A Dizzying Problem

Once properly diagnosed, vertigo or dizziness caused by the inner ear can be successfully treated in most cases

Your favorite room in the house can suddenly become the most hated—if it starts spinning. That’s called vertigo.

This sometimes bothersome, sometimes frightening sensation is usually brief, but not always. In more protracted cases, it is incapacitating and can increase the chance of falling. Inner ear disease is the most common cause of vertigo, but before considering treatment, other causes of dizziness must first be eliminated as possibilities. Vertigo is only one type of dizziness.

How Is Vertigo Diagnosed?

“Many people use the words dizziness and vertigo interchangeably,” explains otolaryngologist Robert Logan, MD, of Georgia Ear, Nose & Throat Specialists. “However, when we speak of vertigo that means there is a sensation of motion, while dizziness could mean lightheadedness, a drunken feeling and imbalance.”

A thorough medical history and physical examination of the patient is always the starting point in the diagnosis and treatment of vertigo.  

Dr. Logan also, if necessary, refers patients for diagnostic testing at St. Joseph’s/Candler’s Center for Oto-Neurology.

“Vertigo can be documented with videonystagmography, or VNG,” says Dr. Logan. (Learn more here.) “Patients may also need other tests, including an MRI of the head.”

The history, exam, and testing is needed to eliminate other possible causes of vertigo and dizziness such as a head injury, medication interaction, anemia, or cardiac arrhythmia. Dizziness can also be present in a variety of conditions including diabetes or migraines.  But one of the most common types of vertigo that ENT physicians see is benign paroxysmal positional vertigo, or BPPV.

What Is BPPV?

Benign paroxysmal positional vertigo causes patients to feel that they are spinning or that the room is spinning around them. It usually happens when the person has changed the position of their head, such as when they turn over or sit up in bed.

Inside the ear, there are three semicircular canals that contain fluid and hair-like sensors that provide information to the brain about your head movements. Meanwhile, other balance structures in the inner ear, called otolith organs, contain microscopic crystals of calcium carbonate. These crystals help the brain perceive gravity, but if they become dislodged and move into the semicircular canals, the result is BPPV.

Head trauma, colds or inner ear infections are some of the possible causes of the crystals becoming dislodged.

“BPPV can affect people of all ages, but is typically seen in older patients, age 50 or above,” explains Michael Zoller, MD, an otolaryngologist at ENT Associates of Savannah. “In many cases, a cause can’t be found. This is called idiopathic BPPV.”

Particle Repositioning

BPPV also have different types which can determine what kind of treatment plan is most effective. For many cases, patients receive what is called an Epley procedure. This procedure repositions the dislodged particles through a series of guided head movements performed on the patient by physicians or by physical therapists trained in vestibular rehabilitation.  

For certain patients, Dr. Zoller will recommend the Vestibular Rehabilitation program at St. Joseph’s/Candler, which has seen a success rate of more than 95 percent with particle repositioning. Some patients may need more than one session, but the treatment only takes about 15 minutes. 

“BPPV comes and goes quickly but it can be scary, especially for the elderly who live alone,” Dr. Zoller says. “Sometimes they may fear they are having a stroke. But most commonly, when the room is spinning and they have nausea, it is due to BPPV. Fortunately, once we confirm this diagnosis, a short and simple procedure will usually fix the problem.”

Testing Center

For more than 40 years, St. Joseph’s/Candler’s Center for Oto-Neurology has provided the most advanced diagnostics and therapy for ear, hearing, balance, speech/language and central nervous system disorders.

The center helps diagnose conditions such as vertigo with videonystagmography (VNG) and the Equitest.

The eyes and ears communicate information about balance to the brain.  The VNG provides information about how the inner ear balance system functions by measuring how the eyes move in different conditions. Patients are asked to follow a dot on a screen, which moves unpredictably. The goggles also record eye movements as the patient moves into different body and head positions. Lastly, the test activates each ear’s balance system separately by caloric stimulation—a small amount of cold water gently delivered into each ear, then the same with warm water, as the patient’s eye movements are recorded.

For the Equitest, patients stand upright in a special harness. The platform can create and detect small movements by the patient as they maintain their balance. The Equitest helps to assess both sensory and motor function in patients dealing with imbalance.

“The diagnostic audiological and vestibular tests are important for determining if the inner ear is affected and contributing to the symptoms of vertigo, dizziness and imbalance,” says clinical audiologist Shea Stromberg. She and the staff at the Center provide these and other tests in one place. “The results of the tests are used to develop an effective intervention program.”

The Center for Oto-Neurology offers a variety of other diagnostic tests, including:

Comprehensive Audiological Evaluations:  A series of hearing tests to determine the type and degree of a hearing problem in a patient.

Auditory Brainstem Response (ABR): Evaluates hearing loss using a computer to check the pathway from ear to brainstem. The pediatric ABR can detect hearing loss in newborns and children.

Ambulatory Electroencephalogram (EEG):  Records electrical impulses in the brain continuously while a patient goes about normal activities.

Somatosensory Evoked Potentials (SER):  Evaluates the brain's response to brief electrical pulses, which are applied to peripheral nerves.

Visual Evoked Response (VER): Measures the time it takes for a televised image to go from your eyes through the brain's occipital lobe.

To learn more about other testing, appointments, or physician referrals to the Center for Oto-Neurology, call 912-819-2479 or visit www.sjchs.org/oto-neuro