Dr. O’Leary shares how a woman should care for her dizzy symptoms.
Well the first thing we know about dizziness is, respect it for the giant symptom that it is. You know, probably our most important sense of all the senses we have is our sense of where we are in the world. A single cell amoeba has an organelle that tells it where up and down is. So, this sense is so powerful and so overwhelming that we don’t even know it exists because we presume we are going to be able to navigate and get around.
In our five senses that we list, we don’t even count balance as one of the senses, but yet, when you don’t have it, the whole system is designed to shut itself down.
So people who have problems with their balance, dizziness, are in a horrible state. Essentially a preservative reflex is that when the prehistoric cavewoman and caveman couldn’t tell where the world was, they got so sick that they would lie in their cave until they could tell again.
Those that didn’t have that reflex were eaten by, or falling out of trees, eaten by woolly mammoths, who knows. The ones that were shut down until the system could recover from a virus or from whatever the problem--a blow to the head, whatever it was that caused the dizziness--they survived.
So we have this reflex in us from hundreds of thousands of years that says, when you can’t tell where the world is up and down, you are sick as a dog, and it’s a horrible place to be.
So it’s one of the most common things we see in the inner ear because the inner ear, as you know, is one of our primary pieces for balance. We have these gyroscopes that, like the hair cells in the inner ear that do such a good job of hearing, these little hair cells help tell us if we moved our head in even the slightest bit, and it’s hardwired to our eyes. It actually connects directly to the eyes and tells you move the eye this way or move the eye this way because the head is moved reflexively in the background where we don’t know it exists.
When that system, which we call the vestibular system, goes off, boy, that’s a big challenge and a big problem. The brain actually sits on top of this whole connection. The connection really is pretty simple like a three-legged stool: the gyroscope in the ear being one, your eyes and vision leading you being the second, and the third is your proprioception; that’s a big term for the ability to feel where the ground it is, how hard it is, and how it’s sloped.
So all these three inputs come into the brain; it simulates the whole group and says, “Okay, we are okay; keep walking,” and we don’t even know it’s happening. So it’s really a remarkable system. They can’t get a Cray computer, a huge, multibillion dollar computer to do what our brain does so simply in this regard, but when it’s off the whole system shuts down.
The unique thing about imbalance, and it’s a tough symptom. In fact, many doctors don’t like to hear that there’s a dizzy patient is their next patient; it scares them because I think there are two principles in the management of this. One is, it overwhelms a single doctor. If you are going to a single doctor for dizziness, my advice to you is, look elsewhere before you go. Find some team because this is such a big complex area you need a team to do it right.
And, I have, fortunately, in my practice as an ear specialist, have another teammate, a neurologist, brain doctor, who looks for all the things that aren’t in the ear. The good news then, and the second principle actually in managing dizziness is first you diagnose and then you treat.
So find out what it is because the gamut of all the things it can cause this range from strokes and terrible things to things that are very innocent and simple–a virus, little crystals that are loose in the inner ear. So, make a diagnosis first and then treat.
Now having said those two principles, here’s the good news about dizziness. In 50% of the cases that we see of spinning vertigo where they’re sick to the stomach or can’t navigate the world, 50% of them are related to a very simple thing where little crystals in the gyroscope get loose, and if you can think of this it’s almost what your gyroscope looks like. If this is the nerve cell, when we tilt our head right or left, the little crystal makes that hair cell bend. That’s normal; that’s why our eyes move, but if they get loose and you turn your head suddenly and after a little delay, all these crystals now are floating and banging into that nerve cell telling us that the head has moved and the brain says, “No, no, the neck is still; everything else is still.” That mismatched signal is vertigo, and that’s why we feel so sick. The brain knows something is wrong with one of my three systems, in this case the inner ear, and shut the organism down. You get sick to your stomach. You feel terrible. You want to just go to bed.
The beauty of this is Dr. John Epley, who really is the person who made the big dent to this; we’ve known it’s been around for a while. He figured out that actually, because these are not fish tanks, but actually canals like the canals of Venice connected, that we can get the crystals out of the active area and into a place that I like to call the Lake Hodges, for those of you in San Diego, it’s a big reservoir, and there’s no nerving endings in there.
So when we find, for example, the most common canal that this can occur in is right here--the posterior canal. Once we have made that diagnosis, principle two, we can do a thing where we shake the head and reposition the patient and let these crystals settle into a place right here called the vestibule, which is an open space with no nerve endings that now the dizziness is cured.
And it’s very hard for the crystals to get back into that spot. You’d almost have to reverse this complex maneuver to do that. So, that condition is called benign vertigo or benign positional vertigo, and the beauty is, it’s 50% of all the action and it’s easily diagnosed and easily treated.
No need for big workups, no need for MRI scans, wasted time, sick patients hanging around emergency rooms. It’s a great diagnosis to make and our cure rates truly are about 90% for this, and if they are the one in ten where it comes back, we just treat it again, and it works beautifully. So that’s really the biggest thing about vertigo.
I talk about it in dizziness as been like a roulette wheel. When you spin the roulette wheel, it’s either red or black. That red entity is just one thing. Of all the other things that remain, if it’s not the red are a hundred things, and again, if that first test in the office shows that it’s not the crystals, we do have to hunt for things like tumors and stroke and other things that are, migraine headaches can do this, a whole host of things, and that’s that workup that ensues to try to find the answer to the problem.
But the good news on dizziness, at the end of it is, it’s not something you should have to live with because it’s a terrible place to be.
About Dr. O'Leary, M.D.:
As a neurotologist, Dr. Michael O'Leary specializes in diseases of the ear and balance, treating all aspects of ear problems, both medical and surgical. Among his unique areas of expertise in the ears are correction of surfer’s ears (exostosis), stapes surgery and repair of chronic mastoidectomy defects. His role on the skull-base team focuses on tumors of the lateral skull base, such as acoustic neuromas and meningiomas. He is also a nationally recognized leader in the development of minimally invasive techniques, including the endoscopic removal of pituitary tumors.