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"Why do I feel like I'm spinning?".

Although vertigo--a "spinning" sensation--is a fairly common complaint among older adults, it is not an inevitable part of aging. There are many possible causes, and it's important to be evaluated by a doctor who can determine the cause and recommend appropriate treatment.

"Vertigo caused by vestibular (balance) system disorders can lead to falls in older adults, so although the condition may be benign, the consequences can be hazardous," explains Eric Smouha, MD, associate professor of otolaryngology at Mount Sinai School of Medicine.

Common causes. Since balance is regulated in the inner ear, this is the location where vertigo usually originates. A condition called benign paroxysmal positional vertigo (BPPV) is caused by crystals (microparticles of calcium, or "otoconia") that form in the balance canals of the inner ear. "Patients complain of brief spells of intense spinning that are provoked by turning in bed, bending down, or looking up at the ceiling. The problem is diagnosed in the office and treated by a simple procedure named the Epley, or particle repositioning, maneuver," explains Dr. Smouha. This involves your head being moved into certain positions while you recline in a chair or lie down. The goal is that the crystals will slip back into another area of the inner ear, where they can be reabsorbed.


Another condition, which is caused by a viral infection of the inner ear, is vestibular neuritis (acute labyrinthitis). It manifests as a sudden, unexpected attack of vertigo that can last from a few days to a few weeks. "vestibular neuritis usually resolves completely, but occasionally, patients are left with chronic imbalance that may be treated by vestibular physical therapy ('balance therapy')," says Dr. Smouha.

Medications are another possible factor. "Providing a complete list of medications is essential for the doctor evaluating the problem," advises Dr. Smouha. While few drugs can cause vertigo on their own, interactions with other medications and/or alcohol, or taking more medication than is prescribed, may sometimes produce vertigo.

Evaluation tools.

To determine what is causing vertigo, history is key. "As a doctor evaluating a patient, I usually ask them to describe the first episode, the character of the vertigo, what they were doing when it started, the frequency and severity of further episodes, precipitating factors such as position and movement, and associated symptoms such as loss of hearing, tinnitus (ringing in the ear), loss of vision, and headache," explains Dr. Smouha.

A physical examination helps to identify nystagmus (a repetitive, abnormal eye movement) and any abnormalities in gait and balance. An audiogram (hearing test) and electronystagmography (ENG) record the function of the hearing and balance systems. MRI is helpful in many cases to rule out tumor, stroke, or multiple sclerosis.


Other common causes of vertigo that can occur at any age include:

* Meniere's disease (sudden episodes of vertigo lasting several hours).

* Acoustic neuroma (a benign tumor of the hearing and balance nerve).

* Vestibular migraine (vertigo accompanied by headache and motion sickness).

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Title Annotation:IS THIS NORMAL AGING?
Publication:Focus on Healthy Aging
Article Type:Report
Geographic Code:1USA
Date:Nov 1, 2010
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