So you have dizziness or know
someone who has. What to do and who should one see? If the dizziness also comes
with hearing loss, tinnitus or the sensation that the room is turning (vertigo),
it is likely that the problem lies with the ear so seeing an ENT Specialist
would be appropriate.
Inner ear problems affecting both
the hearing and the balance are generally uncommon. If the hearing reduces
suddenly with dizziness, it may be denoted as idiopathic sudden hearing loss.
The cause is usually never found (and never known hence idiopathic) but it is
suspected to be probably viral or inflammatory in nature. The principle of
treatment here is to save the hearing, and the golden period for effective
evidence based treatment is within the first 2 weeks. As it is thought to be
inflammatory, a 2-week high dose steroid regime to reduce inflammation of the
nerve and/or inner ear is prescribed. Medication to improve the blood flow, and
therefore the oxygen delivery, to the inner ear is also given. Full or partial
hearing recovery, in up to two-thirds of patients, treated in this golden
window, may be expected.
Equally, and thankfully, uncommon is
hearing loss associated with tinnitus and an ear fullness sensation, combined
with severe vertigo. The dizziness here is so severe, the sufferer is usually
unable to stand and starts vomiting. This condition is called Meniere’s disease
(after Dr Prosper Meniere, a 19th Century French Physician). It
recovers suddenly, usually within 24 hours, as fast as it attacks out of the
blue. Luckily Meniere’s disease is uncommon as sufferers can have several
attacks without warning, and can slowly lose their hearing over time. We treat
this condition symptomatically, that is to say, we prescribe anti-vomiting
medication as required, together with other treatments. Surgery may also be
considered for some severe cases.
A commoner cause of vertigo
(dizziness with turning of the room or floor) is a treatable condition called
benign paroxysmal positional vertigo (BPPV). Here the sufferer experiences
vertigo and nausea whenever he moves the head; they prevent the diziness by
keeping the head still. There is no hearing loss or tinnitus. The condition
lies with a problem in our balance system. As mentioned in the previous
article, our balance organ of each ear consists of three semi-circular bony
tubes in which the fluid sits. These tubes are orientated to pick up movement
through sensors called otoconia. Sometimes one of these otoconia in one of the
tubes becomes hyper-stimulated. When this occurs, the wrong signals are sent to
the brain every time the head moves; hence the brain gets confused and “dizzy”.
If recognized correctly, the treatment for BPPV is a series of targeted exercises
to recalibrate the sensors. It is very effective if diagnosed and done well.
Finally for all dizziness, we must
mention the prescription of the anti-dizzy medications. They work very well and
can make a patient feel better very quickly. However they work because they
cross our blood-brain barrier, to damp down the brain’s responses, and in doing
so can cause the patient to feel drowsy. As the brain is “numbed”, it is also
unable to recognize the actual problem, and full recovery may be delayed. Nonetheless
they are very helpful in managing dizziness.
Dizziness is really an awful and
unpleasant condition to have, and numerous conditions can cause it. If vertigo,
tinnitus, ear fullness sensation and/or hearing loss are associated with the
dizziness, these are clear signs to the dizzy patient that the ear is probably
the cause.
The Chinese version of this article was published in
Hong Kong Economic Journal on November 4, 2013.
