Unraveling the Inner Ear Mystery of Room-Spinning Sensations

Think you may have vertigo? You won’t want to miss this episode of We Nose Noses. From common causes to the crucial signs, learn how to recognize when it’s time to seek medical help and which specialist to consult. Gain insights into the inner ear, explore various vertigo types, and discover the diagnostic tests and treatment options that can bring relief.

What you’ll learn

  • Why the duration, frequency, and triggers of episodes help decipher causes and types of vertigo
  • What inner ear-related causes and common misconceptions for those experiencing dizziness or imbalance
  • When to consult an ENT specialist for a comprehensive assessment and treatment options

Take the first step toward a balanced future. Listen now for all your ear, nose, or throat matters and get insights from the experts. For professional ENT support, schedule a consultation today at our Marlton, New Jersey location by visiting NJENT.com or call 609-710-NOES (6673).

Listen to the audio version below.

Audio Transcript:

Dr. Smith
Hi, welcome back to the We Knows podcast and Dr. Smith with Dr. Undavia and Dr. Reddy. Today we’re going to discuss a very common topic which we all see, which is vertigo. So a lot of patients come into our office describing movement or room spinning type of sensation and these things can be acute and happening right now. They can be happening chronically or happening over months.

And so we’ll talk a little bit about the most common causes of room spinning vertigo and discuss kind of the presentation, what to look for and how to kind of decide when it’s time to go see a doctor and which doctor to see because that’s probably the most common issue that we see from patients is not knowing who to go see for it. So a lot of patients end up trying to get a hold of the primary doctor and may end up in the emergency room or an urgent care center with vertigo. And the goal of this topic is hopefully to keep people out of dire situations where they don’t know what to do. So Dr. Reddy, do you want to describe a little bit of what vertigo is?

Dr. Reddy:
Sure. So vertigo is a sensation of the room spinning around you. And it can often be confused or kind of grouped in together with symptoms such as dizziness or imbalance. And so if you have vertigo, dizziness or imbalance, then it oftentimes, patients oftentimes see either their primary care doctor or urgent care or their ENT or neurologist. And it’s sometimes tough to figure out where it’s coming from. And so our job as ENTs is to try to figure out is there maybe an ear, nose and throat reason for these symptoms and the workup and the differential diagnosis for something like this, the different causes for this is quite large and extensive and complicated. And so sometimes it takes a lot of patience and testing to try to figure this out.

Dr. Smith:
Perfect. Well said. So yeah, we’re going to talk about the causes but as we get into the causes we’ll talk a little bit about some non ear causes too because sometimes those can mimic your Ear-related causes, but we’ll start with the inner ear related causes Dr. Undavia, do you want to discuss just kind of what the inner ear is what it does? In response to sensing movement?

Dr. Undavia:
Well, can I just talk a little bit about the non ear causes? Our patients might say oh, I just need to go see an ENT but because they won’t be able to figure out that this is not ear related. So the first thing I just wanna say is the real reason patients go to the ER for this is because they’re ruling out a stroke. So that is the most serious thing that patients might have when they have these vertigo or balance or disease symptoms. So if, you know, and by listening to this podcast, you’re not gonna be able to tell that for sure. So if you are at all worried, we want everybody to know, you should call your primary doctor or go to the ER. Always. There’s never a wrong situation where you go to the ER for a symptom that you’re worried about.

So having said that, when it comes to the inner ear, the inner ear is meant to detect angular motion that we have in all 360 degrees, and it also helps us analyze the sounds that are going into our ear. Perfect. Yeah, exactly.

Dr. Reddy:
Yeah, I think it’s probably a good idea to take a quick step back and just think about why do you even get dizzy and have imbalance or vertigo, right?

Dr. Undavia:
I have the, can I do this or did you wanna do this?

Dr. Reddy:
Oh, you can do it.

Dr. Undavia:
I have the best lion example.

Dr. Reddy:
Okay, go for it. Let’s hear it.

Dr. Undavia:
So if you hear a lion roaring to your left and you did not have a balanced center, you would not, you would turn your head to the left and that momentum would whip you down and make you fall. However, if you hear a lion to the left and you have your balance center, the first thing that your balance center does after you make the decision to move to the left, is apply pressure on your quads, on your left quad, and it helps brace you while you turn to the left. So there’s a thousand different reflexes that your body is doing in relation to your balance and your head movements alone.

Dr. Reddy:
Yeah, thank God there aren’t any lions around.

Dr. Undavia:
Yeah, there might be.

Dr. Reddy:
But the main thing I try to tell people is that, when there is a mismatch in your brain when it comes to different inputs that’s telling you where you are in three-dimensional space. That’s when you potentially have the symptoms of vertigo and dizziness or imbalance. So you have multiple sensory inputs that go to your brain to tell you where you are in three-dimensional space. You have your vision, you have your inner ears, you have your spine, you have what’s called proprioception, which is the sensation of you feeling the ground, the joint position, and there’s others, right? And if any of those things are a mismatch, then you can feel dizzy or imbalance. And the classic example of this is if you’re reading a book while you’re in the backseat of a car, because at that moment, your ears are telling you that you’re going forward. But your eyes, when you’re looking at the page is telling you that things are still and that mismatch for some people can cause that sensation.

And so when you see an ear, nose, and throat doctor, we’re essentially kind of focused more on the ears, but there’s a lot of other issues that can cause that mismatch. And you have to make sure your primary care, make sure your heart is okay. There isn’t a heart issue. There’s not, you know, blood is getting up to your brain as it should. There isn’t like a brain issue from a neurologist, et cetera.

Dr. Smith:
Yeah. The brain is essentially your central computer getting all that information from the ear, the eyes, and the proprioception. So, any one of those things that Dr. Reddy was saying could be off. So we’ll focus a little bit on more of the inner ear type causes now, because this conversation could go on for hours if we discussed all of the causes that are brain related, proprioception related, even cardiac related. So as far as the ear related causes, you know, I often find the, the the history is probably one of the most important things and probably the most useful things as to trying to determine what the cause of vertigo is. And so a lot of times I’ll have patients that come in and they’re trying to describe it and trying to explain it. And I try to simplify things down to them. I just, you know, one thing that’s very important is the duration, like how long are these happening, these episodes, are they episodic? So are they actual episodes?

So are they lasting seconds? Are they lasting minutes? Are they lasting hours? Is it happening over and over throughout the day? Is it happening, did it just happen once and it never happened again, but it lasted for hours or days? So a lot of these things can be pretty helpful. And sometimes it might start one way and you may come in and you may be having something that is still vertigo or spinning to you, but it may be different. So I often ask patients, well, how did it start? The first episode that you got, how did that present? And then, you know, then you wanna know the duration, how many episodes they’ve had, how frequently does something provoke it? You know, is there movement that provokes it or bending, sitting, lying, those types of things. And so the history, you know, I can’t emphasize it enough, even the patients that go into the ER aptly so, the history is probably the most important thing because really the history can tell you if it is something like a stroke going on a lot of times. Sometimes it can guide you to something which is the most common type of vertigo and the most benign type of vertigo, which is something called benign paroxysmal positional vertigo or BPPV. I’ll let Dr. Reddy talk a little bit about.

Dr. Reddy:
Alright, so you have these three little canals in the inner part of your ear called the semicircular canals. These canals are filled with fluid and when you move your head, the fluid moves and it excites certain neurons in your brain which tell you where you are in three-dimensional space. So the theory is that you have these things called otoliths that for some reason are free floating in your inner ear and when you’re moving your head, the fluid moves in one speed and the little particles or the otoliths move in a different speed, and they cause a mismatch again in terms of your perception of where you are on three-dimensional space, and it can cause dizziness. The dizziness that most people get from this, or the vertigo that most people get from this is usually on the second, on the order of seconds rather than minutes or hours. So usually like the classic person that has this is someone that’s laying in bed and moving suddenly from left to right with their head, and then they get these dizzy episodes where the room spins around them for about 30 seconds and then it stops.

Dr. Smith:
And patients can feel this is where the history is really important because patients sometimes have that, but then they come in telling you they were spinning for three days or a week. But when you really kind of pare it down, there are episodes that are happening, but every time they move, they’re getting it, or every time they’re bending over or leaning back, they’re getting it. So BPPV is the most common type of vertigo and the nice thing about it is that it’s fixed typically with some physical therapy exercises. So, you know, seeing an ENT or a primary doctor, physical therapist, often these things can be fixed and treated pretty quickly and easily in the office. We actually do the physical therapy for the first time in the office. So we know that that’s the diagnosis and that we know how to fix it.

Dr. Smith:
Excellent. So, that kind of gets me to the next category of vertigo that I talk about typically with patients and I’ll kind of let you talk about it a little bit, but the minutes to hours causes. So typical vertigo patients that get episodes that last either 30 minutes, several hours, even up to a day. And sometimes the…
So do you want to talk about…

Dr. Undavia:
Are you talking about the civilian neuritis?

Dr. Smith:
So no, I’m talking about migraine variant vertigo.

Dr. Undacia:
That’s you. You can’t talk about that.

Dr. Smith:
And then Meniere’s disease. So Meniere’s disease is typically characterized by fluctuating low frequency hearing loss or feeling like your ear’s clogged on and off, room spinning vertigo, and plus or minus some ringing in the ear and pressure sensation in the ear as well.

These episodes typically occur frequently and they can occur for several hours at a time. They can be either pretty mild or they can be pretty debilitating. But patients typically will get room spinning vertigo with Meniere’s disorder. And it’s thought to be a problem with those fluid filled tires swelling and causing some issues with basically the information that’s getting sent to the brain.

The underlying cause of it is debatable, but there’s thought to be some autoimmune causes or some post-viral causes that can cause these things within the inner ear. So that’s Meniere’s disease. The other one that we see commonly, and probably more commonly than ENTs like to recognize, but migraine-variant vertigo, migraine-associated vertigo, or vestibular migraines are the three common terms for it and these are not always typical migraines with the normal unilateral headache and sound sensitivity, light sensitivity. Sometimes it’s just dizziness or vertigo. This is probably the one that’s the history that’s the hardest to get from a patient because they don’t really know how to describe the vertigo. It’s some sort of movement or rocking swaying that doesn’t seem to fit the typical circular pattern of the other vertigos. And so those are kind of the harder ones for you know, physicians to kind of diagnose. And then there’s also a very severe cause of vertigo, which typically lasts hours to days.

Dr. Reddy:
Yeah. It’s, you’re referring to labyrinthitis or vestibular neuritis.

Dr. Smith:
Correct.

Dr. Reddy:
Yeah. So it’s essentially thought that maybe there’s a viral exposure and that results in inflammation of your balance nerve or your hearing and balance nerve in your inner part of your ear. And that results in potentially days worth of severe vertigo, dizziness, sometimes hearing loss and ringing in the ear. But you know one of the things that we’ve noticed a lot of is a lot of our patients that come in with these symptoms have been bounced around right from one doctor to another and a lot of times patients are just given like a band-aid medication like meclizine for example or antivert but really getting to the root cause of what’s causing, what’s the underlying disorder that’s causing this is really important because otherwise, whatever you’re treating this as is just a band-aid. You never gonna get better.

Dr. Smith:
Absolutely.

Dr. Reddy:
And so it takes a lot of time, energy to kind of get to the root cause of this. Sometimes it takes additional testing. Maybe you wanna go over some of the additional testing that we do.

Dr. Undavia:
Yeah, it goes back to when patients should see an ENT. We generally think that if somebody has an ear symptom, they should come see the ENT when it comes to vertigo or disease. So if they have a hearing loss, or if they have a ringing in their ear, or if their ear is draining or their ear hurts, we should be seeing you for that. But so some of the diagnostic tests that we do, we do a hearing test. We can do tuning for tests like Dr. Smith loves to do. We can do diagnostic imaging like an MRI, um, the Dix Hall Pike maneuver. Yeah, we can do the Dix Hall Pike maneuver. Yep. Yeah. Maneuvers and the office. There are maneuvers. Um, those are the main things we can also do.

Dr. Reddy:
Sometimes we even do a nasal endoscopy, right? And some, usually sinus issues are not the root cause of the dizziness, but oftentimes they’re an exacerbating factor. So if you have sinus issues.

Dr. Smith:
Especially if it’s migraine related, sometimes these can be sinus related issues that can trigger those migraines. So there’s lots of different triggers that can be the culprit for some of these.

Dr. Reddy:
And then you mentioned imaging, there’s either a CAT scan or an MRI and you went over the VNG as well? I mentioned VNG. VNG is a series of mini tests that looks at your balance system as a whole and tries to essentially classify the cause of your dizziness as either a central issue or a peripheral issue. Central meaning within the brain, like a processing problem or a peripheral issue, meaning the sensory organ. And then in terms of treatment options, it all depends on what the diagnosis is. But generally speaking, it’s good. We can occasionally use these band-aid type medications for acute flare ups, like an anti-anxiety medication like Xanax or Valium or a suppressed vestibular suppressant like meclizine, oral steroids are really helpful during acute flare ups. Um, we sometimes do ear injections. It’s called intratomaniac steroid injections, especially for Menieres disease patients and, um, certain maneuvers like the Epley maneuver for BPPV can be helpful, uh, vestibular therapy, depending on, um, what type of diagnosis there is. Dr. Smith is an expert on migraines, right? So migraine medications can sometimes be helpful.

Absolutely. Or even antidepressant medications in some cases can be helpful.

Dr. Smith:
Yeah, so I think that sums it up perfectly. That was a big shotgun of things that need to be done, but as you said, the root cause is the most important thing. So certainly, if you’re having vertigo, room spinning, dizziness type symptoms, I think it’s certainly important to make sure that you seek medical attention and get to the underlying cause of it instead of just saying, all right, here’s a pill, take this pill for this spinning that you don’t know why you’re spinning. Exactly. Excellent. Well, thanks for joining our podcast again, guys. Look forward to seeing you next time.

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