Dizziness (Vertigo)

 

Click here to watch the video from the 4+1 show, featuring a talk by Prof.Dr. Şafak Dağlı and Specialist Audiologist Özgür Uğurtay on Balance, and Dizziness.

Some people refer their balance problems as dizziness. This balance problem, in which the environment remains motionless, may sometimes be caused by a disorder related to the inner ear.  

What is Vertigo?
Some people, however, explain their difficulties in balancing themselves with the word "vertigo". These words derive from the Latin verb "to turn". These patients frequently report that themselves or their environment are revolving around. Vertigo is usually initiated by inner ear disorders.

What are motion sickness and seasickness?
Some people become nauseous or even vomit when they are inside a car or a plane. This is called carsickness. Many people experience the same problem when they are on a ship, although the factors triggering the problem are the same, this is called seasickness.
Seasickness is only a minor ailment. It is not a symptom of any other medical disorder. However, passengers having seasickness may feel restricted due to this sickness. Rarely, the sickness endures several days after the travel.

Dizziness and Balance Disorder Unit at Ekol ENT

Posturography

Posturografi

It helps to identify which systems are affected by the problem or by the pathology when patients admit to the clinic with balance disorder complaints.

At the end of the analysis of the results of 18 different tests on the patient in standing position;

Posturography produces numerical data showing and comparing the ratio of damage on three systems, the somatosensorial system, the visual system, and the vestibular system, which may cause patient's balance disorder.

Which systems are damaged and their damage ratios are identified by a method, which compares the patient's values with the normative data of expected values from healthy people having the same weight, height, and other features, recorded in the system.

Balance rehabilitation is also done by means of the Posturography device. The patient undergoes a treatment protocol, which consists of 5 phases organized according to their level of difficulty.

Before the evaluation, if the patient is undergoing a medical treatment for dizziness and balance disorder, the patient should stop taking medicines two days before the test day for obtaining the most accurate results.

Patients with pre-diagnosis who have been examined by ear, nose, throat doctors, or who have undergone medical or surgical treatment if necessary are evaluated by our unit and taken to medical treatment if they have one of the following disorders:

  • Balance disorders due to somatosensorial system damage,
  • Continuing balance disorders due to vestibular system damage,
  • Loss of function due to ankle and knee injuries, requiring postoperative rehabilitation,
  • Falling problems due to balance disorder.

VIDEONYSTAGMOGRAPHY (VNG)

It is the computerized video recording process of nystagmus and eye movements experienced by the patient, which are checked by 10 different tests. For the purpose of inspection, causes of dizziness, whether they are originated from the center or the periphery are researched. Before the evaluation, if the patient is undergoing a medical treatment for dizziness and balance disorder, the patient should stop taking medicines two days before the test day for obtaining the most accurate results.

Having examined by ear nose throat doctors and with a pre-diagnosis, the following groups of patients are admitted to treatment at our unit:

  • The patients whose dizziness should be identified as central or peripheral;
  • The patients whose dizziness should be examined thoroughly;
  • The patients whose eye movements could not be examined properly,
  • The patients who require their nystagmus to be examined without eye fixation.

Anatomy of Balance


Dizziness, vertigo, and carsickness are related to the balance system. Space researchers call this sense “spatial orientation”. The balance system is located inside the inner ear. It informs the brain about the body’s position in space, its direction, its moving course, and about whether the body is turning or motionless.
Your balance sense is a product of complex relationships between various nervous system parts specified below.
A diagnosis must be made before initiating treatment process. This includes a through ear nose throat examination and some potential laboratory, endoscopy, and x-ray works. Bacterial infections are remedied with antibiotics, but they provide a temporary healing. In choric sinusitis, a surgical operation is required for opening sinus inlets.
1. The inner ear (labyrinth) identifies the movement direction such as forward, backward, horizontal, vertical, or turning.
2. Eyes identify the body’s position within space (such as upside down etc.) and movement direction.
3. Pressure receptors located in joints and in the spine identify which parts of the body are below and touching the ground.
4. Perception receptors in muscles and in joints identify which parts of the body are moving.
5. The central nervous system (the brain and the spinal cord) processes the signals transmitted from the previous four systems, and generates a coordinated perception at the end.

Dizziness and the symptoms of carsickness occur when contradicting signals are transmitted to the central nervous system from the other four systems.
For instance, consider that you are on a plane on a stormy day and your plane is shaking due to airstreams. However, your eyes do not perceive this movement of the plane, because all you see is inside of the plane. As a result, your brain can get discordant messages. This may cause your plane sickness.
Or consider reading a book at the backseat of a car. Your inner ear and skin receptors perceive the movement of the car, but your eyes see only the book. This may cause your carsickness.
Scientifically speaking, consider your inner ear on one side of your head is injured due to a blow. The injured inner ear does not signal the same messages with the normal inner ear. This complication may cause sending wrong signals to the brain about the turning movement, and the person experiencing this may complain about dizziness or vertigo. Sometimes nausea is also observed.


Which medical illnesses cause dizziness?

1. Circulation: Circulation disorder is one the most frequently encountered factors triggering dizziness. If your brain cannot get enough blood, your head starts spinning. Almost everyone has experienced this when suddenly getting up from laying position. However, some people make complaints about dizziness that is happening frequently and chronically. This is due to arteriosclerosis (vessel stiffness). This illness is usually observed with hypertension patients, diabetics, and people having high blood lipids. It is also seen with people having inadequate heart functionality, and anemia complaints. Some medicines, especially nicotine and caffeine, reduce the blood flow to the brain. Excessive salt in diet may also reduce blood flow. Sometimes, circulatory system may suffer from dysfunctions caused by stress, vexation, and agitation. If the inner ear cannot take sufficient blood, vertigo, a special type of dizziness, may occur. The inner ear is very sensitive to changes in blood circulation. Thus, a weak blood circulation may cause disorders for the inner ear, as it does for the brain.

2. Injury: A fracture on the skull, which injures the inner ear, results in an extremely confining vertigo as well as nausea and hearing loss. Dizziness may last for several weeks. In the meantime, the normal side gradually undertakes the functions.

3. Infection: Viruses, for instance the ones causing cold, may affect harmfully on the inner ear, and on the nerves connecting the inner ear with the brain. While this causes a bad vertigo, hearing function usually remains unharmed. Despite this fact, bacterial infections may disrupt both balancing and hearing functions. Severity of dizziness and healing period are the same with skull fractures.

4. Allergy: Some people may experience dizziness and vertigo when they eat allergic foods or become exposed to allergic air particles. 

5. Neurologic Illnesses: Illnesses harming the nervous system such as multiple sclerosis,syphilis, and tumor may disrupt the balance. Although they are rarely seen factors, your doctor considers these possibilities as well during your examination.

What can I do to avoid carsickness?
1. Try to sit on places where you’re your ears and your eyes perceive your body movements in the same way. For instance, you could on the front seat of a car and stare directly ahead, or you could watch the horizon standing on the shipboard, or you could view outside sitting on the window-side seat of a plane. During a flight, choose the seats close to the wings of the plane.

2. If you have carsickness, do not read books in the car, and do not sit on reverse seats.

3. Do not talk to the people having carsickness and do not look at them.
4. Stay away from strong odors, spicy and fatty foods before and during travel. Scientific researches do not show that folk remedies are effective.
5. Take one of the medicines suggested by your doctor before the travel. Some of these medicines can be purchased without prescriptions. For tranquillizers and nervous system depressants, proscriptions from your doctor are required. Some of them are pills or bougies, and some of them (scopolamine) are strips that can be applied on the backside of ears.
Remember: Dizziness and carsickness are mostly minor illnesses and can be treated by self-efforts of the patient. However, a specialist on ear, nose, throat, balance, and nervous system subjects should check major and deteriorating cases.

What does a doctor do for treating dizziness?
Your doctor would ask you to describe your dizziness. She asks you whether it is a blackout or a sense of movement, how long it lasts, and if you have hearing loss, nausea, or vomiting. She may also ask under what conditions you experience dizziness. You may be required to answer many questions regarding your overall health condition, medicine use, head trauma, recent infections, and your ears and nervous system. After examining your ear, nose, and throat, your doctor performs tests about your nervous system. Since the inner ear takes role in both hearing and balancing functions, a balance disorder affects hearing function and vice versa. Thus, your doctor may require a hearing test (audiogram) In some cases, your doctor may ask for your skull’s x-ray, its tomography, and its view generated by magnetic resonance, or a test (electronystagmography=ENG), which monitors your eye movements after stimulating your ears by applying hot and cold water. She may sometimes recommend an examination of your heart and some blood tests.
Not every patient requires all of the aforementioned tests.
Your doctor’s decision will determine which tests are necessary. Similarly, the recommended treatment will be related to the diagnosis.


What can I do to ameliorate dizziness?
1. Avoid sudden position changes. For instance, do not stand up suddenly when you are in laying position, or do not rapidly return from one side to another.
2. Avoid drastic or rapid head movements (especially staring up).
3. Reduce consumption of substances that may disrupt circulation (such as nicotine, caffeine, and salt).
4. Try to avoid stress, temper, and exposition to allergic substances.
5. Avoid activities that may be hazardous to your health when you are feeling dizzy such as driving cars, using dangerous instruments, or climbing ladders.

 

 

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