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PATHOLOGY PERSPECTIVES of the other threats to equilibrium that clients of any age may face. LABYRINTHITIS This is inflammation within the bony or membranous labyrinth of the inner ear. It is usually related to a self-limiting viral infection, but the pathogen is not always identified. This condition— which involves dizziness, hearing loss, and headache—tends to last a few days or weeks, and then gradually subsides. ACUTE VESTIBULAR NEUROPATHY This is damage to the vestibular portion of cranial nerve VIII. If the cochlear branch is affected, hearing loss may develop, along with vertigo. Like labyrinthitis, this condition may be related to viral infection. It tends to be self-limiting and is usually resolved within a few days or weeks. MENIERE DISEASE This idiopathic condition involves episodes of vertigo along with tinnitus (ringing in the ears), hearing loss, and a feeling of fullness in the middle ear. It is not well understood, but some experts believe it has to do with the accumulation of too much fluid within the bony labyrinth. HEAD INJURY Blows to the head, violent sneezing, or whiplash-type accidents can cause inner ear fluid to leak into the middle ear in a condition called perilymph fistula. This can also occur with barotraumas, a type of injury frequently associated with scuba diving accidents. These balance disorders are most common in mature adults, but they certainly aren't exclusive to that population. Other causes of disequilibrium include central nervous system problems like stroke, tumors, multiple sclerosis, or migraine headaches. Allergies and nasal congestion that block the eustachian When is Vertigo an Emergency? If vertigo, nystagmus, and nausea are the only symptoms that occur, benign paroxysmal positional vertigo is not a medical emergency. However, if the symptoms are accompanied by the following, it's time for a visit to the emergency room: • An extreme and sudden headache. • Arm or leg weakness. • Changes in heart rate. • Chest pain. • Double vision or loss of vision. • Hearing loss. • Numbness. • Tingling. • Trouble speaking or understanding. Any combination of these symptoms with vertigo can be indicators of stroke, brain tumor, or other serious situations. tubes can interfere with fluid in the inner ear. Some psychological disorders (specifically anxiety and depression) can cause vertigo, as can medications to treat those conditions. Additional drugs, including alcohol, barbiturates, anti-hypertensives, diuretics, and cocaine can also cause balance loss. BPPV: ETIOLOGY AND SYMPTOMS The layout of the inner ear is complex. The vestibule, a hollow area at the center of the bony labyrinth, has several sub-portions. Tiny crystals of calcium carbonite called otoliths (literally "ear stones") are normally embedded in a gel-like substance within the vestibule. In BPPV, these otoliths fall out of position and into the semicircular canals. Their movement stimulates the vestibular nerve endings, creating an intense sensation of spinning— this is the definition of vertigo. Direct causes of BPPV can be difficult to trace. It can develop after a head trauma, but the majority of cases are not connected to a specific triggering event. BPPV strongly correlates to age: most new diagnoses are in people aged 50 and over. The most reliable triggers for bouts of BPPV involve changes of position of the head. Getting up, lying down, rolling over in bed, tilting the head to look up or down—any of these movements can elicit an attack of vertigo, which may be described as a feeling of spinning, or that the world is spinning around the affected person. Other symptoms commonly seen with BPPV include dizziness (this is distinct from vertigo, because while it may suggest that it is difficult to orient to the horizon, dizziness doesn't necessarily involve a spinning sensation), lightheadedness, nausea, and possible vomiting. BPPV has two markers that distinguish it from other balance disorders: it is not associated with headache pain, tinnitus (ringing of the ears), or a feeling of 100 massage & bodywork july/august 2010