Why Does it Feel Like I’m Spinning?

by malam53, posted in Blog

Vertigo is a common phenomenon seen in patients with and without hearing loss. It is described as the perceived movement or spinning sensation of one’s surroundings without actual physical movement. Research indicates that over 20 percent of patients with hearing loss have had an incidence of vertigo in their life (1). Vertigo can be present as a symptom in both peripheral (inner ear) or central (nervous system) related pathology. Benign paroxysmal positional vertigo (BPPV) is seen in 44 percent of patients and is the most common occurrence and most successfully treated inner ear dysfunction.  Other conditions affecting the vestibular system include vertebrobasilar insufficiency, meniere’s disease and sudden sensorineural hearing loss (1).  The focus of the discussion will be on BPPV as it is the most common clinical presentation of vertigo.

Causes of BPPV 

 The main cause for vertigo to be triggered is due to sudden changes in head position (ex. getting out of bed). In BPPV, an immediate onset of symptoms usually is present commonly including dizziness, nausea, tinnitus, feeling off balance and /or lightheadedness (2). The pathophysiology of BPPV arises from a dysfunction of the balance system located in the inner ear.  In the main type of BPPV, small crystals, known as otoconia, get dislodged from their home position located in the vestibular labyrinth. In BPPV, the movement of the otoconia into the semicircular canals (SCC) causes stimulation of the vestibulocochlear nerve, resulting  in the sensation of vertigo. (3) The main cause is idiopathic and vertigo most commonly occurs around the age of 50 to 70 years. Secondary causes of BPPV commonly include head injury and meniere’s disease (3). For other common vestibular disorders, symptoms can include but are not limited to certain viral or bacterial infections, autoimmune disorders, genetic conditions, medication, environmental factors and/or allergies (2). 

Treatments

The most common treatment for BPPV includes canalith repositioning maneuvers that can be performed in a clinical setting. Treatment using repositioning maneuvers can be determined by a thorough case history and beside assessment including the dix hallpike maneuver which can indicate the site of lesion (5). The most common treatment for BPPV is the Epley maneuver which aids in returning the otoconia  back to their home position in the vestibule located in the inner ear.  Other uncommon approaches include the use of medication or surgical intervention in more severe cases.  For meniere’s disease, low salt diet and diuretics can be used to control for vertigo related symptoms experienced (4).

Recommendations and Conclusions

For patients with episodes that are short lasting (less than a few minutes) it is recommended to avoid sudden head motions that induce symptoms. Furthermore, it is important to see a trained professional that specializes in vestibular assessment and rehabilitation which may include a physiotherapist, physician or audiologist. They can help determine the type of problem and facilitate the necessary treatment or determine if further medical management is required. Since vertigo may be present in certain  hearing related conditions,  health professionals may recommend getting a diagnostic hearing assessment to rule out red flags that may be present in the peripheral auditory pathway.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841877/#:~:text=In%20our%20study%2C%20vertigo%20with,being%20the%20most%20common%20cause.
    1. Sunitha M, Asokan L, Sambandan AP. Vertigo: Incidences, Diagnosis and Its Relations with Hearing Loss. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 2):1282-1286. doi:10.1007/s12070-018-1315-6 
  2. https://www.sac-oac.ca/wp-content/uploads/2023/01/vestibular_info_sheet_en.pdf
    1. Vestibular Disorders Audiologists Can Help . Available at: https://www.sac-oac.ca/wp-content/uploads/2023/01/vestibular_info_sheet_en.pdf (Accessed: 03 January 2024). 
  3. Benign Paroxysmal Positional Vertigo (BPPV) | Johns Hopkins Medicine
    1.  Benign Paroxysmal Positional Vertigo (BPPV). Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-positional-vertigo-bppv (Accessed: 03 January 2024). 
  1. https://www.aafp.org/pubs/afp/issues/2005/0315/p1115.html
    1. Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician. 2005;71(6):1115-1122.
  2. https://www.ncbi.nlm.nih.gov/books/NBK470308/
    1. Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2022 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470308/

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