Pick one. Any one. You can save a life.
By: Dr. Jacques Doueck
This month, Dr. Doueck interviews Dr. Michael Gordon, an Ear Nose and Throat specialist, subspecializing in Otology and Neurotology.
I first heard of Dr. Michael Gordon from one of my dental patients who had been suffering from vertigo for years. Amazingly, Dr. Gordon was able to help him without drugs in two painless office visits.
What is “vertigo”?
Vertigo is a symptom, not a diagnosis. Vertigo is defined as the hallucination of motion. Typical patient descriptions are of the “room spinning” or a“shifting” of their environment. Sometimes the motion is felt to be occurring internally or inside their head.
What are some of the common diagnoses associated with vertigo?
Benign Paroxysmal Positional Vertigo (“BPPV”):This is the most common cause of vertigo. It is also the easiest to diagnose and treat. BPPV occurs when small crystals become displaced within the inner ear and settle into what is known as the semicircular canal. The particles tend to sink to the lowest point of the canal. Certain positional changes, such as rolling to one’s side in bed, can result in a change of the orientation of the canal in space, causing the particles to sink to the new “bottom.” This causes movement of the fluid within the canal, typically resulting in a sensation of “room spinning” that lasts for less than one minute.
Labyrinthitis:This is an inner ear infection or inflammation which can be bacterial or, more commonly, viral in nature. Labyrinthitis can cause rapid progression of vertigo and possibly hearing loss.
Meniere’sSyndrome: This is an inner ear disorder related to abnormal inner ear fluid pressure. The symptoms can include: episodes of vertigo, fluctuating hearing loss, tinnitus (ear noises) and a sense of ear pressure.
There are many less common causes of vertigo, some ear-related and some neurologic.
What is the first step in treating vertigo?
Diagnosis is the first step to solving the problem of vertigo. This is often a complicated process. The patient’s medical history and physical examination remain the most important elements of the evaluation. Additionally, nearly all patients should undergo hearing testing to help evaluate inner ear function. Some patients may also require other audiological testing as well as a CT or MRI. Not every patient requires every test. The specialist on the case analyzes the information gathered from the history and physical examination as well as the various diagnostic studies in order to determine the diagnosis.
What is the Canalith Repositioning Treatment?
These are various maneuvers designed to treat BPPV. They use gravity to get the displaced crystals out of the semicircular canals, where they are causing symptoms. The best known and probably the most effective reposition treatment is the Epley maneuver. Specifically, the patient is guided through a series of positional changes designed to cause the crystals to sink to the new canal bottom for each position. The goal is to allow the crystals to move through the length of the canal and out into the chamber known as the vestibule. This often provides complete resolution of the vertigo within one to two office visits.
What is Vestibular Rehab?
This is a subspecialty area of physical therapy. It is often effective for chronic imbalance or motion intolerance. Vestibular rehabilitation specialists also often perform the positional maneuvers for BPPV.
When is medicine prescribed for vertigo?
In some cases, medication may be given to relieve symptoms such as nausea or motion sickness associated with vertigo, or to diminish the severity of a prolonged vertigo episode. It is important to be aware, however, that most of these medications do not address the cause of the vertigo and do nothing to solve the problem or prevent recurrences.
What about antibiotics?
If a particular case of vertigo is caused by infection or inflammation, antibiotics or steroids may be effective.
How is Meniere's Syndrome treated?
A low sodium diet is usually the single most effective treatment.. It will most likely prevent or limit the excessive inner ear fluid pressure that causes the symptoms, Diuretics (water pills) may also be prescribed to reduce the fluid pressure. There are multiple other options including treatment with oral or injected steroids.
Michael Gordon, MD is an Ear Nose and Throat specialist, subspecializing in Otology and Neurotology. He received his medical degree from Albert Einstein College of Medicine of Yeshiva University and has been in practice for more than 20 years. Dr. Gordon is a partner of ENT and Allergy Associates, working at their Garden City, NY location. He is the former section head of Otology and Neurotology at the Long Island Jewish Medical Center (LIJ), and continues to maintain appointments in the departments of Otolaryngology and Communicative Disorders, and Neurology. Dr. Gordon treats patients with a variety of disorders, including hearing loss, vertigo, imbalance, and dizziness. He can be reached at 516-222-1881