Dr Chris J B Smit is an Ear Nose and Throat specialist at Louis Pasteur Hospital. He completed his MB.CH.B (UP) in 1967 and Need (Leto)(UP) 1972. He has been in private ENT practice since 1974.
DIZZINESS: imbalance with sensation of light-headedness, giddiness, drowsiness, fainting. Non-spinning dizziness when standing or walking indicates a neurological problem and not vestibular (ear problem). Blackout or loss of consciousness indicates central or a vascular cause of dizziness and not an ear problem.
Dysarthria (speech), difficulty in swallowing, double vision, hemiparesis, seizures, or memory loss point to a central (brain) cause.
VERTIGO DEFINITION: an illusion of movement, a feeling of spinning of patient or of surroundings. This is usually accompanied by symptoms of nausea, vomiting, falling as well as ear symptoms like tinnitus (ringing noise in ears), deafness and feeling of fullness in one of the ears.
Many causes of vertigo will be listed but he majority of cases are due to 3 conditions.
1 . Benign paroxysmal positioning vertigo is the major cause of vertigo in the elderly, 60y. Cause of the condition: in the inner ear two structures i.e utriculus and sacculus have tiny microscopic calcium crystals (otoconia). Due to degeneration by ageing or previous head injury, these crystals break lose. Float in the inner ear fluid and deposit on the copula of the post semi-circular canal. This causes the cupula to be “heavy” on one side and moves due to gravity and then sends a message of spinning to the brain.
- Episodes of vertigo induced by turning over in bed (even when sleeping),
- bending over or
- sudden head movements which last for 10 – 20 seconds.
Nausea and vomiting may occur. As it is a benign condition, recovery is spontaneous after 4 – 6 weeks but has a tendency to recur after months or years.
Diagnoses: can be made by GP by performing the Hallpike procedure. Turning patients head 45 to the side and then turns rapidly on the back with the head under the horizontal (hanging off the bed).
- Semont manoeuvre
- Epley procedure
- MRI if nystagmus in non-fatiqueble or if condition persists 6 weeks.
2. Vestibular neuritis second most common cause of vertigo usually affects 30 – 60 age group. Often a history of upper airway infections preceding onset of attack. Probably herpes simplex.
- Vertigo, nausea and vomiting without ear symptoms like hearing loss.
- Unsteady and off balance for few weeks.
- Horizontal rotaty nystagmus and falling tendency.
- Acyclovir, high doses of prednisone. Stugeron, Sere, Hidrist, Valium.
- Vestibular exercises
3. Meniere – Endolymphatic hydrops) Third most common cause of vertigo.
- Combination of four symptoms
- Vertigo lasting minutes to hours
- Fullness or feeling of pressure in ear
- Fluctuating low frequency deafness
- Tinnitus followed by vomiting
Serc Cyclizine, Inapsin – for acute attack.
For severe recurrent attacks:
- Intratympanic gentamycin and or cortisone
- Labyrinthectomy if severe deafness is present
- Middle fossa vestibular nerve section
Less common causes of vertigo:
- Acoustic neuroma
- Vestibular migraine
- Sup, Semi-circular canal dehiscence
- Viral or bacterial labyrinthitis
- Vertebrobasilar insufficiency
- Cerebellar tumours
- Vascular lesions