- The Washington Times - Monday, June 19, 2006

One morning last October David Magnant had a problem getting out of bed and walking.

“I stumbled along. I balanced myself against a piece of furniture,” says Mr. Magnant, 58, about his symptoms of vertigo and imbalance, which lasted for a couple of minutes, then disappeared.

The symptoms continued each morning and when he laid down at night or moved his head in certain positions. His primary care physician sent him to Dr. Howard Hessan, an otolaryngologist and chief of otolaryngology at Howard County General Hospital in Columbia, Md. Otolaryngologists, commonly known as ear, nose and throat doctors or ENTs, treat diseases and disorders of the ear, nose and throat, including problems with the sinuses and inner ear.

Dr. Hessan diagnosed Mr. Magnant, a Howard County, Md., resident, with benign paroxysmal positional vertigo, or BPPV, which causes vertigo with movement or changes of position of the head. Mr. Magnant was treated with a 45-minute, in-office procedure that was able to restore his balance.

“I was absolutely amazed,” Mr. Magnant says. “It’s like I never experienced the problem.”

The classic definition of vertigo is a spinning or rotating sensation inside a patient’s body or a sensation that causes the environment around the patient to seem to move when it isn’t, says Dr. Jeffrey Kim, an otolaryngologist specializing in neurotology at the Georgetown University Medical Center in Northwest. Neurotology is a subspecialty of otolaryngology dedicated to inner ear disorders.

Dizziness, a broad term that includes vertigo, refers to anything from lightheadedness to a feeling of faintness.

“The common complaint that is often cited is called dizziness. That is a very vague, not well-understood term that is not terrific for diagnosis,” says Christopher Platt, program director of the balance and vestibular program at the National Institute on Deafness and Other Communication Disorders (NIDCD) in Bethesda. NIDCD supports clinical research, vertigo-inducing experiments and other research and studies on vertigo.

“Vertigo is a more specific diagnosis,” says Mr. Platt, who holds a doctorate in marine biology.

Vertigo can be a symptom of a migraine headache, a brain tumor, or a heart, circulation or neurological problem, along with a side effect of some medications. It can be associated with various inner ear problems, as can hearing loss, a feeling of fullness or clogging in the ear, and tinnitus, or ringing or buzzing in the ear.

“A function of the inner ear is to tell us where we are relative to the environment. When you move your head, you stimulate your inner ear to tell you where you are,” Dr. Kim says. “If that function is not normal, it causes dizziness.”

The inner ear houses the hearing and balance apparatuses, but when infected or damaged by disease, the inner ear can send false signals to the brain about movement or balance, says Lisa Haven, executive director of the Vestibular Disorders Association (VEDA), an organization based in Portland, Ore., that provides access to information, offers a support network and increases awareness of vestibular, or balance, disorders.

“This is an invisible illness to other people,” Ms. Haven says about vestibular disorders.

Eighty percent of vertigo comes from inner ear disorders, the most common of which is BPPV, also a vestibular disorder, according to metro-area otolaryngologists.

Three semicircular canals in the ear, which are oriented at 90 degrees to one another, have fluid in them and nerve hairs that send messages of movement, Ms. Haven says. Disease or head injury can cause the microscopic calcium carbonate crystals on the hairs called otoliths to break off and bounce around, giving the brain a false sense of movement, she says.

The crystals function to help the inner ear detect gravity, says Dr. Lloyd Minor, otolaryngologist for Johns Hopkins School of Medicine in Baltimore.

“The inner ear is always giving the brain signals of the position of the head relative to gravity,” he says.

BPPV is treated with an in-office procedure that uses a series of head and body maneuvers to relocate the problematic crystals from one area of the ear to another where they can do less damage, Dr. Kim says. The method, he says, is 90 percent effective.

Vertigo symptoms last less than a minute with BPPV and 20 minutes to a few hours in the case of Meniere’s disease, another vestibular disorder, Dr. Kim says.

Meniere’s disease results from a buildup of fluid in the inner ear of one or both ears, causing episodes of vertigo, fluctuating hearing loss, ear fullness and tinnitus.

“The fluid normally produced and reabsorbed by the inner ear begins to increase in volume and pressure in the inner ear,” says Dr. Dennis Fitzgerald, neurotologist for the Capital Ear Group, LLC, in Northwest.

Meniere’s disease is manageable, but not curable, Dr. Fitzgerald says. It typically is treated with a low-salt diet and diuretics to reduce pressure of the fluid in the inner ear, a method that has been found to be 80 percent effective, he says. Other options include surgery and injections that destroy the sensory fibers of the inner ear’s balance system, thereby reducing the number of vertigo attacks, he says.

“For the most part, what we try to do is manage the symptoms,” Dr. Hessan says.

Patients complaining of vertigo or dizziness may first be diagnosed with a magnetic resonance imagining (MRI) scan and blood tests to rule out the possibility of benign growths, tumors, diseases and infections as the cause, Dr. Kim says. If the inner ear is suspected, the patient will be sent to an otolaryngologist or other ear specialist for hearing tests to check for hearing loss and balance tests, he says.

The most common balance test is the electronystagography (ENG), which measures abnormal eye movement and improper responses to stimulation of the ear from cool and warm air, Dr. Kim says. The eye normally experiences nystagmus, or eye jerking or twitching, when looking outside the visual field, but inner ear problems can cause the eye to respond in that manner when looking straight ahead or to move improperly when responding to various stimuli.

Vertigo is not a serious or life-threatening condition, Dr. Hessan says. “Though it has an effect on your day-to-day life.”

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