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Vertigo: It May Be Menieres Disease or BPPV

Imagine waking up in the morning, opening your eyes, moving your head, and seeing your room spin around you. As you get out of bed, you have to hold on to the furniture and walls just so you can take a few steps.

Assuming you did not have too much to drink the night before, one of the most plausible explanations for this moving experience is that you are suffering from a bout of vertigo.

As frightening and uncomfortable as the sensation is especially accompanied by nausea and a headache most cases of benign positional vertigo are just that benign.

And, interestingly enough, it may all be in your ears.

A Balancing Act

Most episodes of vertigo are brief, and though they may be intense, they are usually harmless. That is why they are commonly referred to as Benign Paroxysmal Positional Vertigo (BPPV), which can occur when you get out of bed in the morning, or when you turn your head too quickly. The cause of BPPV is not known, although it may be related to head injury or simply aging.

Another cause may be an infection or inflammation of the inner ear called Labyrinthitis. As you know, labyrinth is a complex maze of paths. We all have a labyrinth in each of our inner ears, an elaborate system of fluid-filled interconnected canals, enclosed in the bone near the base of our skull. Half of the labyrinth is the cochlea, the spiral-shaped cavity in the inner ear containing the hair cells that send sounds to the brain. The other half is the vestibule, which provides the sense of balance.

The labyrinth interacts with other systems in your body such as eyes, bones and joints to maintain the balance. But any disturbance of the vestibular system can cause faulty information going to your brain. As a result, you can feel unsteady, or have an illusion that your environment is moving, even though you remain stationary.

A more serious cause of vertigo is Menieres disease, an inner ear disorder that can affect both hearing and balance. It can also cause hearing loss, tinnitus, and the sensation of fullness in the ear.

National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that there are currently 615,000 people with diagnosed Meniere's in the United States, and 45,500 new cases are diagnosed each year.

Diagnosis and Treatment

Since accurate assessment of hearing loss is essential in diagnosing Mnires disease, several tests are usually performed. According to NIDCD, these procedures include hearing and balance tests, as well as magnetic resonance imaging (MRI), which is useful in determining (or excluding) that a tumor might be causing the hearing loss and balance disorder.

Doctors use several types of hearing tests to pinpoint whether hearing loss is sensory, that is, arising from the inner ear, or neural, deriving from the hearing nerve. Physicians make this determination by recording the auditory brain stem response (which measures electrical activity in the hearing nerve and brain stem). A test called electrocochleography, which records the electrical activity of the inner ear in response to sound, is also used in confirming the presence of Mnires.

To test the vestibular system, doctors use the procedure called caloric testing, which has nothing to do with your calorie intake. The physician will flush your ears with warm and cool water or, in some cases, with air. The resulting involuntary, rapid eye movements (called the nystagmus) can help a physician analyze a balance disorder.

Treatment options depend on the underlying causes of the vertigo and will vary accordingly.

One option includes balance-retraining exercises, which include movements of the head and body specifically developed for each individual patient. These programs are administered by professionals with proper training and knowledge of the vestibular system, as well as its interactions with other systems in the body.

According to Menieres Disease Information Center ,which compiles all available data of treatment options, no one treatment works for everyone, yet every treatment seems to work for someone. We each seem to respond differently to various treatments. Some patients are nearly symptom-free just by observing a low-sodium diet. Other patients may need more complex and/or more invasive treatment. Other patients seem unresponsive to any treatment -- even invasive surgery. The bottom line: each patient tries to find the treatment (or treatments) that works best for each one of us.

Whats Ahead?

The NIDCD, which is part of the National Institutes of Health, says scientists are looking into environmental and biological factors that may cause Mnire's disease and are also studying how fluid composition and movement in the labyrinth affect hearing and balance. Obviously, new insights gleaned into the mechanisms of Meniere's and other balance disorders will enable scientists to develop preventive measures and more effective treatment.

And, good news may be coming from out of space. The NIDCD has joined NASA for Neurolab, a research project focused on the most complex part of the human body -- the nervous system, which also encompasses the balance system.

Since the exposure to the weightlessness in space temporarily disrupts balance on astronauts return to earth and gravity, researchers believe that data collected during space missions may shed light on the mechanisms of recovery from balance disorders.

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