New Spin on Vertigo Treatment

July 1, 2009  
Filed under Health & Wellness

By Phyl Newbeck

Getting dizzy and feeling faint are troublesome enough when you are young and sturdy, but for the older population, the medical condition known as vertigo can be downright frightening. Combine a loss of balance with more brittle bones and you have a recipe for disaster.

Susan Cromwell, a physical therapist at Fletcher Allen Health Care, says humans maintain balance by using information gained from their eyes, muscles, joints, and inner ears. As we grow older, all of these systems begin to break down somewhat. Problems with the inner ear can lead to a disorder known as benign paroxysmal positional vertigo or BPPV.

BPPV results in short episodes in which people feel as though they are spinning. These episodes occur after individuals change the direction of their head by movements such as lying down, sitting up, bending down or perhaps reaching over their heads.

Cromwell says the inner ear has three semi-circular canals which are filled with fluid. When a person tips their head, the fluid moves, stimulating nerve endings which give the brain the location of your head, i.e., forward, sideways, tilting, etc. In the section of the ear where the canals meet, there are microscopic pieces of calcium carbonate. The combination of fluid and crystals works as a “mini gyroscope” to provide an indication of where you are in space and how fast you are going. However, particularly in older people, the crystals sometimes migrate into the canals. The confluence of the two stimuli causes what feels like “momentary episodes of spinning” according to Cromwell. These episodes can last less than a minute, but may still be dangerous. A senior with orthopedic problems or perhaps other balance issues can get seriously hurt. They may get BPPV from sitting up in bed, causing them to fall and break a hip. Worse, if they are reaching for something in a cabinet and tilt their head back, they may fall and hit the back of their head.

The good news, according to Cromwell, is BPPV can be easily treated by a sequence of three or four head positions known as the Epley Maneuver, which moves the crystals back into position. These movements can be performed by a variety of health care providers including physical therapists. Cromwell said 90 to 95 percent of all BPPV cases can be cured in one or two treatment sessions.

Richard Tonino, a South Burlington physician who specializes in geriatric medicine agreed, noting that vertigo is extremely common in senior citizens. “In simplest terms, it relates to the deterioration of the cranial nerve which controls hearing and balance,” he said. Just as hearing worsens with age, the nerve function within the inner ear can also deteriorate. Tonino said at least half of all vertigo cases come from inner ear problems. He conceded that the manual manipulation used to treat inner ear vertigo is “a little voo-dooish, but it works.”
Mark Whitaker, an otolaryngologist (ear, nose and throat specialist) at Fletcher Allen Health Care, said there is no proven way to prevent vertigo. While some might be able to ward off the problem by changing their sleeping positions, others might find such a change impossible to make. Whitaker said manual manipulation has an 80 percent success rate, although he noted that sometimes the procedure needs to be repeated.

Whitaker said that if a physician is absolutely certain a patient’s dizziness is caused by BPPV, surgery is a possibility. The surgery, which takes two to three hours, seals off the inner ear to prevent the movement of particles. Whitaker stressed that surgery is quite rare.

Other conditions which may cause vertigo are Menieres, a disorder of the inner ear which also results in ringing in the ears (tinnitus), pressure in the ear, and fluctuating hearing loss; a stroke; certain medications; or a condition known as vestibular neuronitis (a swelling of the inner ear nerve which carries balance signals to the brain). When vertigo comes from one of those disorders, the condition itself must be addressed, not the vertigo which is merely a manifestation of the problem. Vertigo which comes as a result of these conditions may be longer lasting and more immobilizing for patients, preventing them from activities such as flying.
Robert Jauch, an otolaryngologist in St. Johnsbury, stressed the need to differentiate between dizziness and vertigo. He stated that a common disorder is a condition known as “disequilibrium of the elderly” which results in mobility problems often confused with vertigo. Jauch also pointed to certain benign tumors known as acoustic neuronomas which affect balance but again, do not cause true vertigo. Jauch said seniors with any type of dizziness should see a specialist since many family doctors will simply prescribe sedatives which hinder the patient’s ability to exercise and move.

Dick Walters, an 84-year-old Shelburne resident, is living proof that, voo-dooish or not, manual manipulation works for BPPV. He had a minor episode of vertigo in 2008 which was cured by Susan Cromwell. This year, the vertigo returned with a vengeance. “I sat up,” Walters said, “and the world started spinning. It didn’t matter if my eyes were open or closed; everything was whirling.”

Walters spent several days almost completely bedridden while the vertigo continued. His stomach was so queasy that when he was able to walk, he carried a bucket with him. When the episode subsided, he immediately returned to Cromwell.

Walters explained that Cromwell won’t treat someone during a vertigo episode. She waits until it is over and then puts her patient through a series of head movements to recreate the problem. By doing so, she can pinpoint the location of the trouble and then direct further movements to correct it. Cromwell does not manipulate the patient’s head herself; she directs the patient and they turn their head in the direction she requests. “I call her the witch doctor,” Walters said. “She’s absolutely fantastic.”

After his episode, Walters has learned how widespread the problem is among seniors. He recognizes that vertigo may return but for now, he’s happy. Since his visit to Cromwell, he and his wife have gone skiing and he varnished the mast and trim on his boat. “I know it can return at some point,” he said, “but this time it won’t scare the hell out of me.”

For information on support groups, visit the following Web sites: www.dailystrength.org/c/Dizziness-Vertigo/support-group www.mdjunction.com/vertigo or www.vestibular.org/support-groups.php

 

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