THE SPINNING ROOM

Vertigo is the sensation that you are moving while you are actually sitting or standing still. Typically, you might feel like the room is spinning around in circles. This feeling is often associated with nausea and a sense of imbalance. Other symptoms might include sweating, hearing loss, ringing in your ears, and abnormal eye movements.

Your sense of balance is controlled by delicate communication between several locations – your eyes, your sensory nerves which carry signal to and from your skin, muscles, and joints, and your inner ear. Your inner ear contains the organ of balance – the labyrinth which contains calcium particles which move when your head is moving and send signals to your brain detecting gravity and back-and-forth movement. If these systems are not working, you may develop symptoms of vertigo. The symptoms of vertigo are made worse by moving the head.

Vertigo can have many causes and, before initiating treatment, your doctor will want to make a more precise diagnosis. Most causes of vertigo are benign and should go away quickly but a few rare causes can be more dangerous. Benign paroxysmal positional vertigo (BPPV) is associated with a change in the position of the head and is one of the most common causes of vertigo. It occurs when the calcium particles in your inner ears shift. BPPV becomes more common with aging and may be associated with head trauma. Inflammation in the inner ear – vestibular neuronitis or labyrinthitis – may be caused by a viral infection and is characterized by sudden, intense vertigo sometimes lasting for several days, including nausea and vomiting, difficulty walking, and requiring bed rest. An acoustic neuroma is a benign tumor which usually develops slowly and may be characterized by ringing and hearing loss in only one ear.

Meniere’s disease involves excessive build-up of fluid in the inner ear. This is characterized by episodes of vertigo lasting 30-60 minutes and typically includes ringing in the ears and hearing loss. A vestibular migraine is a variant of a migraine headache in which typical migraine triggers such as watching television or riding in a vehicle may lead to vertigo symptoms which may or may not involve headache symptoms. In very unusual circumstances, vertigo can be a sign of more serious disease like stroke, brain hemorrhage, or multiple sclerosis.

In diagnosing vertigo, your doctor will typically want to understand your symptoms. He or she may ask you whether you feel like you are losing your balance, whether you have hearing loss or ringing in your ears, and whether you have other neurologic symptoms like headaches or weakness in an arm or leg. Your doctor will examine you for abnormal eye movements and sometimes will do a special test to see if you have vertigo symptoms when lying down and turning your head. Usually these tests will be adequate to make the diagnosis but sometimes your doctor will order a CT or MRI scan, blood tests, and an EKG.

The treatment prescribed will depend on your doctor’s diagnosis. Infection of the middle ear will likely require antibiotics. Meniere’s disease may by treated with a low-salt diet and medication to increase urine output. BPPV is often treated with drugs but may also require treatment with exercises which attempt to move the calcium stones to their normal position. Medications prescribed for BPPV often include Antivert or Benadryl. In some cases, your primary care doctor may need to refer you to an ear, nose, and throat (ENT) specialist for comprehensive care.

Of course, if you have symptoms of vertigo, you should take precautions to prevent harm to yourself and others. Do not drive a car or operate heavy machinery until you have been thoroughly evaluated by your physician and your symptoms have resolved. Sit down immediately if you feel dizzy. If you need to, consider walking with a cane. Avoid use of alcohol or other substances which might make you more unsteady.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.