vary depending on the response.

The results of Gentamicin are: relief of vertigo spells in 70 percent of patients, permanent hearing loss in 30 percent. Patients may also experience imbalance or unsteady gait. This is usually temporary, but may occasionally require treatment with physical therapy.

Dexamethasone is a strong form of cortisone that can be injected into the inner ear. It is sometimes effective in treating severe Meniere’s disease, but the effect is not permanent.

Surgical Procedures for Meniere’s Disease

If the incidences of vertigo are not controlled by medications, surgery may be recommended. Surgical procedures can eliminate the frequent spells of vertigo that occur in Meniere’s disease; however, no surgery has been found to improve the hearing loss.

The decision about which operation depends on the patient’s age and health, medical condition, and hearing status.

Endolymphatic sac, or shunt, surgery strives to decompress the inner ear fluid by making an incision in the endolymphatic sac. The procedure is safe, and the recovery is usually quick. In our experience, endolympahtic sac surgery has a rate of cure of vertigo of about 70 percent and a risk of hearing loss of about 5 percent.

Vestibular nerve section is a highly effective operation that relieves vertigo attacks while preserving the hearing. In this operation, the balance nerve is isolated under the microscope and cut. The operation provides excellent relief in most patients, with minimal side effects.


Vestibular nerve section is performed through an incision behind the ear. The balance nerve is identified as it travels between the ear and the brain. Under the microscope, the balance fibers are separated from the hearing nerve fibers and are cut.

Vestibular nerve section is very effective. More than 90% of patients will have complete relief of their vertigo. Hearing is preserved at the preoperative level about 80% of the time. Patients usually stay in hospital 2 to 3 days after surgery, and the balance usually recovers over 3 or 4 weeks.

Labyrinthectomy is the operation with highest rate of cure of vertigo, but always causes a total loss of hearing in the operated ear. It is only recommended to patients who have very poor hearing. In this operation, the balance canals are destroyed and so the source of the vertigo is permanently removed. The recovery after surgery is similar to vestibular nerve section.

90,000 Meniere’s disease – symptoms, diagnosis, treatment

Meniere’s disease is a disease of the inner ear that is accompanied by the following symptoms:

Meniere’s syndrome usually affects only one ear. It can develop at any age, but it is more common in adults between the ages of 40 and 60.

Dizziness attacks may occur suddenly or after a short period of tinnitus or hearing impairment. Dizziness attacks do not occur frequently in some people.Others may feel dizzy several times during the day. The dizziness associated with illness can be so severe that it can lead to loss of balance and falls. These symptoms are called “drop attacks”.

Causes of Symptoms

Symptoms of Meniere’s disease are caused by the accumulation of fluid in the inner ear called the labyrinth.

The labyrinth contains the organs of balance (semicircular canals and otolith organs) and hearing (cochlea). It consists of two parts: the bony labyrinth and the membranous labyrinth.The membranous labyrinth is filled with a fluid called endolymph, which, in the organs of balance, stimulates receptors as the body moves. The receptors then send signals to the brain about the position and movement of the body. In the snail, fluid contracts in response to sound vibrations that stimulate sensory cells to send signals to the brain.

In Meniere’s disease, the accumulation of endolymph in the labyrinth causes imbalances and disrupts the transmission of auditory signals between the inner ear and the brain. This abnormality causes dizziness and other symptoms of Meniere’s disease.

Why do people get sick with Meniere’s disease

Currently, the causes that provoke Meniere’s disease are not fully understood. Some researchers believe that Meniere’s disease is the result of narrowing of blood vessels, similar to those that cause migraines. Others believe that Meniere’s disease may be due to viral infections, allergies, or autoimmune reactions. Because Meniere’s disease appears to be inherited, it can also result from genetic changes that cause abnormalities in the volume or regulation of endolymphatic fluid.

Diagnosis

Diagnosis of Meniere’s disease is based on history and physical examination. The doctor may refer the patient to several types of examinations to confirm the diagnosis of Meniere’s disease.

Diagnostic tests

• Tonal audiometry
• Brain stem auditory response (ABR test)
• Computed tomography (computed tomography)
• Magnetic resonance imaging (MRI).

Ménière’s syndrome is often associated with low-frequency sensorineural hearing loss in the affected ear, so tonal audiometry is usually performed to assess hearing thresholds at different frequencies, especially responses in the low-frequency regions.Other tests, such as the auditory response of the brainstem (ABR test), computed tomography (CT), or magnetic resonance imaging (MRI), may be needed to rule out other causes, such as swelling or pressure on the vestibular cochlear nerve (cranial nerve VIII).

Treatment

There is no cure for Meniere’s disease yet. But to reduce symptoms, you can take the following actions:

• Reduce or quit smoking altogether
• Reduce consumption of tea, coffee, spicy foods.

Another common diet is a low salt diet, as high salt concentrations cause the body to retain excess fluid and cause fluid pressure fluctuations in the inner ear. If necessary, your doctor may prescribe diuretics to lower salt levels.

Patients with dizziness and / or dizziness may take oral medication for vertigo.
In severe cases, surgery may be done to remove excess endolymphatic fluid in the inner ear or by cutting the balancing nerve.

However, such surgery may put patients at risk of hearing impairment or facial nerve palsy. Therefore, surgery is a last resort and requires a thorough preoperative examination.

Fominov Dmitry Vitoldovich

Audiologist-otorhinolaryngologist of the first category. Receptions for adults and children. Work experience: since 2013

Receptions for adults and children:

Minsk, st. Nemiga, 42 Center for Good Hearing

DIDDENESS: HOW TO RECOGNIZE AND TREAT

Vertigo is a symptom of illusory movement or sensation of movement, even if you are completely motionless.This is a temporary phenomenon of varying duration and can occur suddenly. There are different types of vertigo, mainly rotary-type vertigo, which, if severe, can lead to a real fall. This problem affects almost all people throughout their lives and gets worse with age.

Dr. Pietro Bassi, a neurologist at the Center for Diagnosis and Treatment of Headache and the Center for Diagnosis and Treatment of Vertigo at the Palazzo della Salute, explains how to recognize the type of vertigo and the importance of referring to a specialist experienced in treating these conditions.

TYPES OF VISITS

In 90% of cases, dizziness occurs due to changes in 2 organs: the ear and the brain. They represent different types of vertigo that can be clinically identified when visiting a specialist; at the same time, instrumental studies are required for a more accurate diagnosis.

Peripheral vertigo

“ Vertigo is called peripheral when it is caused directly by a vestibular problem in the inner ear, of which benign paroxysmal positional vertigo (BPPV) is the most common.This type of vertigo associated with head movement leads to a loss of perception of oneself in space. This sensation disappears a few seconds after the movement of the head stops.

BPPV is caused by the separation of small crystals of calcium carbonate, called otoliths, from the vestibular apparatus of the inner ear, which can cause dizziness with every movement. This phenomenon is called domeolithiasis (also otolithiasis).

If the otoliths are separated from the structure that holds them together as a result of injury, accidents or other reasons, they cause abnormal disturbances that touch other parts of the inner ear and transmit signals to the brain that are different in the case of the two ears.If two different signals are sent to the brain, dizziness occurs because they are not synchronized , ”explains Dr. Bassi.

In addition to benign paroxysmal vertigo, there is also a pathology of the nerve, which was previously called labyrinthitis, and now is called vestibular neuronitis. It is inflammation or ischemia of the vestibular nerve that connects the labyrinth (that is, the set of channels that make up the vestibular apparatus of the inner ear) to the brain.This compound, which is responsible for regulating the balance, if damaged, causes a feeling of dizziness. More often, vestibular neuronitis is of an inflammatory viral origin.

Central vertigo

« In turn, central dizziness occurs due to problems in the brain (most often the brain stem or cerebellum) and sometimes it can be a sign of even more serious diseases:

• inflammatory diseases such as multiple sclerosis;
• neoplasms, eg brain tumor;
• vascular pathologies, for example, cerebral ischemia, stroke. “

Pseudo-dizziness

In addition to peripheral and central dizziness, there is also pseudo-dizziness or feeling of instability, the characteristics of which are different from true dizziness (especially a feeling of instability when walking). Most often, this instability is of microvascular origin.

RISK FACTORS AND SYMPTOMS

The most important risk factors associated with the onset of vertigo are:

• wrong posture,

• hypertension,

• diabetes,

• improper power supply,

• ototoxic drugs (i.e.e. harmful to the ear).

Symptoms accompanying dizziness, in addition to spatial disorientation, may also include:

• nausea,

• vomiting,

• loss of balance,

• nystagmus, that is, oscillatory movements of the eyes,

• hearing impairment,

• fall.

The duration of vertigo varies and depends on the cause of the origin. Symptoms can appear gradually or suddenly. If the frequency of dizziness is high, you should consult a specialist.

DIAGNOSTICS

The specialists we most often contact with such diseases are an otolaryngologist and a neurologist, they often work in close cooperation.The first step, of course, is an accurate history, an objective examination, which will direct the specialist to the appointment of the most appropriate diagnostic method.

It is important to evaluate the external auditory canal and perform nystagmus analysis to check for involuntary eye movements.

The figure of an otolaryngologist is important to exclude more “trivial” pathologies (eg, earwax plugs, ruptured tympanic membrane) and refer the patient to a neurologist who examines this particular pathology with a special examination.

Almost always, we resort to diagnostic imaging: in this regard, MRI gives the specialist more detailed images of the internal organs and tissues of the human body, and compared to CT, which was used more often in the past, MRI is safer, since it does not have ionizing radiation, which is harmful to health.

TREATMENT OF VIBRATION

Treatment for vertigo varies according to the origin of the disease:

• in the case of benign paroxysmal positional vertigo (BPPV): therapy consists of repositioning maneuvers such as the Hallpike maneuver, the most commonly used one, effective in bringing the otoliths to a point where they can no longer harm, thereby, restoring the balance of a person.These special maneuvers, which should only be performed by experienced professionals, involve a series of sessions that vary depending on the amount of otoliths scattered around the inner ear. Treatment can progress very quickly or over several weeks or months.

• in the case of vestibular neuronitis, that is, inflammation of the nerve, drug therapy is used with the use of certain drugs, such as, for example, cortisone, antihistamines or antipsychotics.

• in the case of central vertigo, it is necessary to more carefully investigate the causes of the ailment and treat them with targeted therapy.

PREVENTION OF VISION

In addition to all of the above, it is advisable to observe some useful forms of behavior, for example:

• avoid sudden head movements;

• do not get out of bed too quickly;

• Avoid turning only with a neck movement, for example, when your name is called;

• , if possible, avoid stressful situations that could cause or worsen symptoms.

90,000 Office for the treatment of vestibular disorders: an appointment with a chiropractor, neurologist in Chelyabinsk

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What is dizziness

Dizziness is a sensation of the apparent movement of the body in space or surrounding objects relative to the body.This is one of the most common complaints in the practice of a neurologist. The following systems provide the balance function:

1. visual analyzer

2. vestibular apparatus

3. system of proprioception or musculoskeletal sensation

4. motor apparatus

It should be remembered that there is physiological dizziness (normal) and pathological.Physiological dizziness can occur at altitude or in the water (“motion sickness”).

Pathological dizziness

Pathological dizziness, in turn, is divided into systemic, non-systemic, psychogenic.

• Systemic (vestibular) dizziness is characterized by the appearance of a sensation of movement (rotation, spinning, falling, rocking) of one’s own body or surrounding objects, often accompanied by nausea, vomiting, imbalance, nystagmus.The main cause of this dizziness is damage to the vestibular system at any level (damage to the inner ear, auditory nerve, cerebellum, temporal cortex).

• Non-systemic dizziness can manifest itself as a light-headed state with a feeling of weakness, darkening in the eyes, “sinking”. This kind of dizziness is most often associated with diseases of the cardiovascular system, hypovolemia, disorders of the autonomic nervous system.Also, non-systemic dizziness can be of the type of instability, unsteadiness when walking, it disappears or decreases in a lying or sitting position, while there are signs of a neurological disease that a neurologist can detect upon examination (pathology of the central or peripheral nervous system).

• Psychogenic dizziness can manifest itself in completely different ways, but on examination there is a dissociation between the severity of subjective sensations and the absence of changes in neurological examination, symptoms from the mental sphere are noted.Psychogenic dizziness is most common in anxiety, depressive disorders.

Diagnostics

The examination of a patient with dizziness is based primarily on the data of complaints and anamnesis. The neurologist at the reception can ask the following questions, the answers to which will allow the doctor to draw preliminary conclusions and correctly diagnose.

Questions might be:

• How and when did the dizziness start?

• How long does it last?

• What type of dizziness does the patient feel?

• Does it occur spontaneously or is it triggered by certain circumstances (for example, turning the head)?

• Is dizziness accompanied by pain (headache, ears, chest)?

• Is dizziness accompanied by hearing loss?

• Are there any significant vegetative symptoms (nausea, vomiting)?

• Are there any additional complaints during dizziness (double vision, trouble swallowing, speech disorders, weakness in an arm or leg)?

A somatic examination is mandatory, namely, the measurement of blood pressure, heart rate, neurological examination with the obligatory conduct of specific tests to identify imbalances.If you suspect a disease of the ear or nasopharynx, if you have a history of ear disease, an examination by an otorhinolaryngologist is required.

Depending on the presumptive diagnosis, comorbidities of the patient, additional instrumental examination (CT, MRI of the brain, electronystagmography, tone threshold audiometry, cardiac studies, etc.) may be prescribed.

Vertigo treatment

Treatment depends on the diagnosis made by the specialist.It can include both medication (for example, vertigolytics) and non-drug methods (for example, vestibular gymnastics, cognitive-behavioral therapy, etc.).

If the cause of dizziness is correctly identified, the treatment of this category of patients can be effective. Well-being is restored, and with it the efficiency and quality of life of patients.

The following specialists are involved in the treatment of vestibular disorders:

Prices

Dear patients!
Please note that the cost of a visit to a doctor does not always coincide with the indicated admission price.The final cost of admission may include the cost of additional services. The need for the provision of such services is determined by the doctor depending on the medical indications directly during the appointment.

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Manual maneuvers for M. Tupe, Simon, Eple

Benign paroxysmal positional vertigo (BPPV) is a fairly common pathology.Epley maneuver is one effective therapy to reduce symptoms of the disease.

BPPV develops more often in women. The most likely cause of the disease is the deposition of calcium salts (otoliths) in the canal of the inner ear. Head movements (bending, turning, rolling back) provoke short-term attacks of dizziness. Between episodes, the patient may experience nausea, fluctuations in blood pressure, loss of balance, and impaired thermoregulation.Regular intense attacks can be so uncomfortable that the question of what to do in case of dizziness is in the first place for the patient. With timely initiation of treatment, BPPV does not cause permanent harm to health, the benignity of the disease implies a decrease in the severity of episodes.

The diagnosis of “BPPV” can be made by a doctor based on the collection of anamnesis of the patient who applied. Additional neurological diagnostic methods are the Dix-Hallpike test and the rotational test.

The choice of treatment for this disease depends on the type of damaged canal. In modern medicine, vestibular gymnastics and changing the position of otoliths are used to eliminate symptoms. Special therapeutic techniques will help alleviate the condition with BPPV. Exercise therapy recommended by the doctor for benign paroxysmal positional vertigo reduces the severity of seizures. Treatment should take into account the location of the otolith crystal in the semicircular tubules of the inner ear.The Epley positional maneuver is the most studied method and controls seizures in posterior and lateral pathology. The essence of the treatment is to change the position of the otoliths. The fixed crystal dissolves, thereby facilitating the disappearance of symptoms.

The Epley maneuver is also referred to as a canal repositioning procedure. The correctness of the implementation at first should be monitored by a doctor. He must assess whether the patient will be able to do therapeutic exercises on his own. The health risk, according to experts, is minimal with the wrong technique, but it is likely that the expected effectiveness for the treatment of BPPV will decrease.If you are unsure of what to do if you experience dizziness on a regular basis, you should see your doctor. If the diagnosis of benign paroxysmal positional vertigo is confirmed, it is necessary to adhere to the prescribed treatment. This disease is quite common and responds well to therapy.

Peripheral vertigo is caused by a pathology of the vestibular analyzer outside the brain. They are frequent, but usually do not reach a pronounced degree, since the brain adapts to the incorrect operation of the source of impulses.

Central vertigo occurs when the structures of the brain are affected, most often the medulla oblongata and cerebellum.

They are often combined with other manifestations:

• dysarthria (pronunciation disorder due to insufficient innervation of the speech apparatus),
• diplopia (double vision),
• paresthesia (unusual feeling of numbness of the skin, “creeping creeps”, tingling, arising without external influence),
• headache,
• weakness,
• ataxia (disorder of coordination of voluntary movements) of the extremities.

Dizziness Diagnostic Problems:

Osteochondrosis

Dizziness is often attributed to cervical osteochondrosis. If you take X-rays of the spine, any elderly person can be diagnosed with osteochondrosis. Pathological changes will be found in 100% of the population of this age, but it would be an absolute mistake to pass off “osteochondrosis” as the cause of dizziness.

Vertebrobasilar insufficiency

Slightly more reasonably (but also mistakenly) doctors attribute dizziness to vascular vertebrobasilar insufficiency (VBI, which occurs when blood flow to the brain through the vertebral arteries is disturbed) due to atherosclerosis or congenital vascular tortuosity, explaining to the patient: “you turn your head, the vessels are pinched, and the blood stops flowing to the brain, which makes the head spin. “

Semont’s maneuver

To be performed with the help of a doctor or independently. Starting position: sitting on a couch, legs hanging down. Sitting, the patient turns his head in the horizontal plane by 45 ° to the healthy side. Then, fixing the head with his hands, the patient is placed on his side, on the affected side. He remains in this position until the dizziness stops. Further, the doctor, quickly moving his center of gravity and continuing to fix the patient’s head in the same plane, puts the patient on the other side through the “sitting” position without changing the position of the patient’s head (i.e.e. forehead down). The patient remains in this position until the dizziness disappears completely. Further, without changing the position of the patient’s head, he is seated on a couch. Repeat the maneuver if necessary.

Epley maneuver (with pathology of the posterior semicircular canal).

It is advisable to be performed by a doctor. Its feature is a clear trajectory, slow movement from one position to another. The initial position of the patient is sitting along the couch. Previously, the patient’s head is turned 45 ° towards the pathology.The doctor fixes the patient’s head in this position. Then the patient is placed on his back, the head is thrown back at 45 °. The next turn of the fixed head is in the opposite direction in the same position on the couch. Then the patient is laid on his side, and his head is turned with the healthy ear down. Then the patient sits down, the head is tilted and turned towards the pathology, after which it is returned to its usual position – looking forward. The patient’s stay in each position is determined individually, depending on the severity of the vestibulo-ocular reflex.Many specialists use additional agents to accelerate the settling of freely moving particles, which increases the effectiveness of the treatment. Typically, 2-4 maneuvers per treatment session are sufficient to completely stop BPPV.

* CONTRAINDICATIONS ARE AVAILABLE, SPECIALIST CONSULTATION REQUIRED
* NOT A PUBLIC OFFER

Vertigo Treatment Unit | Centro Coromina

Vertigo Treatment Unit | Centro Coromina – Dr. Jordi Coromina

VISITING DEPARTMENT

What is vertigo?

Dizziness, or vertigo, is the feeling of rotation of surrounding objects, or the body itself.This malaise is almost always accompanied by instability or imbalance, and sometimes nausea , severe sweating, vomiting, etc. In some cases, with dizziness, only instability or imbalance is observed with a feeling of “loss of soil from under the feet.”

Anyone can experience dizziness in childhood, as well as in adulthood and old age.

In children, as a rule, vertigo is associated with problems in the middle ear; in older people, the manifestation of dizziness can develop to a chronic imbalance.

What are the causes of dizziness?

The main causes of vertigo are hearing disorders . The most common are benign paroxysmal positional vertigo, Meniere’s disease, and vestibular neuritis, which occur in half of patients who complain of dizziness.

Other auditory disorders can include tumors (vestidocochlear neuroma), trauma, infections, toxins (ototoxic drugs), and idiopathic disorders.They occur in 33% of cases of dizziness attacks.

Also, the reasons can be of a neurological nature: pathologies of vascular origin, cervical spine and multiple sclerosis are common.

Meniere’s disease

Meniere’s disease is one of the most common types of vertigo, which is characterized by the presence of attacks of dizziness with nausea, vomiting and sweating, accompanied by progressive hearing impairment and noise in the ear.

It often happens that initial drug treatment does not give any results, therefore, intratympanic administration of gentamicin is performed .The patient is injected with the drug gentamicin directly into the ear under local anesthesia in order to achieve the correct concentration of the drug in the inner ear and thus ensure its effectiveness.

Intratympanic administration of gentamicin is the most modern and effective method of treatment. 90% of patients with Meniere’s disease stop experiencing dizziness attacks, which allows them to lead a normal life. This method, widely used in the USA, was first applied in Spain by Dr. Jordi Coromina of Teknon Medical Center.

How is vertigo diagnosed?

Diagnosis of vertigo, or vertigo, begins with a conversation with the patient to help determine the type of vertigo.

The specialist pays special attention to the restrictions that vertigo places on the patient’s daily activities and tries to assess the extent to which the disease affects the life of the patient and his family.

The second stage in the diagnosis of vertigo consists in a detailed examination of the ENT organs: ears, nasal cavity, mouth and throat (larynx and pharynx).

The third stage of vertigo diagnosis consists of the following procedures performed by a specialist:

• Neurological examination. (Fig. 3, 4, 5, 6 and 7)
• Audiometry (examination of the patient’s auditory functions)

If necessary, also carried out:

• Examination of the vestibular apparatus located in the ear ( computer method for a comprehensive assessment of the state of the vestibular function )
• Magnetic resonance imaging and computed tomography (CT) of the ear and brain

Anamnesis and examination, along with the results of audiometry and a comprehensive assessment of the state of vestibular function, help to determine the exact localization of dizziness and the causes of its appearance, on the basis of which the appropriate treatment.

In other cases, the patient is referred to a neurologist specializing in vertigo.

How is vertigo treated?

Treatment depends on symptoms and type of vertigo. In Meniere’s disease , the following steps are usually performed:

First of all, only medications are prescribed. 70% of patients experience improvements already at this stage, which allows them to lead a normal life.

If the patient does not feel better, then intratympanic gentamicin is used In some cases, intratympanic gentamicin is initially administered (into the middle ear).

Intratympanic Gentamicin

Gentamicin is an antibiotic that prevents dizziness and is given through the eardrum. It penetrates into the inner ear and acts on the vestibular apparatus. The procedure takes place on an outpatient basis in the doctor’s office.

After that, the patient must come for an examination every week. When the condition improves, the treatment is considered complete. The improvement is expressed in a gradual decrease in the intensity, severity and frequency of dizziness attacks until they disappear completely.Otherwise, gentamicin is given again (Fig. 8).

Fig. 8. If in Meniere’s disease the initial drug treatment does not work, intratympanic administration of gentamicin is performed

If gentamicin does not help

If gentamicin is ineffective (in 10% of cases), surgical intervention is required, which, depending on the patient’s hearing condition, can be performed by the method vestibular neuroectomy , or by the method labyrintectomy .

During vestibular neuroectomy, an incision of the vestibular cochlear nerve is performed, thus, the patient retains hearing.

Labyrintectomy involves removing the inner ear, causing the patient to lose hearing. This operation is performed in extreme cases, in which the development of the disease leads to deafness of the patient.

What treatments are used for other cases of vertigo?

The method of treatment for other cases of vertigo depends on the cause of its occurrence:

• Benign paroxysmal positional vertigo (BPPV) .In this disorder, dizziness occurs at the time of sudden movements, especially when going to bed or getting out of bed, when turning the head in different directions while lying down, stretching the neck strongly in order to get an object from the shelf, bending over, etc. These movements affect the inner ear, provoking dizziness. The reason for this is the wrong position of the cells in the inner ear (otoliths), which are stimulated by these movements. To eliminate this ailment, the doctor performs the Epley maneuver, thanks to which the otoliths return to their place.(Fig. 9 and 10).
• Vestibular neuritis . This is an inflammatory lesion of the vestibular cochlear nerve, in which the patient experiences dizziness without impairing hearing and ringing in the ears. It manifests itself as an isolated, acute and prolonged attack (3-6 days) with severe dizziness and nausea, which leads to a feeling of unsteadiness for 2-3 weeks. Treatment consists of a set of exercises called vestibular rehabilitation gymnastics.

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BPPV – Benign positional paroxysmal vertigo

4. Classification of BPPV

BPPV can be divided according to the type of canal lesion:

– cupulolithiasis and canalolithiasis

canalolithiasis is the most common form of the disease treatment. Cupulolithiasis is a severe form of BPPV that cannot always be easily corrected. In the treatment of cupulolithiasis, special maneuvers are used, which are described below, in order to translate it into canalolithiasis and continue to deal with a simpler form of the disease.

Distinguish BPPV by localization of otolithiasis:

– posterior semicircular canal ; horizontal semicircular canal ; anterior semicircular canal ;

The posterior semicircular canal is the most common variant (more than 80%). Then there is a horizontal semicircular canal in frequency. And the most rare localization is the anterior semicircular canal (about 1-2%), which is due to its anatomical location.

There is a combined lesion of several canals and bilateral otolithiasis (lesion of one or more canals on both sides), which is often formed after a traumatic brain injury.

Society of Sheep ( International scientific medical community dealing with the problems of dizziness and balance ) in the diagnostic criteria also distinguishes:

Probable BPPV, spontaneously resolved – when a typical case of BPPV is described in the history of the disease, characteristic symptoms, timing and triggers (change in body position), but at the time of appointment with a specialist there is no observable nystagmus and no dizziness with any positional diagnostic maneuver.Another reason for this condition is also excluded.

Potential BPPV – when a case similar to BPPV is described in the history of the disease and there are no other causes of this disease.

Treatment and diagnosis of dizziness at a neurologist’s appointment at the St. Petersburg hospital of the Russian Academy of Sciences

Dizziness (Vertigo) is a distorted perception of the position of one’s body in space and the feeling of an imaginary movement of one’s own body or the environment.This symptom can be a manifestation of diseases of the nervous system or various somatic diseases, incl. ENT pathology.

Distinguish:

1. Vestibular dizziness associated with damage or physiological stimulation of peripheral or central vestibular structures (inner ear, vestibular nerve, vestibular nuclei in the brain stem or their connections). It is manifested by a feeling of rotation in a certain direction and is accompanied by imbalance, walking, sometimes nausea, vomiting.

A special type is benign paroxysmal positional vertigo (BPPV) – short-term attacks of dizziness when changing body position. Patients with this pathology receive vasoactive, metabolic, nootropic therapy for a long time, which turns out to be ineffective.

2. Dizziness in light-headedness associated with orthostatic hypotension, hypoglycemic state, overdose of sedative or antihypertensive drugs.The patient complains of a feeling of lightheadedness, “fog” in the head, pronounced general weakness, drowsiness.

3. Psychogenic dizziness develops in patients with pronounced emotional and personal changes. It develops suddenly, accompanied by a feeling of anxiety, anxiety, fear.

4. Unsteadiness when walking, perceived by patients as dizziness.

For any type of dizziness, a diagnostic search for the possible “organic” nature of the disease (tumors of the cerebellopontine angle, strokes in the VBD, neuroinfections, etc.) is necessary.