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Balance/Vertigo

Dizziness and loss of balance can be caused by a multitude of causes such as heart, thyroid or brain disorders but vertigo – a feeling of either your surroundings moving around you, or you moving in relation to your surroundings – is usually linked to problems with the inner ear and its balance organ.

What is vertigo?

Balance is dependent on three different bodily functions that give information to the brain – one of these is the balance organ (also called the labyrinth) in the inner ear. It is made of three semicircular canals and the vestibule, all filled with liquid; the canal senses rotational movement and the vestibule senses acceleration and deceleration.

What causes it and what are the associated problems?

Vertigo and balance problems can be caused by a number of factors and Mr Fayad will usually determine which factor based on the duration of the dizzy spells the patients is suffering.

Short episodes of a few seconds to a minute
Most of the time the patient feels normal but can have short spells of dizziness, usually when the patient suddenly looks upwards or sideways. This is probably caused by a small piece of the inner lining coming loose and affecting the messages sent to the brain. Often there can be no obvious cause, although it can be as a result of whiplash or head injury, and for most people it usually disappears with time.

Medium episodes of half an hour to several hours
This is more rare and is thought to be caused by an increase in pressure of the fluid in the inner ear. Menière’s disease results in episodes of severe vertigo that can last up to several hours. Dizzy episodes are usually linked with vomiting, and the sufferer can often tell an episode is about to start because he or she notices a drop in their hearing, a feeling of fullness in the ear and some tinnitus. The hearing recovers once the vertigo has settled, but may gradually deteriorate with time.

Longer episodes of dizziness that last from days to weeks
An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks.

Again, the initial episode is often associated with vomiting and the patient can be bed-bound because the dizziness is so severe.

What are your treatment options for vertigo?

If you suffer from vertigo due to inner ear problems, be assured that 99 per cent of people will recover with time and without any treatment. If Mr Fayad thinks it is necessary to do a more in-depth investigation into the cause of vertigo, the tests may include hearing, balance or blood tests and MRI or CT scans.

There are some specifically targeted exercises that can help speed up the brain’s natural compensation after inner ear disease and Mr Fayad may prescribe a rehab programme to follow, which can be organised either by an ENT or physiotherapy department.

Short episodes of a few seconds to a minute
There are medicines that can be prescribed that help, but Mr Fayad may also perform a simple but effective repositioning procedure called Epley’s Manoeuvre.

Medium episodes of  half an hour to several hours
Treatment of Menière’s disease usually start with a vestibular sedative such as Stemetil which will help reduce the feeling of dizziness and any vomiting when experiencing an attack. The second part of treatment is to reduce the frequency of the episodes. Restricting intake of salt, caffeine and alcohol can help. Increasing the bloodflow of the inner ear may help and so drugs like Betahistine (Serc) are often prescribed. Some people with Menière’s disease may benefit from surgery if the episodes of vertigo are frequent and disabling and do not respond to medical treatment.

Longer episodes of dizziness that last from days to weeks
This is best treated at first with a vestibular sedative such as Stemetil, which reduces the over-activity of the balance organ and so reduces the dizziness and vomiting. However, any treatment should be stopped quite quickly to allow the brain to compensate and recover from the dizziness. Recovery is much quicker in the long run if treatment with anti-dizziness medicine is not prolonged.

Surgical treatments
If other medical treatments prove ineffective and the vertigo is disabling, then surgery may be an option. The options range from the insertion of a grommet, to procedures which completely destroy the inner ear, or divide the nerves from the inner ear to the brain. This will often also destroy hearing in that ear, so this is usually only offered when the vertigo is unusually severe. Mr Fayad will be able to go through all the surgical options in detail during the consultation.

New treatments
New treatments are continually being developed for long-term vertigo sufferers and Mr Fayad has seen very encouraging progress being made using drugs, delivered directly into the ear, that selectively destroy the inner ear balance without affecting hearing.

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