Spin Control

Gayda Jackson was visiting a cathedral in Avignon, France, while on holiday last year when she was suddenly unable to keep her balance enough to walk or even stand. To Jackson, then 68, the room seemed to be spinning – a sensation she’d never experienced before. Somebody called an ambulance, but when the paramedics checked Jackson’s vital signs, all was well.

Later that same week, Jackson was overcome by another wave of violent vertigo. “I stumbled towards my husband, who was in a café next door,” she says. “He called a waiter to give me water, and I sat there for a few minutes until I felt better.”

Back home after her two-week trip abroad, Jackson endured two more spells within a 24-hour period. She called an ambulance and, once at the hospital, was given an intravenous drip to prevent vomiting (she was struggling with severe nausea). “I had no idea what was wrong with me and I was terrified,” she recalls. Then, a few weeks after they’d begun, her vertigo attacks suddenly ceased. While Jackson’s family doctor couldn’t confirm what had caused the attacks, she was confident her patient was perfectly healthy.

According to a 2015 University College London systematic review of 20 previous studies, up to one-tenth of the global adult population will develop vertigo at some point; between 17 and 30 per cent will experience dizziness. (These numbers refer to people who have significant dizziness or vertigo, not just the fleeting discombobulating after-effects of riding a roller coaster or watching a 3D movie.)

Medically speaking, vertigo means that your perception of your body’s movement doesn’t line up with reality. What Jackson experienced was called ‘external vertigo’: when she had the sense that she was inside a spinning cathedral, her surroundings seemed to be moving, not her body itself. Dizziness, on the other hand, refers to spatial disorientation without a false or distorted sense of motion. It might involve unsteadiness or feeling faint.

There are dozens of possible causes for dizziness or vertigo, such as low blood glucose, drug-related side effects, dehydration or a stroke. (In the case of a stroke, dizziness is often accompanied by other symptoms, such as slurred speech or sudden numbness in the face, arms or legs, and immediate medical attention is recommended.)

Frequently, however, the problem is rooted in the inner ear’s vestibular system, which is essential for balance and orientation. Its components detect the head’s movements and how those relate to the pull of gravity. The system sends this information to the brain, helping you to stabilise your gaze and move around without falling over.

Like vision and hearing, the vestibular sense can decline with age. According to a 2009 estimate published in Archives of Internal Medicine and based on a sample of more than 5000 Americans, around 35 per cent of adults over age 40 experience dysfunction in this system.

A Common Culprit Is BPPV

One of the most frequently diagnosed vestibular conditions is benign paroxysmal positional vertigo (BPPV). There are tiny bits of calcium, called otoliths, that roll around in the inner ear, pushing on sensory hair cells. BPPV starts when one of those bits breaks loose. The dislodged calcium floats about, stimulating receptors that monitor the movement of inner-ear fluid and sending confusing messages to the brain. The result: bothersome spells of vertigo that typically last for a few minutes or less.

BPPV tends to go away within a few weeks or months, possibly because the calcium crystal is dissolved into the inner-ear fluid. If the condition doesn’t resolve, it can usually be cured by quick, painless treatments that involve repositioning the particle. The most studied approach is the Epley manoeuvre, which results in immediate relief in 70 to 80 per cent of cases. With this technique, the doctor moves the patient’s head into certain positions – 45 degrees towards the affected side, for instance – that are each held for 30 seconds or so. The goal is to slide debris out of the ear fluid and into another area, where it won’t cause trouble.

For reasons that aren’t entirely clear, there’s a good chance BPPV will come back: estimates of the recurrence rate have ranged as high as 50 per cent over three years. The good news: repeating the Epley manoeuvre will probably solve the problem again.

While particle repositioning is simple enough to perform by yourself at home, neurologist Dr Alexandre Bisdorff cautions that you should confirm a diagnosis first, in case you’re overlooking a more serious problem. In situations where this non-invasive particle treatment doesn’t work after repeated attempts, surgery may be the way forward.

Chronic Disorders

Not every vestibular problem can be solved as readily as BPPV. When Melanie Simms developed dizziness and an earache in August 2007, it was only the beginning of a frustrating medical ordeal. The then 20-year-old student from Yorkshire, England, was told she had an inner-ear infection. The symptoms should have stopped once Simms’s immune system killed off the virus, but in this case, there was lasting damage.

“For about a year, I kept telling my doctors I wasn’t getting better,” Simms recalls. Stimulating settings, such as the supermarket, left her nearly debilitated; at times, she needed another person’s help to walk. Finally, during an appointment in 2009, an otolaryngologist asked, “When the car stops, does it feel like it’s still moving?” Simms was overcome with relief that somebody seemed to grasp her condition.

She was diagnosed with uncompensated vestibular neuritis, one of several disorders that cause dizziness or vertigo on an ongoing basis. (Another one is Ménière’s disease, which results from an abnormal amount of fluid in the ear and may also trigger tinnitus and hearing loss.) While there isn’t always a cure for chronic vestibular disorders, treatments can minimise symptoms. Depending on the diagnosis, these might include medications, surgeries and vestibular rehabilitation therapy (VRT), which is based on exercises.

VRT can be tailored to specific complaints, according to Lena Kollén, a vestibular physiotherapist in Gothenburg, Sweden. She and her colleagues design plans that involve a patient’s entire balance system. “These could include anything from head movements to balancing in one place with your eyes closed,” she says. For Simms, it initially meant moving her chin up and down while focusing her gaze – first on a static pattern, then on the TV. The hope is that the brain will slowly learn to compensate for imperfections in the signals it receives by learning to rely on other senses, such as vision and touch, for orientation.

Earlier this year, Simms finished attending VRT sessions. She’s now able to work as a hospital receptionist four days a week. She also helps run the Yorkshire Balance Support Group. One of this organisation’s aims is to increase awareness of vestibular disorders so fewer patients will suffer needlessly and instead get the treatment they need. “A lot of people feel afraid and alone because they don’t know what’s happening,” says Simms. “But these conditions are more common than you’d think.”

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