Vertigo and Dizziness

Vertigo

The patient reports of attacks that include a sensation of spinning as the main symptom. During the Vertigo attack the patient may feel that the head is spinning or the environment is moving.vertigo bppv

The duration of the event is few minutes to few hours. In severe cases it lasts more then one day. Between vertigo attacks the patient is afraid of falling during the next episode.

Dizziness

The patient reports of attacks that include a sensation of unsteadiness or imbalance or disorientation in space as the main symptom.

During the Dizziness attack the patient does not feel that the head is spinning or the environment is moving. The duration of the event is few seconds to few minutes. Between dizziness attacks the patient is afraid of falling during the next episode.

Treatment Options

Treatments in Otolaryngology (ENT)

Treatment should be given to patients that underwent a comprehensive evaluation of their auditory and vestibular systems by an ENT specialist. The most common treatments are physiotherapy, H2-Blockers and psychotherapy.

My Medical Approach

The treatment program in this clinic based on clinical studies started in 1981 as a co-production between the Israeli Defence Forces (IDF) and The Hadassah Hospital, Jerusalem.

The treatment objective is directed towards creating a normal metabolic environment around the nerve cells in the auditory and vestibular systems. Such environment enables the "Curative Mechanisms" to initiate regeneration in a case of mild damage to the neurons.

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Causes of Vertigo or Dizziness and Diagnostic tests

The cause, in most cases, is unknown. A comprehensive Otto-neurological assessment should be conducted in order to rule out tumors, blood vessels abnormality or "canal paresis" in one or more of the semi-circular canals. Audiograms (Hearing test), Imaging (CT, MRI), ENG or Posturography (see: Glossary) may help.

Statistics

About 40–60% of the population under 60 years suffers from vertigo or dizziness from time to time. In older population it is more common.

Examples of treatments

The most common treatments are physiotherapy, H2-Blockers and psychotherapy. The Metabolic Intervention is reserved for the severe cases.

The vestibular system

The vestibular organ

Oversimplification of the vestibular system presents it as a system of two parts: (1) the peripheral part inside the inner ear. (2) The central part in the central nervous system. Input from the visual system and skeletal muscles are important contributing factors, but it is easier to focus on the oversimplified model. The vestibular organ is the mainvastibular system  vertigo treatment part of the peripheral part, and is the major contributor to our balance and our sense of spatial orientation. It is the sensory system that provides the dominant input about movement and perception of equilibrium. The vestibular organ together with the cochlea, that is a part of the auditory system, constitutes the labyrinth of the inner ear. It is situated in the vestibulum that is the main part of the inner ear. Our movements consist of two kinematic types: rotations or curvilinear type of motion and linear or rectilinear type of motion that is called also accelerations.

The vestibular system comprises two components: the semicircular canal system, which indicate rotational movements, and the otoliths, which indicate linear accelerations. The neurons of the vestibular system sends processed signals primarily to the neural structures that control the human eye movements, and to the muscles that keep people standing in erect position. The projections to the former provide the anatomical basis of the vestibulo ocular reflex, which is required for clear vision, and the projections to the muscles that control our posture are necessary to keep us upright. The semicircular canal system is the specific peripheral organ for the detection and quantification of rotational movements.

The semicircular canals are the main tool to achieve this aim. The three semicircular canals include: (1) the lateral canal. (2) The superior canal. (3) the inferior arches. They may be called also horizontal, anterior and posterior canals. Rotational movement of the head in erect position of the body generates flow of the liquid within the horizontal semicircular canal. The liquid inside the anterior and posterior semicircular canals flows as a response to movement of the head in the sagittal plane. The movement of fluid activates a biological transducer called cupula. It contains hair cells that converts the mechanical energy of sound waves to electrical signals.

The activity of the canals is arranged in pairs. There is a mid line symmetry, and every canal on the left side has an almost parallel counterpart on the right side. When a semicircular canal on the right side is stimulated by the movement of fluid, the biological transduction on its corresponding canal on the left side is inhibited. This pattern of action is called a push-pull way. Vertical canals are coupled in a crossed activity. It means that movements fluid that generates excitatory activity of the posterior semicircular canal are also inhibitory for the contralateral anterior semicircular canal, and vice versa.

The same applies to the other pairs of the semicircular canals. The vestibular system takes important part in the generation of the vestibulo ocular reflex. This term means a reflex eye movement that stabilizes images on the retina during head movement. The mechanism of action is activation of the relevant eye muscles that move the eye ball in the direction opposite to head movement. It is done in synchronization with the vision stimuli and enables to preserve the image on the center of the visual field. When the head moves to one side, the eyes move to other side, and vice versa. Slight head movements are present all the time, even in people who do not suffer from medical conditions that involve the nerve supply to muscles.

The vestibulo ocular reflex is a main factor in stabilizing vision. Patients who suffer from pathology that affects the vestibulo ocular reflex have difficulties to read, because they cannot achieve a stable picture of their visual field. The mysterious phenomenon is that the vestibulo ocular reflex is not dependent on visual input. It works even in complete darkness or when the eyes of a person are closed.

Otolytic organ

The otolithic organs detect linear accelerations (positive accelerations) and linear decelerations (negative accelerations). We have two peripheral organs for sensing the linear accelerations on every side of the skull. One called utricle and the other is called saccule. The crystals in the otoconia layer rest on a viscous gel layer. The otoconia crystals are heavier than their microenvironent. The process of transduction from the mechanical energy of acceleration to the electrical is due to the linear acceleration of the crystals, which in turn deflects the ciliary bundles of the hair cells to produce a sensory electrochemical signal. The utricular impulses usually produce eye movements, while saccular impulses usually produces control of muscles that determines our posture. The signals of linear acceleration should be processed in order to distinguish between acceleration of gravity and other causes of linear acceleration.

Common pathologies

Diseases of the vestibular system in the broad sense (central and peripheral) include various symptoms among them are vertigo and instability, often accompanied by nausea and vomiting. In a healthy person various types of motion sickness such as sea sickness, air sickness or so called "entertaining machines" (Ferris Wheel, Roller Coaster) may cause similar symptoms. The most common medical condition is vestibular neuritis. A related condition called labirintitis and benign paroxysmal positional vertigo. Among the typical symptoms are vertigo, dizziness and nystagmus in certain head positions. In addition, the function of the vestibular system can be modified by space occupying lesions on the vestibulo cochlear nerve, brain stem pathology such as infarct, lesions in cortical regions related to the processing of vestibular signals, and cerebellar degeneration. Alcohol is a common cause of transient disequilibrium due to its effect on the vestibular system. Vertigo and possibly nystagmus are part of the clinical picture, but the basis for the diagnosis is usually the strong smell of alcoholic drink that is exhaled from the respiratory system of the happy patient. Vestibular cortex is the final common pathway for the input from the peripheral part of the vestibular system. The location is not clearly defined, but there are evidence for a right hemisphere dominance. Pathologies of the vestibular nucleus impair the vestibular function of the patient. The temporo peri sylvian vestibular cortex has been proposed as the main cortical area for the vestibular system in humans.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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