From: anonymous@ustc.MHS.CIBA.COM
Subject: Vertigo Symptoms
Posted-By: xx108 (ENT Clinic Moderator)
Organization: Organization For Community Networks
Date: Mon, 25 Nov 1996 08:28:35 -080


Approximately 1 week ago on a Sunday, I woke up, open my eyes and found the bedroom spinning around, this also produced nauesa sensation. That day I rested but found any sudden head movement would re-introduce a very dizzy feeling. The next day I went to work and it did't seem nearly as bad. Tuesday it seeemd bad again but I could still function at work. Wednesday was a repeat of Monday. Thurday I paid a visit to my family doctor who diagnosed the problem as an inner ear problem. He suspected that fluid what interfering with the inner ear balance system.

He perscribed two medications, Claritin-D once every 24HR (7 days worth with renewal capibilities) and Meclizine 25MG three times a day when needed, but indicated that I may not require it at all, so I might not want to fill it until required. I believe the Claritin was to work on reducing the fluid within the inner ear and the Meclizine to came down the abnormal dizzyness. I began taking the Claritin on Thursday but did not fill the percription for Meclizine as suggested. I worked a full day on Friday without not too much discomfort as long as I minimized sudden head movements. Saturday morning I woke up a again with the room spinning but found that I also had major difficulty walking, I decided it must be time for the Meclizine. Taking both medications I must have slept most of Saturday & Sunday away. It seemed like the only relief I could find from the dizzyness. Monday has arrived and I'm still taking the perscribed medications and not feeling nearly as bad as either Saturday or Sunday, but still feeling myself. This is the first time I've encountered this situation in my 56 years and quite honestly I'm hoping it will soon pass. Just some bit of backgroud information that may have connection or bearing on the case. About two week prior to the first occurance of this problem I hit the center of my head pretty hard causing it to bleed. Again this was at least two weeks prior to the first occurance of dizzyness so up to now I have dismissed it as being related. Please let me know if you feel this has any connection to the problem.

Please let me know if the medication regimine I'm taking properly fits my symptoms and if you think there is something else I should be doing, including working, driving etc. I'd also like to know how long you think I should continue the two medications and how long I could expect to have these symptoms? I believe the Meclizine is what's making me so sleeply. Do you recommend I reduce its dosage during today & tomorrow or continue until all symptoms have disappeared?

I appreciate any input you could provide as a second opinon.


Reply: ------------------

The symptoms you have described are possibly caused by a so-called "inner ear infection". Such conditions may be related to an infection of the nerve to the inner ear, vestibular neuronitis; or they may be related to infections of the fluid in the inner ear, labyrinthitis. The term inner ear fluid is sometimes confusing. It should be understood that the inner ear consists entirely of fluid-filled channels. It is therefore not the presence of fluid that is the problem, since there is always fluid filling the inner ear, but rather an infection in the fluid. This is in contrast to having fluid behind the ear drum or in other words middle ear fluid. The middle ear is normally air-filled and fluid is usually associated with infection in this location.

Vestibular neuronitis or labyrinthitis are conditions which cause similar symptoms and both are most often caused by viral infections. Typically one experiences fairly severe whirling dizziness known as vertigo that is typically associated with nausea and vomiting. The vertigo is often sudden and severe enough to result in a visit to the emergency room. The severe vertigo typically lasts anywhere from 1 to 3 days and then is followed by a variable period of dysequilibrium that can last for several weeks. During this latter period, whirling dizziness can often be triggered by sudden head movements. Occasionally there are some auditory symptoms present such as plugging of the ears, hearing loss, or ringing. Antibiotic therapy is typically not helpful. The usual management involves bedrest, hydration with fluids, and the use of medications known as vestibular suppressants. Meclizine (antivert) is one of the more commonly used medications. Antihistamines in general are frequently helpful. Claritin is a newer generation centrally acting antihistamine and in my experience can be helpful for minor dysequilibrium. When vertigo is associated with nausea or significant whirling, usually more sedating medications are required.

Bothersome symptoms that persist warrant further evaluation including the possibility of consulation with an ears, nose, and throat specialist to rule out other types of inner ear conditions. If other neurologic symptoms exist including visual disturbance, unusual headache, weakness of arms or legs, immediate consultation with your physician is advisable.


Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis

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