Spin Doctors

Understanding why the room is spinning—and how to stop it.

Written by John Ferrari

You remember this feeling, perhaps when playing on a swing set or merry-go-round as a kid: The world is spinning around you. You need to grab something to steady yourself. Except you’re not a kid, and you’re not on the playground. It’s vertigo, and you’ve had this feeling again and again recently. Should you be worried?

Not immediately, says Torrance Memorial Physician Network otolaryngologist Alexander Gertel, MD. It’s probably a common and relatively harmless condition with a tongue twister of a name: benign paroxysmal positional vertigo (BPPV). It is a good idea to track any episodes of vertigo, because they can be symptomatic of other potentially serious issues.

That’s the first thing to understand about vertigo, Dr. Gertel says: It’s a symptom. Vertigo is related to the body’s vestibular system, which senses the position, movement and acceleration of your head essentially by detecting the movement of fluid in the inner ear.

If something makes your brain think fluid (called endolymph) is moving when it isn’t, it causes a disconnect in your brain’s sense of yourself—are you moving or not?

The second thing to understand about vertigo is it’s a specific sensation: the feeling of movement when you’re not moving. Vertigo is often experienced as spinning, but it also can be felt as other forms of motion—swaying, for example, or bouncing. Dizziness, similar to lightheadedness, is a more general term for feeling unbalanced.

Now that you know how to talk to your doctor about vertigo, here’s what your doctor may tell you: It’s probably BPPV, which affects about half of adults over age 65. “We think BPPV is caused by microscopic calcium carbonate crystals in the inner ear,” says Dr. Gertel. “These crystals, called otoliths, can become displaced and fall into the wrong part of the inner ear’s balance system. The brain senses extra inertia from these crystals, producing a sensation of vertigo.”

The displacement of otoliths is likely a normal aging process, Dr. Gertel adds, but in rare instances (less than 10% of all BPPV cases) it can be triggered by trauma—a bump on the head can shake otoliths loose. Episodes of vertigo caused by BPPV usually are brought on by certain body movements—laying down or getting up, for example, or bending over, looking up or turning your head quickly.

BPPV symptoms typically last up to four to six weeks before they spontaneously resolve, Dr. Gertel says. The displaced otoliths may dissolve on their own, or the brain may learn to compensate for the new signals it’s receiving from the inner ear. BPPV can be a problem before that happens though.

“It’s a very striking feeling and can cause nausea,” Dr. Gertel says. He recommends visiting your primary care physician (PCP), and possibly scheduling a visit with an ear, nose and throat (ENT) specialist if symptoms last longer than two weeks. BPPV can be treated with physical therapy and specific movement exercises to reposition the displaced otoliths.

A range of other conditions can cause vertigo as well, and that’s another reason to visit your PCP or an ENT specialist. One of the most common, after BPPV, is labyrinthitis, an infection of the inner ear. Besides vertigo, symptoms of labyrinthitis may include dizziness and hearing loss or tinnitus, a feeling of pressure inside the ear, fluid discharge from the ear, nausea, fever, headaches and vision changes. The symptoms usually resolve on their own after a few weeks, but they can be severe.

Any change to your hearing or vision should prompt a visit to your PCP. The underlying infection may be viral, in which case the treatment is bed rest and medication for the symptoms (if needed). In some cases the infection may be bacterial, in which case your doctor may prescribe antibiotics.

Less common causes of vertigo include vestibular migraines and benign tumors affecting the vestibular system. Certain medications used to treat high blood pressure or anxiety can cause vertigo. In those cases, changing the dosage or medication may help. Vertigo accompanied by vision changes can also be indicative of brain tumors or strokes—another reason to visit your PCP if you experience these symptoms.

Like vertigo, dizziness and loss of balance is a symptom. Mild balance issues may be part of the aging process, Dr. Gertel says. However, dizziness or a loss of balance can suggest underlying issues—from weakness within the inner ear’s balance system to diabetes, which affects sensation in the extremities, particularly the toes.

“Balance issues are multifactorial,” says Dr. Gertel. “So many things can impact our balance. Often with balance issues as we age, you might see different specialists—an ENT physician, a neurologist and a cardiologist—to diagnose the issue.”

While BPPV and balance issues are common as we age, there are simple steps (literally) you can take to minimize them. Try to stay active, Dr. Gertel advises. At a minimum, walk every day. Aerobic exercise and strength conditioning help too.

“This movement helps strengthen the ear-brain connection,” Dr. Gertel explains. And if vertigo or balance problems are affecting your daily living or last more than a few weeks, see your PCP or an ENT specialist. You don’t have to live an unbalanced life. 

Alexander Gertel, MD, practices at Torrance Memorial Physician Network ENT, located at 23550 Hawthorne Blvd., Suite 125, Torrance. He can be reached at 310-891-6733.