With so many factors keeping people stable and on two feet, every once in a while something can go wrong. For many, it’s vertigo.
According to the Mayo Clinic website, “Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady. Dizziness that creates the false sense that you or your surroundings are spinning or moving is called vertigo.”
Dr. Raphael Nwojo is an ear, nose and throat specialist in Odessa. The cerebellum, the spinal cord, your inner ear can all play a factor.
If one part of the equation comes out, “you’re stumbling all over the place,” Nwojo said.
“Dizziness is a very complex part of our specialty a lot. As a matter of fact, a lot of ENTs don’t like to deal with dizziness because it’s so multifaceted.”
When a patient comes to see him for dizziness, Nwojo said it’s almost an hour consultation because he’s ruling things out. He wants to make sure it’s nothing to do with the patient’s head or it’s not a brain tumor.
“The majority of the time it is not …,” Nwojo said.
He added that he has to narrow it down to see if it has something to do with the inner ear.
“Like I said, there’s 10 organs; 10 organs within the inner ear, between both ears and you are trying to see is this what the problem is,” Nwojo said.
“With ENT (ear, nose and throat), the most common thing we see that will explain dizziness in a patient is something called a benign positional paroxysmal vertigo,” Nwojo said.
Nwojo showed a model of a left ear, pointing out the organs inside — where people hear from and where their balance is.
“There’s a part of it called your semicircular canals. There are three of them — superior, posterior and horizontal. They have these calcium crystals that float around them and send a signal to the brain telling the brain where the head is at all times.”
“And for some reason that we’re not sure (of) … the one thing that we’ve isolated is trauma of any kind, or illness. But a lot of the reasoning behind what causes some of those crystals to get stuck, we don’t know,” Nwojo said.
“But the moment they are not flowing freely within these loops, if they get stuck … it gives the brain the signal the head is moving when it’s not. Hence, those patients have that spinning, or vertigo sensation.”
He added that it’s usually set off by quick movements. Nwojo said doctors can isolate which ear it is coming from when they do a special type of exam called Dix-Hallpike maneuver.
“That can tell us telltale signs of what their eyes will do when you do that maneuver. The eyes, you actually see it like twisting … You induce the dizziness when you do that, so I can tell you which is it coming from because there’s a counter maneuver you do to correct it called an Epley Maneuver,” Nwojo said.
Many times patients are given exercises to do at home that are geared toward strengthening their balance area. Nwojo said they figure out what exercise best suits the patient.
“The second most common pathology that brings a patient to us for dizziness is something called vestibular neuritis. In English, it just means somehow a virus got into this organ here, the vestibule … in the inner ear. The telltale sign is maybe they were exposed to somebody with a URI (upper-respiratory infection) like a child at home is having the sniffles and a cough; or they have the sniffles, maybe even up to a month ago and they got over it. But the virus sort of lingered and got into this system. You woke up one morning and the whole world is spinning; you are sick to your stomach; you can’t keep your eyes open because everything is moving …,” Nwojo said.
He added that it tends to go away after a day or two, but there might be lingering imbalance or head fogginess.
“The key difference, though, with vestibular neuritis or with another problem we call labyrinthitis is there is no hearing loss. Their hearing doesn’t go out. They just have dizziness attacks and … projectile vomiting, but their hearing remains intact,” Nwojo said.
“How we treat that … is maybe giving them some steroids to combat inflammation caused by the virus and exercises to recalibrate your binary system … trying to make the other parts of your balance area stronger to carry the weak side until the inflammation is resolved or reversed,” he added.
Labyrinthitis is another common pathology he sees for dizziness.
“With Labyrinthitis, a virus gets into the system, but the virus also gets into this one as well,” Nwojo said. He added that they are sick to their stomach and can’t hear out of the affected ear and can go deaf just like that.
It’s hard to figure out what’s going on because you can’t see anything on a scan. He said an MRI might show you some changes, but it has to be looked at by a neuroradiologist.”
Nwojo said if you come see him within a few days after it happens, he can reverse it.
“I can actually inject steroids through the eardrum to get it in here, so I can reverse the inflammation and get your hearing back,” Nwojo said.
It has to be injected into just the right place. He said there are roughly three sets of injections every five to seven days to try and reverse the hearing loss.
Meniere’s disease is another disorder of the inner ear that can cause dizziness. Nwojo said it is a disease of the labyrinth. Surgery can be done for it, but probably won’t be able to hear out of the affected ear.
There are iron channels that help filter fluid back and forth. In a patient with Meniere’s, something is wrong within the iron channels that cause their fluid exchange not to work as well. The patient tends to have swelling in the inner ear that gives them the spinning sensation. The patient also may have a little hearing loss, plus “deadly spinning or vertigo attacks” where the patient has to lay down. To treat it, fluid has to be removed.
“They have to watch out the amount of salt they take in just to maintain the … fluid balance in this space,” Nwojo said.
There is a surgical procedure to get the fluid out, so they don’t get sick anymore.
He added that it’s best to manage it with medication.