Suite 304 RPA Medical Centre, 100 Carillon Avenue, Newtown NSW 2042
BPV is the most common and easily treatable causes of dizziness worldwide. BPV causes a short spell of spinning vertigo during specific head movements (usually when rolling over in bed, or bending over). These vertigo attacks only last seconds to minutes, rarely longer. This type of vertigo is caused by naturally occurring inner-ear "crystals" or otoconia . These otoconia are microscopic calcium carbonate particles that belong on our gravity sensing organs, but can sometimes break away and fall into the semicircular canals. Whenever the head moves in particular directions, these otoconia move within the duct of the semicircular canals producing the sensation of spinning. This condition is diagnosed by positional testing and concurrently observing the eyes for nystagmus (specific 'dizzy' eye movements). It is easily treated with a physical exercise specific to the type of BPV. Patients who are proven to have BPV and able to identify the affected ear accurately, could be taught to perform the appropriate manoeuvre at home.
Vestibular Migraine (VM) is a common cause of recurrent spinning, rocking or tilting vertigo, with or without headaches. The vertigo could be spontaneous or positional, can last minutes to hours, and could be associated with nausea and sometimes vomiting. Motion-sensitivity and dislike of sudden head movements is common among VM sufferers ('head motion intolerance'). Medications, physical therapies to reduce head motion intolerance and measures to minimize anxiety are useful interventions that help control VM.
Ménière's Disease is a rare but treatable cause of recurrent spinning vertigo associated with tinnitus, a feeling of fullness in the ear (may feel like water or cotton in the ear) and fluctuating hearing loss in one ear.
These signs are caused by an abnormal build-up of fluid in the inner ear. During the initial stage of the disease, only some of the typical symptoms may be noticed. The disease usually affects only one ear, but can sometimes (rarely) affect both ears. The disease will eventually "burn out" after which time there are no more vertigo attacks. A low-salt diet, medications like diuretics or betahistine are used to control the frequency and severity of vertigo. The diagnosis can be assisted by Audiometry, VEMPs, Caloric testing and Electrocochleography.
A low-salt diet or medications like diuretics or betahistine are used to control the frequency and severity of vertigo; an excellent resource for information and purchasing low-salt foods can be found at www.lowsodiumfoods.com.au
Vestibular Neuritis (VN) is a single episode of disabling vertigo, most commonly attributed to a virus. It causes sudden, severe spinning vertigo which can last for hours to days resulting in severe nausea and vomiting. The diagnosis can be confirmed with VEMP, VHIT and Audiometry tests. VN may result in profound motion-sensitivity and imbalance for several days or weeks. Most individuals make a full recovery, although it is significantly helped by maintaining physical activity and undertaking balance physiotherapy (vestibular rehabilitation) starting immediately after the attack.
A Vestibular Schwannoma (previously called Acoustic Neuroma) is a benign, slow-growing tumor of the balance nerve. The name "Schwannoma" comes from the name of the cells (Schwann cells) which cover the nerve. The initial symptoms may include one-sided hearing loss, one-sided tinnitus (ringing in the ear), and sometimes mild imbalance. An MRI scan with views of the internal acoustic meati is the test of choice for diagnosis. Once diagnosed, the management of a schwannoma may be conservative or involve an intervention. Where the tumor is small, its growth is monitored with repeat imaging and balance function tests. Tumors that are medium to large may require surgical removal or radiotherapy. Physical therapies play a vital role in helping post surgical patients to optimise their balance.
Superior Canal Dehiscence (SCD) is a disorder caused by a defect in the bony roof that covers the superior semicircular canal. The auditory (hearing) symptoms of SCD may include hearing that is "better than normal" or "ultra-sensitive". Some sounds that are generally imperceptible or barely perceptible (heart beat, eye-movement, chewing, heel strike upon walking) may be easily audible when an SCD is present. Other vestibular (balance) symptoms may include short spells of dizziness or visual blurring or jiggling vision triggered by a loud sound, or pressure changes when sneezing, blowing your nose, coughing or straining. Some patients have no symptoms at all and are incidentally detected during testing. The diagnosis is made based upon the history, examination, a thin slice CT of the temporal bones, VEMP and Audiometry.
Vestibular Paroxysmia is a recurring, short attack of dizziness usually lasting less than 30 seconds, caused by an irritation to the balance nerve. The vertigo spells can occur at rest but can also be caused by sudden head movements such as turning the head or bending over. An MRI scan can sometimes help to confirm the cause: for example an arterial loop that periodically presses on the balance nerve. Vestibular function tests may indicate dysfunction affecting one side.
Psychophysical Vertigo Syndrome is a set of symptoms that can begin for no particular reason, or can begin after a stressful event or a traumatic vestibular event (like an inner ear infection or virus). This syndrome causes recurring dizziness or light-headedness, but usually not true spinning vertigo. Other symptoms may include; a constant rocking or tilting feeling, unsteadiness when walking or a feeling of being pulled to one side, feeling that the ground is moving or unstable, "fogginess" or "heaviness" of the head, dizziness after sudden head movements, feeling overly tired, tingling on the head or face, nausea, headaches, tinnitus (ringing in the ears), tightness or aching neck, throat or jaw, agitation or difficulty relaxing. Although inner-ear balance function test results are undertaken to exclude other causes of vertigo, they are often normal.