The Ear, Balance and Vertigo Treatment in Miami

Dizziness is a fairly common presenting complaint with a lifetime prevalence of 30% in general population (Filippopulos et al., 2017). It is a whirling feeling; you may be unbalanced and/or lightheaded. Dizziness itself is not a disease but rather a symptom of many. If you are dizzy, then there could be a few reasons for that, one of which is vertigo. But first lets review the inner ear anatomy to fully understand what causes dizziness.

The ear consists of the three (3) following parts:

  1. The Outer Ear (Figure 1) – The auricle or fleshy part of the visible ear, the ear canal and the outer tympanic membrane or eardrum.
  2. The Middle Ear (Figure 2) – this part of the ear lies within the skull (temporal bone). It consists of three tiny bones whose main function is to transmit vibrations from the eardrum to the inner ear. The three bones are the Malleus, Incus, and Stapes.
  3. The Inner Ear (Figure 3)

outer ear anatomy

Figure 1: Anatomy of the Outer Ear

anatomy of the middle ear

Figure 2: Anatomy of the Middle Ear

anatomy of the inner ear

Figure 3: Anatomy of the Inner Ear

 

Focus: The Inner Ear

The inner ear (See Figure 3), or the innermost part of the ear is responsible for hearing and maintaining balance. It is located in the bony labyrinth, which is lined by a membranous labyrinth. The inner ear broadly consists of two parts; the cochlea works for detecting sounds and the vestibular system is responsible for your balance and orientation. The vestibular system consists of the three semicircular canals, the saccule and the utricle. The vestibular system interacts with your eyes and the muscle receptors in your feet and spine. The signals from all these are received by the brain to maintain balance.The three semi circular canals are superior, posterior and horizontal. The two canals are positioned horizontally and vertically and the third is at 30° angle from the horizontal. The semi circular canals are filled with fluid called the endolymph that helps in determining your orientation in space and when you are in circular motion.

In 1825, Jean Pierre Flourens discovered the function of the semi circular canals by destroying the horizontal ones in pigeons and noting that the pigeons continued to fly in a circle (Pearce, 2009). The different orientations of the semi circular canals cause them to get stimulated relative to the movement of your head. When you move your head, the endolymph in your inner ear moves too and stimulates the hair cells. This in turn, stimulates your vestibular nerve to send information to your brain about your position.

What is Vertigo?

So back to vertigo: If it feels like you are spinning or the room around you is spinning, then it can be rotational dizziness or vertigo. There can be multiple types of vertigo:

Types of Vertigo

Benign Paroxysmal Positional Vertigo (BPPV)

This is one of the most common causes of vertigo. It is characterized by repeated short periods of dizziness that usually lasts less than one minute. There may be associated nausea with BPPV. The underlying reason is the tiny bits of calcium carbonate known as otoliths that are moving freely in the endolymph. There are several maneuvers to help determine the side of BPPV (Dix-Hallpike Maneuver) and to help restore the crystals to their correct position (Epley’s Maneuver, Half-Sommersault, Log-Roll)

Viral Labyrinthitis

This is an inflammation of the labyrinth in the inner ear caused by a viral infection. There is sudden onset of dizziness and there may be ringing in your ears. Vertigo of viral origin is typically very strong for several days until the virus subsides. Unlike BPPV it is not related to head position.

Cervicogenic Dizziness

This form of dizziness arises from your neck or the cervical spine. Anomalous signals from the muscle receptors in your neck may cause altered orientation and imbalance. It is sometimes difficult to distinguish between BPPV and cervicogenic dizziness. If, after following the Epley’s maneuver, Half-Sommersault or Log Roll, there is no improvement, then the cause may be coming from your neck. Seek a neck specialist to evaluate further.

Vestibulo-ocular Reflex

This reflex helps to keep an image on your retina while your head moves. In other words, while walking on a sidewalk you will be able to read the street signs. However, if there is vestibule-ocular reflex dysfunction, there is movement related dizziness and blurry vision.

Brain origin

This is dizziness resulting from a dysfunction in the balance centers of the brain. A few possible causes for an imbalance originating from the brain are brain tumors or strokes. An MRI of the inner ear and brain is recommended to evaluate this possible source of dizziness further.

Ototoxic Vertigo

Ototoxic drugs refer to those drugs that harm the auditory and/or the vestibular system. Antibiotics such as gentamicin and erythromycin have known ototoxic effects. If you’re taking one of these medications, chances are you could be dizzy. Although less common, other environmental toxins, such as Mercury and heavy metals may contribute to dizziness.

Mercury Toxicity and Dizziness

Mercury toxicity may cause vertigo, incoordination, irritability, muscle weakness and a wide number of systemic effects.

Hypertensive Dizziness

More common in the elderly with uncontrolled hypertension (high blood pressure). The dizzy patient usually reports difficulty in mental concentration, memory loss, fatigue, and falling. The physical insecurity generated by dizziness and imbalance can lead to irritability, loss of confidence, fear of going out alone, anxiety, depression, or panic and can change the routine of life and affect family, social, and professional relationships, in turn causing loss of confidence, concentration, and income (Lopes et al., 2013).

Vertigo Treatment in Miami

Neck Treatment & Vertigo 

According to published case studies, NUCCA (National Upper Cervical Chiropractic Association) treatment is helpful in treating dizziness. NUCCA treatment may help correct misalignment in the upper cervical spine. This may reduce abnormal signals of altered orientation causing imbalance and dizziness as related to cervicogenic vertigo.

Detoxification & Dizziness

We offer a variety of advanced diagnostic tests to determine if your dizziness may be coming for an increased total toxic load. These are typically blood tests that are drawn in our office. We also offer chelation programs to help remove these toxins from your body.

 

References
  1. Filippopulos, F. M., Albers, L., Straube, A., Gerstl, L., Blum, B., Langhagen, T., … & Landgraf, M. N. (2017). Vertigo and dizziness in adolescents: Risk factors and their population attributable risk. PloS one12(11), e0187819.
  2. https://www.myvmc.com/anatomy/ear/#C26
  3. Pearce, J. M. S. (2009). Marie-Jean-Pierre flourens (1794–1867) and cortical localization. European neurology61(5), 311-314.
  4. http://www.neuropt.org/docs/vsig-physician-fact-sheets/cervicogenic-dizziness.pdf
  5. https://emedicine.medscape.com/article/1836134-overview
  6. http://www.nucca.org/blog/can-nucca-help-patients-suffering-dizziness/
  7. Lopes, Moreira, Trelha, Marchiori (2013) Association between complaints of dizziness and hypertension in non-institutionalized elders.. Int Arch Otorhinolaryngol. 2013 April; 17(2): 157-162.
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