MEDARVA: The Spin on Age-Related Vertigo

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By Joan Tupponce
Henrico Monthly
September 2014

Maybe you feel dizzy after rolling over in bed. Or when you go from sitting to standing.

“Vertigo is the presence of spinning when you are not spinning,” says Dr. Wayne Shaia, an otologist/neurotologist with the Balance and Ear Center in Henrico.

“It can happen in any age group but it frequently happens in the elderly. People often confuse vertigo with imbalance, which is not really spinning. You are not really dizzy. With imbalance, your brain can’t process information to the balance system because it is not getting feedback from the body due to some problem or condition. You have to have some feedback from the body to balance yourself or you will be unsteady on your feet. We can test the balance system in our office.

“There are a lot of different things that can cause vertigo. Here are some of the more common inner ear causes:

“Benign paroxysmal positional vertigo (BPPV) is a common term of dizziness that we see in all ages. It often occurs when a person changes position such as rolling over in bed, for example, or from bending over. Crystals (otoconia) floating around in their balance system causes them to have extreme episodic vertigo that can last from seconds to minutes. This condition can be easily fixed. After verifying which ear canal is experiencing the problem, a repositioning procedure (Epley maneuver) is performed to put the crystals back where they belong. The patient will have to sleep upright for a couple of nights, but 90 percent of the time the vertigo is resolved.

“Other causes of vertigo can be related to dehydration, not drinking enough fluid. When people stand up or change position, their blood pressure drops and when that happens they have a 10- to 15-second brief spell of vertigo. It can be rectified by drinking more fluids, but remember, caffeine drinks cause dehydration and do not count as fluid intake.

“Ménière’s disease can be another cause of vertigo. People will suddenly lose hearing in one ear. They will experience ringing or noise in one ear and have vertigo for several hours. It’s most common in women between the ages of 45 and 55, but can happen at any age. Ménière’s is caused by a buildup of fluid in the inner eat which affects the balance system. The theory is that there is too much sodium that builds up inside the inner ear. When the inner ear swells it causes ringing in the ear and vertigo for hours. The most common treatment is to start the person on a low-salt diet, limit caffeine intake, and also put them on a fluid pill. If it continues, steroid injections in the ear and surgery can help decrease the vertigo. 

“Other causes of vertigo include heart disease and stroke. If you have severe vertigo, make sure you are not having a heart attack or stroke. If you have a sudden onset of dizziness accompanied by slurred speech and weakness or chest pain with your heart racing and sweating, you need to call 911. 

“Tumors of the inner ear can also cause vertigo. Acoustic neuroma is a condition with benign growths on the balance nerve. When the tumors grow they will cause hearing loss and vertigo. Treatment can include observation with MRI scans, surgery, or gamma knife radiation.

“In most cases, we can make vertigo better; if we identify the problem, we can usually treat it.” ■

Wayne Shaia, MD, of The Balance and Ear Center, specializes in ENT with specific subspecialty in disorders of the ear and balance systems.