Inner Ear And Vertigo Q&A
Explain a little about the inner ear and balance problems.
In the inner ear, there is the hearing portion and the balance portion and the problem is in the balance portion. The structure is totally surrounded by bone and it’s about the size of your fingernail, so it’s very small. You have one on each side of your head. What happens in this problem is that structures called the canals are filled with fluid and normally detect head movement so when you turn your head and make what we call angular acceleration, you make a head turn, these detect that motion and that information is used to keep your balance and to keep your eyes steady in space. Two structures called the modiolus have in them calcium carbonate crystals. These structures primarily detect the pull of gravity so if you tilt your head they detect that head tilt. If you move in a straight plane they detect that motion. The calcium carbonate crystals are constantly being broken down and regenerated and what can happen sometimes we believe, is that they break off in a larger clump than they should or in some way the crystals end up in one of the canals. When the crystals are in the canal they make that canal sensitive to the pull of gravity. So when the person is sitting upright there is no problem but if the person lies down gravity pulls on those crystals, causes them to move that in turn excites the neurons from the canal and the person feels as if they are spinning. It is fairly brief because once the debris has stopped moving the stimulus goes away, but it’s a very potent stimulus.
What is that called when that happens?
The term that describes the presence of debris in the canal is called canal labyrinthitis, which means stones in the canal. The other possibility is there is a structure that is a receptor area called the cupula and that the stones or calcium crystals can adhere there and then it’s called cupulolithiasis stones on the cupula. Either one can cause a problem.
Once the debris is in the ear and you know you have that problem what is the treatment?
The idea of the treatments is to move the head in a way that will shift the debris through the canal. It moves it out of the canal back into the part of the inner ear where it won’t cause the vertigo. In reality what’s involved is having the patient lie down into a certain position, keeping them there for a brief period of time and then changing the head position so that the debris moves until you finally have moved the debris totally through the canal system back into what’s called the vestibule, the central area of the inner ear. There are two techniques that can be used. One was developed by a physical therapist in France, and the other was developed by an otolaryngologist in Portland, Oregon. In this country we use the canal lithiasis repositioning maneuver.
How long are treatments?
Treatment takes probably a total of ten minutes from start to finish.
How many times?
This is the fun part, in eighty five percent of the cases one treatment is all that it takes to get rid of the problem. The patient is vertigo free with a single treatment. The other fifteen percent we have to work harder on but it’s unusual not to be able to get relief from the problem.
What are some of the symptoms that people should look for?
The primary one is brief periods of vertigo when the person moves their head a certain way. Now it’s not during the movement as much as when the head is in a certain position.
Explain what vertigo is.
Vertigo is a sensation or illusion that the world is moving and most commonly is a spinning sensation. Sort of like being on a carousel when everything is whirling around you. Only it’s happening without any apparent reason. Along with that people can have some nausea, they can vomit and they often have balance problems as well along with that. Most patients will tell you that they experience it when they lie down at night or when they roll in bed. They wake up in the morning the alarm clock comes on, they turn their head and as they turn the clock off they start to spin. Or they go to a beauty parlor or the dentist and they lie down. Some patients will say they are shopping and they reach up for something above their head and they tilt their head up and that is enough to cause the debris to move and cause them to spin.
How long does that last?
Less than a minute.
What type of reaction do they usually have when that’s going on?
People grab hold because it is totally disorienting. They often close their eyes automatically, some of them scream, some of them wave their arms around. But most often you just grab hold and just try to brace yourself waiting for it to stop. It helps a little bit if they know what’s happening. Once the disorder has been identified and they understand what’s going on it is not as frightening. It is very frightening when you don’t know what’s going on.