|
This article appeared in The Home News Tribune, 50+ section…Your Health.
July 2006
Dizziness: a Common but Treatable Problem
By Dr. Paul Abend
My patient feels dizzy, especially when he moves his head. He feels nauseous. An avid bowler, he has given up the sport he loves because of the dizziness.
Dizziness is a broad term that describes a number of different feelings. To some it can feel like the room is spinning. Other people use the word to describe feeling lightheaded, as if floating. Still others say they feel wobbly and unsteady, as if they’re on a moving boat. Dizziness is also a big reason people see their doctors. It’s estimated that more than half the population will experience dizziness or a balance problem during their lifetime. The good news is that the cause of these feelings can be diagnosed and, in most cases, treated effectively. That’s especially important because dizziness is one of the leading causes of falls, which can have devastating consequences in older patients.
Dizziness can be a very frustrating for both doctors and patients. Many conditions can cause dizziness. Some of those conditions include hardening or narrowing of the carotid arteries leading to the brain. That narrowing decreases blood flow.
A tumor on the nerve from the inner ear to the brain can also cause dizziness, as can Ménière's disease, an abnormal accumulation of fluid in the inner ear. Another cause of dizziness can be osteoarthritis, a joint disease. Openings in the neck vertebrae contain arteries that supply the brain with blood. When these openings narrow as a result of osteoarthritis, blood flow is restricted, resulting in dizziness.
Yet another cause of dizziness is benign paroxysmal positional vertigo or BPPV. This occurs when small particles or crystals within the semicircular canals of the inner ear become detached from their normal location and interfere with the normal function of the vestibular system, or the balance system in the inner ear.
Because dizziness can be caused by so many things, patients generally bounce from one specialist to another in search of answers. Many just give up and try to live with it. The Balance Center at Robert Wood Johnson University Hospital Rahway was created to diagnose and treat dizziness and balance disorders in one location, ending the bouncing from one physician’s office to another.
At our Center, we start with a complete health history and physical exam. Depending on history and symptoms, we might order a series of tests that could include an MRI. Depending on the suspected type of balance abnormality, we may perform a series of tests called electronystagmography or ENG. One of those tests is a nystagmography, designed to document a patient’s ability to follow visual objects with the eyes and how the eyes respond to some types of information from the inner ear. Eye movement tests are useful because some patients with balance problems have problems seeing clearly when moving or get the false sense that objects are moving.
If the diagnosis is paroxysmal positional vertigo or BPPV, the treatment plan is a repositioning therapy that is both simple and effective. BPPV is a problem of the inner ear’s gravity perception mechanism. Within the semicircular canals in the inner ear are small crystals. Normally, these crystals rest on a membrane that allows the brain to perceive gravity. With BPPV, the crystals dislodge and float around in the canals. This causes an aberration in the brain’s gravity perception, which produces a spinning sensation. BPPV treatment involves special repositioning of the head so the crystals move back to their normal position.
It turns out that my patient had BPPV and he received two sessions of vestibular-repositioning therapy. By the second session, his symptoms had resolved completely. He no longer felt dizzy and nauseous and was able to resume the sport that he loved.
Dr. Paul Abend is Medical Director of The Balance Center at Robert Wood Johnson University Hospital Rahway, where he also is Associate Director of the Department of Physical Medicine and Rehabilitation and Medical Director of Inpatient and Outpatient Rehab Services. He is a Fellow of the American Academy of Physical Medicine and Rehabilitation and Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, Kessler Institute, UMDNJ-New Jersey Medical School. He is past president of the New Jersey Society of Physical Medicine Rehabilitation.
|
|
