Many of us have experienced this at least once in our lives. When we stand still, we suddenly feel as if everything around us is spinning or rocking on the deck of a boat. This is vertigo, “an illusion of movement,” says Dr Raphaël Maire, head physician of the Department of Otoneurology and Audiology at the Vaud University Hospital Center (CHUV).
In most cases, the origin of these discomforts is in the inner ear. Especially in the vestibular system, which governs balance in conjunction with vision and proprioception (“body awareness”). Via the vestibular nerve, it provides information to the brain “about the position or movements of the head in space,” which integrates them, allowing it to be bipedal, upright. If there is an imbalance in any of these sensory inputs, the information received by the brainstem is distorted and imbalanced.
Head movements
There are fainting spells and fainting spells. The most common, called “benign positional paroxysmal” (BPPV), occurs when the head is changed. Episodes are brief, but violent; They recur several times a day, usually for four to eight weeks, but sometimes for two or three months.
This mechanical pathology occurs when “tiny crystals of the inner ear move out of their normal place,” explains physical therapist Daniel Goldman, who specializes in vertigo and balance therapy. Then they start floating in the semicircular canal of the inner ear, which is “very stimulated and sends a false message to the brain for a certain amount of time,” Dr. Mair continues.
These vertigos appear especially after cranial trauma, inner ear infection or surgery of this organ. However, in either case, the cause is unknown. “This is probably a degenerative problem, as their incidence increases with age,” notes the CHUV expert.
However, these BPPVs are benign and most of the time they disappear when the small crystals break or leave the canal. “Using various precise displacement maneuvers that mobilize the head, we stimulate the expulsion of the disturbers, which significantly reduces episodes of vertigo”, underlines Daniel Goldman.
Prolonged vertigo, almost always single
Acute unilateral vestibulopathy (also known as neuronitis or vestibular neuritis) is characterized by a sudden and spontaneous onset of rotary vertigo lasting at least twenty-four hours – but often a few days – associated with nausea, vomiting, and disorientation. It is treated with medication (anti-nausea and vertigo) and physiotherapy. It initially involves exercises aimed at “stabilizing the most disturbed vision,” notes Daniel Goldman. Patients are rotated in a rotary chair “to ‘fatigue’ the vestibular reception on the healthy side in order to restore balance between the two ears”.
Treatment is completed with compensatory exercises on a computerized platform that “promotes the functions of balance.” It is necessary for the physiotherapist to carry out the treatment as quickly as possible, because “the early nature of the assumption of liability determines the quality of the evolution of the disease”.
Repeated crises
Vertigo can be very disabling when it comes with repeated seizures, lasting from twenty minutes to twelve hours (often two to three hours), with low-frequency hearing loss and ringing (tinnitus). “People often think their ear is under pressure,” says Dr. Mair. When two or more such attacks occur, doctors diagnose Meniere’s disease.
The origin of this pathology is still unknown. According to some doctors, due to excess fluid in the inner ear, one of its structures, the labyrinth, expands. “This theory is debated, the CHUV doctor underlines. Of course, this expansion is a witness to the disease, but it does not mean that it is the cause.
A source of particular reluctance, treatment varies by region of the world. In Europe, doctors prescribe calcium antagonists and antihistamines. They sometimes drain the ear to prevent atmospheric pressure from building up too much pressure there. Treatment is heavy when the disease develops and the hearing loss is significant. It injects toxic antibiotics into the ear through the eardrum, damaging the horizontal canal causing severe vertigo. As for physiotherapy, according to Daniel Goldman, “it specifically tries to relieve symptoms between acute attacks”.
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Published in Le Matin Dimanche on 06/11/2023
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