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Dizziness

Meniere's Disease

Meniere's disease is an inner ear problem causing episodes of spinning dizziness (vertigo) lasting between 20 minutes and several hours and often is associated with hearing loss, loud noise in the involved ear, ear fullness, nausea and vomiting. Often the onset of vertigo unpredictable and the hearing loss is fluctuating in nature. It is believed that Meniere's disease is secondary to build up of inner ear fluid.

The majority of patients with Meniere's disease can be treated medically in the office and surgery is very seldom indicated nowadays. The corner stone of Meniere's disease management consists of a low salt diet (less than 2,000 mg per day) and a diuretic by mouth. Medications for control of vertigo spells, such as Valium, and Robinul, are given for control of the dizzy spells. Patients not responding to the previously mentioned treatment, can be considered for cortisone treatment applied directly into the middle ear as an office procedure. This is helpful in some patients with Meniere's disease. For those who fail this treatment, administration of gentamicin in the middle ear, again as an office procedure, is helpful to control vertigo in to up to 90-95 % of patients. Finally, surgery is indicated in a very small number of patients with this disease.

For an appointment with Dr. Sismanis concerning Meniere's Disease, call (804) 628-4368

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness and is thought to be due to otoconia (crystal like particles of calcium carbonate), which move out of their normal position and start floating within the fluid of semicircular canals of the inner ear. Otoconia are normally a part of a balance structure in the inner ear called utricle. This structure may be damaged by head injury, infection, other inner ear disorders such as Meniere's disease or may degenerate from advanced age.

Diagram of the inner ear

The symptoms of BPPV include positional type of dizziness, lightheadedness, imbalance, and nausea. Getting out or rolling over in bed are common provocative movements.

Diagnosis is easily made by the history and the typical nystagmus (abnormal jerky eye movements) upon placing the patient in the provocative position.

Treatment is very effective by the Epley or Semont repositioning maneuvers, which are done as an office procedure. Both maneuvers intend to reposition the "escaped" otoconia from the involved part of the inner ear (most often the posterior semicircular canal) to their normal position. Each maneuver takes about 15 minutes to complete.

Instructions for Patients After Office Treatments (Epley or Semont maneuvers)

1. Wait for 10 minutes after the maneuver is performed before going home. This is to allow you to rest and avoid increased dizziness that may follow the maneuver. Do not drive home yourself; have someone else drive you.
   

2. Sleep on two pillows for the next two nights (a 45 degree angle). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise, which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eyedrops are required, try to put them in without tilting the head back. Shampoo only under the shower.
   

3. At one week after treatment, put yourself in the position that usually makes you dizzy . Let your doctor know how you did.

For those who have not benefited from any of these maneuvers, the Hamid vestibular exercises, shown below, are very helpful. These exercises are performed 10 times 2 to 3 times a day.

Hamid Exercises

Very rarely, for patients who continue to have BPPV despite multiple office treatments and vestibular exercises, surgical obliteration of the involved semicircular canal is a very effective treatment with minimal side effects.