Self care tips for vertigo

If you experience dizziness associated with BPPV, consider these tips:
Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
Sit or lie down immediately when you feel dizzy.
Avoid sleeping on the side of your affected ear.
When getting out of bed, do so slowly. Sit on the edge of the bed for a minute.
Avoid bending down to pick something up. Don't extend your head back, such as when getting something from an upper cabinet.
Be careful when getting up from lying back at the dentist's office, beauty parlor or barbershop, or during activities, such as yoga or massage.
Use two or more pillows at night to avoid lying completely flat.
Use good lighting if you get up in the night.
Walk with a cane for stability.
Work closely with your doctor to manage your symptoms effectively.

The MediFocus Guidebook

A variety of conditions can cause vertigo and can affect your sense of balance. Seeing a doctor is particularly important if your vertigo is accompanied by other symptoms, including hearing loss, neurological symptoms, severe headache, inability to stand or walk, and any of the risk factors for stroke, such as diabetes, heart disease, and hypertension.The MediFocus Guidebook on Vertigo contains information that is vital to anyone who has been diagnosed with this condition.You will learn about the causes, risk factors, common signs and symptoms, medical tests that are used to establish the diagnosis, and standard treatments. You will also learn about the latest clinical advances in the management of Vertigo as well as about the newest treatment options that are available.The MediFocus Guidebook on Vertigo will also inform you about important new, exciting research in the area of Vertigo. You will also learn about the doctors, hospitals, and medical centers that are at the leading edge in conducting clinical research about Vertigo.

Emory Researchers Report Ways To Diagnose And Treat Patients With Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness spells and vertigo. But if diagnosed correctly, it can often be treated with immediate results, according to two Emory University researchers.

Ronald J. Tusa, M.D., Ph.D., professor of Neurology, Emory University School of Medicine, and director of Emory's Dizziness and Balance Center and Susan J. Herdman, P.T., Ph.D., Emory University School of Medicine, will report at the American Academy of Neurology meeting, in Philadelphia, successful diagnostic procedures and treatment options for BPPV.
BPPV is caused by misplaced calcium carbonate crystals (otoconia) in the semicircular canals (SCC) in the inner ear that have broken free and are found in the fluid of the inner ear. When the head is moved in certain positions, it causes brief periods of vertigo.
"Patients with BPPV usually complain of vertigo in the morning when they get up or turn over in bed," according to Dr. Tusa.

"It can also occur when the patient lies down in bed or tilts the head backwards, maybe while taking a shower or sitting in a dentist chair." Patients also complain of poor balance and trouble walking that may last for several hours following an episode of positional vertigo.
BPPV can affect three areas of the SCC, the posterior, the anterior and the horizontal SCCs. The most common is the posterior SCC.
Drs. Tusa and Herdman have studied several ways to diagnose and treat patients with BPPV. "A common test used to confirm the diagnosis of BPPV is the Dix-Hallpike test," says Dr. Herdman. "It involves turning the head to a certain degree while the patient is sitting, then quickly lying the patient back so the head is hanging off the examination table. If the patient has BPPV, the patient should feel a sense of dizziness." Patients can also be tested for BPPV using a sidelying test and a test of balance.

According to Drs. Tusa and Herdman, there are three basic bedside treatments for BPPV, all of which take less than five minutes to administer. They are canalith repositioning treatment (CRT), Liberatory treatment and Brandt-Daroff (BD) treatment.
CRT is used on patients with severe canalithiasis (free-floating otoconia). It is effective in 85-95% of patients with one treatment. Liberatory treatment is effective in dislodging otoconia attached to the cupula (the cover of the semicircular canals). This procedure has a success rate of 53% after one treatment and 76-90% after two treatments. However, this treatment is difficult to perform on elderly patients because of the quickness of the procedure.

The BD treatment is a series of repetitive exercises that works by dispersing free-floating otoconia and possibly by dislodging any otoconia attached to the cupula. This is the best treatment for mild canalithiasis, when the patient still has symptoms but no signs of BPPV after a single treatment. BD treatment can also be used in patients with severe BPPV, but it is not the first choice since it causes vertigo and takes up to two weeks for success.

In all of the treatments, patients come to the Dizziness and Balance Center and undergo evaluation, testing and treatment by Drs. Tusa and Herdman. Then, in many cases, the patients learn how to administer the treatment themselves and can perform them at home. There are still more ways to treat other forms of BPPV in the anterior and horizontal SCCs. "Treatment varies according to the SCC involved, whether the otoconia is free-floating or attached to the cupula and the severity of the vertigo," says Dr. Tusa. "We hope our research will be of assistance to a number of people who haven't been able to find relief from their vertigo elsewhere."

Emory's Dizziness and Balance Center uses a multidisciplinary approach for diagnosis and treatment. It features physicians and therapists trained in neurology, ophthalmology, otolaryngology, psychiatry and physical therapy. Specialized equipment, including a rotary chair to measure eye movements during head rotation and a dynamic platform posturography to test balance, help provide key information to aid in proper diagnosis.
Dr. Tusa, who holds joint appointments in the Emory Departments of Neurology, Ophthalmology and Otolaryngology, is the founder and former director of the University's of Miami's Dizziness and Eye Movement Center.

Before that, he spent 13 years at Johns Hopkins University, where he began his research in vision and eye movement. He is the author of two books and numerous chapters and articles for professional journals concerning disorders of the eyes and ears.
Dr. Herdman supervises the Center's Vestibular Rehabilitation Program, which includes balance and vestibular or inner ear retraining through a series of special exercises. She is the author of the nation's most utilized textbook on vestibular rehabilitation.

It isn't just dizziness

Vertigo, as its sufferers know, isn't just dizziness - a word that can describe any number of feelings from lightheadedness to feeling weak or unsteady. The medical condition called vertigo is dizziness that creates the sense that you or your surroundings are spinning or moving. It is defined as a false illusion of motion with a distinct sensation of rotation ("The room was spinning around me"). Vertigo can be acute or chronic. Acute attacks are well-defined isolated spells of vertigo with a distinct beginning and end. Chronic vertigo is a continuous sensation. When acute attacks recur, they are treated as chronic vertigo. Doctors can diagnose 75% of vertigo cases based on individual medical history, but you must tell your physician the facts of your case, or the case of the loved one you are helping. When did your dizziness start, what you are feeling and does the spinning sensations come and go or does it persist? Describe what medications you are taking, any stress you are experiencing and any related symptoms that affect you, including nausea, vomiting, tinnitus, deafness or a feeling that your ear is "full." Particularly in the elderly, dizziness can be associated with other diseases and conditions.

Causes of vertigo

Vertigo is usually associated with a problem in the inner ear balance mechanisms (vestibular system), in the brain, or with the nerve connections between these two organs.
The most common cause of vertigo is benign paroxysmal positional vertigo, or BPPV. Vertigo can be a symptom of an underlying harmless cause, such as in BPPV or it can suggest more serious problems. These include drug toxicities (specifically gentamicin), strokes or tumors (though these are much less common than BPPV).
Vertigo can also be brought on suddenly through various actions or incidents, such as skull fractures or brain trauma, sudden changes of blood pressure, or as a symptom of motion sickness while sailing, riding amusement rides, airplanes or in a vehicle.
Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway. These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings.

Vitamin E and Hearing Loss

In a preliminary study, researchers find that vitamin E may be effective in restoring sudden onset hearing loss of unknown origin (idiopathic sudden hearing loss). These findings suggest that further research may reveal the role of antioxidants in the prevention and restoration of hearing loss. Each year some 4,000 Americans report the onset of sudden hearing loss (SHL), sensorineural hearing loss of 30 dB or more for at least three contiguous audiometric frequencies occurring within three days or less. Numerous attempts have been made to identify the cause of this disease and many factors have been documented such as infectious diseases, both bacterial and viral. Other causes can include circulatory disorders, traumatic injuries, as well as immunologic, toxic, neoplastic, metabolic, and neurologic sources. However, the cause of SHL can only be identified in 10 to 15 percent of patients, the remainder of cases, which have no obvious cause are termed idiopathic sudden hearing loss (ISHL). About two thirds of patients with ISHL recover without treatment within days, most in the first two weeks after onset. The prognosis is worse if the patient has severe hearing loss with downward-sloping audiograms and vertigo, and does not begin recovery within two weeks. Many treatment regimens have been proposed for ISHL, but none has been consistently supported. Previous research has shown that superoxide anion radicals (O2-) appear in the inner ear of experimental animals after damage caused by noise-induced trauma, administration of ototoxic drugs, and inflammatory disease. Other studies have shown that antioxidants could prevent the ototoxicity of cisplatin, a common chemotherapy drug. These findings leading this research team from Israel to believe that antioxidants such as vitamin E may have a restorative or protective role in the inner ear. With this evidence, they assumed a similar mechanism may be involved in idiopathic sudden hearing loss and, in that event, antioxidants could reduce the damage and enhance recovery. The authors of "Antioxidants in Treatment of Idiopathic Hearing Loss," are Arie Gordin MD, Avishay Golz MD, Aviram Netzer MD, David Goldenberg MD, Henry Z. Joachims MD, all from the Department of Otolaryngology and Head & Neck Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Their findings are being presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY. Methodology: From 1998 to 2001, 92 patients were hospitalized with sudden hearing loss. After exclusions (known cause of the disorder, recovery), 66 patients were enrolled in the study and divided randomly into two groups (study group, S; control group, C) of 33 patients each, ranging in age from 17 to 68 (mean age, 41 years). The mean age in Group S was 42.2; in Group C, it was 38. Fourteen patients had vertigo (eight in Group S, six in Group C), and 34 had tinnitus (19 in Group S, 15 in Group C). Only patients admitted within eight days from onset of hearing loss were included in the study. Hearing evaluation (pure tone audiometry, speech reception threshold, and speech discrimination) was performed after complete histories had been taken and physical examinations had been done. Severity of the disease was based on the mean hearing loss in frequencies of 250 to 4,000 Hz. Up to 40 dB loss was defined as mild, 41 to 70 dB loss was defined as moderate, and 71 dB loss or more was defined as severe. Hearing gain and recovery rate were used as parameters for hearing recovery. The recovery rate was defined as a result of the hearing gain after treatment divided by the difference in initial hearing level between the affected and unaffected ear, multiplied by 100. Treatment of idiopathic sudden hearing loss consisted of bed rest, steroids (prednisone at a dosage of 1 mg/kg/day), intravenous magnesium sulfate 4 g/day, and carbogen (95 percent O2 + 5 percent CO2) by mask, 30 minutes four times a day. This treatment was given to both groups. In addition, Group S received oral vitamin E (d-[alpha]-tocopherol acetate), 400 mg twice daily. Results: This study divided 66 patients with diagnoses of ISHL into two groups. The basic treatment of both groups was identical except for the addition of vitamin E 800 mg/day administered to the study (S) group. The severity of hearing loss was only marginally significant in the rate of recovery, whereas age and sex difference, incidence of tinnitus, and vertigo were nonsignificant in the rate of recovery. Although the difference in complete recovery in both groups was statistically insignificant, the success of treatment, defined as improvement of 75 percent or more at the time of discharge, was significantly better in the study group (78.78 vs. 45.45 percent), as was the case on follow-up (76.42 vs. 55.79 percent). Conclusions: With the suggestion that antioxidants might prevent cisplatin-induced ototoxicity, reduce the incidence of deafness after bacterial meningitis, and protect against noise-induced hearing loss, this research team sought to determine whether the use of antioxidants in ISHL could improve the outcome of the disease. Vitamin E was selected for this effort. The antioxidant properties of vitamin E have been known for many years. Since its discovery, vitamin E has been recognized as an essential factor in neurologic function, preventing destruction of red blood cells, and some genetic disorders. Its role in the prevention of cardiovascular diseases, reduction of risk of cancer, and functioning of the immune system has also been cited. The recovery rate was better for the patients in the group treated with vitamin E. The researchers believe that the exact pathologic changes inflicted by superoxide anion radicals should be further studied, as should the possible role of antioxidants in the prevention of cochlear damage. Note: The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) represents the nation's 11,000 otolaryngologist-head and neck surgeons. These specialists diagnose and treat disorders of the ear, nose, and throat and related structures of the head and neck. Learn more about the specialty and otolaryngic disorders at the AAO-HNS Internet web site, http://www.entnet.org.
source- medicalnewstoday.com

Vertigo Causes

Vertigo can be caused by problems in the brain or the inner ear.

Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the sensation of motion initiated by sudden head movements.
Vertigo may also be caused by inflammation within the inner ear. This is known as labyrinthitis. This condition is characterized by the sudden onset of vertigo and may be associated with hearing loss.

Meniere disease is composed of a triad of symptoms: episodes of vertigo, ringing in the ears, and hearing loss. People have the abrupt onset of severe vertigo, fluctuating hearing loss, as well as periods in which they are symptom-free.
Acoustic neuroma is a type of tumor causing vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss.

Vertigo can be caused by decreased blood flow to the brain and base of the brain. Bleeding into the back of the brain is known as cerebellar hemorrhage and is characterized by vertigo, headache, difficulty walking, and inability to look toward the side of the bleed. The result is that the person's eyes gaze away from the side with the problem. Walking is also extremely impaired.

Vertigo is often the presenting symptom in multiple sclerosis. The onset is usually abrupt, and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose.

Head trauma and neck injury may also result in vertigo, which usually goes away on its own.
Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by a headache. There is often a prior history of similar episodes but no lasting problems.

What Causes Headaches?

In general, kids get the same types of headaches as adults. And headaches often are hereditary, so if you or your partner get them, your child may get them too.

Some of the many potential headache triggers include:
certain medications (headaches are a potential side effect of some)
too little sleep or sudden changes in sleep patterns
skipping meals
becoming dehydrated
being under a lot of stress
having a minor head injury
using the computer or watching TV for a long time
menstruation
experiencing changes in hormone levels
taking a long trip in a car or bus
listening to really loud music
smoking
smelling strong odors such as perfume, smoke, fumes, or a new car or carpet
drinking or eating too much caffeine (in soda, coffee, tea, and chocolate)
consuming certain foods (such as alcohol, cheese, pizza, chocolate, ice cream, fatty or fried food, lunchmeats, hot dogs, yogurt, aspartame, or anything with the seasoning MSG)

Disorders of Balance - Pathophysiology
Vertigo - Subjective sensation of movement
- will occur where there is a mismatch of sensory input, i.e. between vestibular + visual data. e.g after acute labyrinthitis with loss of function of 1 perpheral vestibular system. The vestibular data is suggestive of rotation and the eyes are therefore moved via the vestibulo-ocular reflex causing a sensation of the visual environment moving.Nystagmus - Involuntary eye movements due to a variety of causes:-
ocular
vestibular
neurological
congenital
hysterical Vestibular nystagmus - is usually horizontal or rotational and results from an ‘imbalance’ between the paired peripheral vestibular systems causing inappropriate eye movements.
There are 2 phases:-
slow phase – as the eyes deviate to one side.
fast phase – is the corrective movement, this results in beating movements of the eyes.
Disorders of balance occur when there is either a mismatch of sensory input (due to malfunction of 1 system relative to the others) or inadequate sensory or central function