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col Treating vertigo begins with its cause

By Dr. Allen Douma

Tribune Media Services

Q: I am suffering from positional vertigo, but the doctors haven't taken it seriously. I can't sleep on my left side because of dizziness and I have a tough time with the dentist. Any help? -- A.M., Huntington, Conn.

A: Vertigo is a sensation of motion when there is none, or an exaggerated sense of motion in response to some movement. It is often accompanied by nausea and vomiting, and occasionally by hearing loss or ringing in the ears.

True vertigo is caused by abnormalities or lesions of the inner ear (the organ of balance), of the nerves connecting the inner ear to the brain, or of the brain itself; the abnormalities may be due to infections, tumors or head trauma. Vertigo can also be caused by pressure on or inflammation of nerves as well as problems with the blood vessels supplying these tissues.

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It can also be a feature or symptom of a number of systemic (whole body) diseases, and can occur as a side effect of some anticonvulsant, antibiotic, hypnotic, analgesic and tranquilizing drugs, and alcohol.

Treatment of vertigo involves identification and removal of the cause, if possible, and relief of symptoms even if the cause is not found.

Antivert, an antihistamine, is often recommended to relieve the abnormal sensations associated with vertigo. More specific treatment for the cause may include, for example, the use of antibiotics for an infection.

If dizziness and lightheadedness occur when you get up quickly, especially in the morning, you may be having an episode of postural hypotension. When someone stands up too quickly, there is a short lag time before the pressure can build up to maintain the good flow of blood to the brain.

The lowering of blood pressure during this time is called postural hypotension. If it takes too long to get your blood pressure up, you may experience dizziness and lightheadedness.

Many things can cause postural hypotension. There is an increased risk of this condition during times of stress or fever, in which the heart is working harder. Also, weak hearts and some medications for high blood pressure may cause it.

Your positional vertigo sounds like it is different from both true vertigo and postural hypotension. Actually, the term "positioning vertigo" is a more accurate description. Episodes of this condition occur when there are quick changes in head position rather than when the head position is maintained over time.

Positioning vertigo episodes last 10 to 60 seconds and occur in clusters for a few days at a time. This form of vertigo is thought to be caused by stony materials called otoliths free floating in the fluid in the semicircular canals.

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Treatment of positioning vertigo consists of a form of physical therapy called single-session habituation, which attempts to reposition the otoliths through a series of head manipulations; and a relatively new surgical procedure to minimize the exaggerated inner-ear response to tilting the head at an angle.

You can treat yourself by trying to avoid head positions that typically trigger a vertigo episode. But if this is not adequate, then I suggest you talk with your doctor about the benefits of medical or surgical treatment.

Update on blood donations: Blood donations dry up a lot during the summer, but the need fro blood doesn't. The problem is worse this year, according to the Red Cross and America's Blood Centers.

About 60 percent of people in North America would be eligible to donate blood, but less than one in 10 of them do so. There are a lot of reasons for this, but recently more and more people are unnecessarily concerned about the dangers of donating.

If you want to help someone in need but are unsure whether to donate, visit a local blood bank to better understand the procedure. Hopefully, you will then decide to give what could be the gift of life.

Dr. Allen J. Douma writes a daily column on a variety of medical and health issues.

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