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If the world is spinning, you may have vertigo.

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 han rdous," explains Eric Smouha, MD, associate professor of otolaryngology at Mount Sinai.

Common causes

Since balance is regulated in the inner ear, this is the location where vertigo originates. It may be caused by:

* Benign paroxysmal positional vertigo (BPPV) This occurs when tiny calcium crystals (otoconia) in the utricle (one of the structures of the inner ear) break loose and stimulate sensory hair cells elsewhere in the inner ear. "This can result in brief . spells of intense spinning that are provoked by turning in bed, bending down, or looking up at the ceiling," says Dr. Smouha. "The problem can be treated with a simple procedure named the Epley maneuver." (See box, below.)

* Vestibular neuritis (acute labyrinthitis) This is caused by a viral infection of the inner ear and cochlea, and typically develops after a cold or the flu. 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, which also is called balance therapy," says Dr. Smouha.

* Meniere's disease, a problem related to sodium and fluid balance in the ear, also may spawn vertigo, as well as hearing loss and tinnitus (ringing in the ear). "The onset of Meniere's may be sudden, and may last for several hours, causing nausea, and vomiting," says Dr. Smouha.

* Medications are another possible factor. "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 meds and/or alcohol, or taking more of a drug than is prescribed, may sometimes produce vertigo.

Evaluation tools "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, 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. Magnetic resonance imaging (Mn) is helpful in many cases to rule out tumor, stroke, or multiple sclerosis.


* Make a note of the circumstances in which your dizziness occurs (for example, the head positions that trigger it), and how long it lasts.

* 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.
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Publication:Focus on Healthy Aging
Date:Feb 1, 2015
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