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Address Vertigo to Avoid Falls: Don't dismiss dizziness--it can cause falls that may result in serious injuries and even death.

Studies suggest that vertigo--or dizziness--is one of the most common reasons older adults visit their doctor. The condition is a risk factor for falls that can result in fractures and loss of independence as you age. But despite the fact it is so common, vertigo is not an inevitable part of getting older, and there are strategies that can help alleviate it.

Getting Evaluated Step one is getting evaluated by your doctor to clarify what is causing your vertigo. Eric E. Smouha, MD, professor of otolaryngology at Mount Sinai, says that your doctor will ask how your vertigo manifests, how long it lasts, and whether anything specific triggers your symptoms (for example, rising from a supine or seated position). "He or she may ask you to describe your symptoms using words other than dizzy," adds Dr. Smouha. "This can help differentiate vertigo from unsteadiness, fainting, general weakness, and fatigue. You might experience the symptoms as lightheadedness and/or a floating, spinning, or tilting sensation."

Your doctor also will carry out a physical exam to assess vital signs such as blood pressure, since dizziness can result from sudden drops in blood pressure. He or she will examine your ears for signs of infection, test your hearing, and assess your gait and balance. Your eyes also will be checked for signs of a phenomenon called nystagmus. "This causes the eyes to make repetitive, uncontrolled movements, and often accompanies vertigo," Dr. Smouha explains.

A medication review also will likely be part of your doctor visit. A number of medications commonly taken by seniors can raise the risk of dizziness, particularly drugs used to treat high blood pressure. In one study, medications were implicated in almost one-quarter of cases of dizziness among older adults. Dizziness also can be a result of anemia, low blood sugar, and dehydration. Assuming these possible contributing factors are ruled out, your doctor will need to identify what type of vertigo you have and possible underlying causes.

Central or Peripheral? Some cases of dizziness are associated with problems in the central nervous system due to head injuries, stroke, Parkinsons disease, and migraines, among others. "In these cases, the symptoms tend to last for long periods of time during which you may be unable to stand and walk even with assistance," Dr. Smouha says "A red flag for central vertigo is that nystagmus is mainly vertical, and dizziness upon rising from a supine position is not accompanied by a drop in blood pressure. If your doctor suspects you have central vertigo, you'll be referred for further tests to establish the cause."

Most vertigo is categorized as peripheral, and stems from a problem with the inner ear, which regulates balance. "In peripheral vertigo, the inner ear signals the brain that your surroundings are spinning," Dr. Smouha explains. "Since this doesn't match what you're seeing, the brain becomes confused and dizziness is the result." Common causes of peripheral vertigo include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease.

BPPV This occurs when otoconia (gravity-sensitive calcium crystals in the utricle, one of the structures of the inner ear) dislodge and float into other structures called semicircular canals. "The semicircular canals contain fluid and sensory hair cells that monitor rotation of the head," Dr. Smouha says. "If otoconia stimulate these tiny hair cells, it can result in brief spells of intense spinning that are provoked by sudden movements such as rolling over in bed or looking up at the ceiling."

BPPV can be treated with a simple procedure named the Epley maneuver, which helps the calcium crystals slip out of the semicircular canals. The Epley maneuver is carried out in your doctor's office. Your doctor will ask you to sit down on the exam table and then turn your head in the direction that makes you most dizzy. While supporting your head, he or she will then tilt you backwards until you are laying flat, with your head still in the turned position. "You likely will experience vertigo at this point, but once it eases your doctor will turn your head to the opposite side and then roll your body over to bring it in line with your head," Dr. Smouha says. "You may have another attack of vertigo but when it stops, your doctor will help you sit up." The Epley maneuver may need to be repeated more than once but is successful the first time in about 70 percent of cases.

Vestibular Neuritis Also known as labyrinthitis, this may occur if the vestibulocochlear nerve of the inner ear becomes inflamed by a viral infection. "This nerve sends information on balance and head position to the brain, and if it becomes inflamed the flow of information may be disrupted," Dr. Smouha explains. "The disruption manifests as a sudden attack of vertigo that can last from a few days to a few weeks, and often is accompanied by nausea and vomiting. Nystagmus is typical, and horizontal in direction."

Vestibular neuritis typically occurs only once and then resolves--however, some people who have had the condition are left with chronic imbalance. This may be treated with vestibular rehabilitation: an exercise-based program that focuses on general fitness, balance, and gaze stability (keeping your eyes focused on an object while turning your head). "These programs train the brain to adjust to movements that otherwise might cause dizziness, and have been shown to help prevent falls and boost quality of life," Dr. Smouha notes.

Meniere's Disease This is related to sodium and fluid balance in the ear, and can cause severe vertigo, as well as hearing loss and tinnitus (ringing or other "phantom" sounds) in the affected ear. The onset of Meniere's may be sudden, and attacks can last for several hours, and cause nausea and vomiting. "It is unclear what exactly causes Meniere's disease, but it may be related to fluid buildup in the inner ear," Dr. Smouha says. "Signs that point to Meniere's disease include problems hearing low-frequency sounds, and difficulty distinguishing between words that sound similar."

There's no cure for Meniere's disease but you may be able to obtain some relief by taking anti-nausea drugs and wearing a hearing aid on the side affected by hearing loss. "Some people with the condition also find that vestibular rehabilitation helps improve their balance," Dr. Smouha adds.

The Epley Maneuver

1. While you are laying flat, your doctor supports your head, which is turned to the same side as the affected ear.

2. Your doctor turns your head quickly to the other side, and then rolls your body over to bring it in line with your head.

3. Once any dizziness has subsided, your doctor will help you sit up. He or she may need to repeat the procedure.


* Make a note of your dizziness triggers (for example, the head positions that cause it) and how long it lasts, so that you can aid your doctor in making a diagnosis.

* Seek medical attention if your dizziness is accompanied by chest pain, severe breathlessness, slurred speech, weakness on one side of your body, and/or a sudden, severe headache.

* Review your medications with your doctor to check if any may be contributing to your dizziness.

* Avoid alcohol, since it can cause or worsen dizziness.

Caption: A common type of vertigo occurs when tiny crystals (otoconia) in a part of the middle ear called the utricle float into other areas (called semicircular canals), where they stimulate tiny hair cells that monitor rotation of the head
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Publication:Focus on Healthy Aging
Date:Feb 1, 2020
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