Spontaneous Spinning (Vertigo) for no cause

By Dr Harold Gunatillake –Health writer FRCS, FICS,FIACS,MBBS, AM(Sing)

Have you ever experienced spinning things round you when you got up one morning? You are not the only one, there are thousands and thousands of peoplemen and women have had such experiences, as they grow over the 60th year. It is most panicky as you are not aware of what’s happening, because you have has had no such episode before- you would say, “I am healthy-why did it happen to me?” The ‘tsunami’ doesn’t last very long; you hold the closest pole or lean against the wall the episode subsides. You think of sudden high blood pressure when you don’t have it normally, or you think of a brain tumour.

You see your family doctor and then referred to a specialist- will do all the required tests and may say, “Everything seems to be okay- it may be BPPV –Benign paroxysmal positional vertigo.

Now that’s a long diagnosis. It is not a disabling chronic disease where your survival is shortened. The condition becomes your friend and you live with it. It belongs to the sea-sickness family where the inner ear gets a jolt as it were.

Let’s look into the technical side of this condition.

The ear is composed of the portion you can see and it’s called the external ear. It has the function of a horn where sound waves are sent to impact on a drum. On the other side of the drum there is the middle chamber containing three tiny bones called ossicles transferring vibrations of the ear drum waves in the fluid as acoustic energy from compression waves in air to fluid membranes within the cochlea-part of the inner ear.

In the inner ear called the vestibular system there are chambers and canals filled with fluid. There are three semicircular canals and there is a small pouch called the utricle fixed to the semicircular canals. The canals are lined with hair-like projections into the liquid filled canals which stimulates the hair cells. Because these canals are placed in different directions, each sends information on a different type of motion and balance to the brain.

The utricle pouch is filled with tiny crystals called otoliths. They are composed of calcium carbonate. So long as the crystals remain in the sacs everything works well.
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When they leak out from the utricle into the fluid containing semicircular canals the brain does not get the normal signals until they disappear or returns to settle down in the sacs. The brain recognises abnormal signals due to this disarray and you feel it as a spinning experience. There is another form of vertigo that can occur without any movement –called ‘Virtual-reality sickness’. It was first reported in 1957 U.S.Army Research Institute where as much as forty percent of the military pilots experience some sickness during simulator training. We shall not discuss any more about Virtual-reality sickness, but only to BPPV.

In BPPV the only symptom is dizzy feeling, accompanied by nausea and vomiting. Sometimes the vertigo and the vomiting may last for a few days, but after many years the episodes will be minor as one gets used to the way it could be avoided or minimised.

There are other forms of vertigo accompanied with ringing ears (tinnitus), nausea, sweating, headaches or and uncomfortable jerking motion in the eyes. In Meniere’s syndrome vertigo is caused by swelling from fluid build-up inside the inner ear. Doctors prescribe diuretics to reduce the tension from fluid within the canals. Viral attacks cause vertigo and the conditions are called labyrinthitis and vestibular neuritis. In this situation there is inflammation of the ear’s internal passageways or vestibular nerves.

Let’s talk about the treatment for BPPV

When you get out of bed, slowly sit up with eyes closed, turn the body and put your legs down. Stay in seated position for about 10 seconds. You can now stand up slowly keeping your eyes closed. Now open your eyes and walk Voila you are fresh as ever.
When you sleep there is a good side and a bad side. Sleep face up or on your good side. Turning on to your bad side you might feel giddy; then promptly turn the other way. Sleeping on a reclining chair at any comfortable angle is very comforting and it is
most unlikely to feel giddy when you stand upright the next morning. There are many manoeuvrers mentioned in the text performed by physiotherapists and doctors. They may work temporarily or the success rate may be low.

Medications- When you vomit a stemetil tablet helps. Some doctors prescribe Serc and stugeron tablets which dopes you and may be unfit for physical work. I find sleeping on a reclining chair would be the best solution to avoid episodes. Remember it is not a medical problem, but purely physical- change of position of the neck and head that triggers attacks.