The world is spinning, and most vertigo is caused by otolithiasis

The world is spinning, and most vertigo is caused by otolithiasis

When it comes to diseases that cause vertigo in the past, many people’s first reaction is Meniere’s disease, but in recent years, the incidence of otolithiasis is much higher than Meniere’s disease. Doctors particularly remind that young people’s occurrence of otolithiasis is closely related to their lifestyle. Staying up late, playing with mobile phones, and not liking exercise can lead to ear ischemia. In addition, factors such as poor eating habits, lack of awareness of health care, and high pressure in life may induce otolith loss and form otolithiasis.

I believe many people have had this experience: when getting up in the morning or turning over in bed at night, or even when lowering or raising their heads, they suddenly experience dizziness, which may be accompanied by nausea, vomiting, palpitation, profuse sweating, etc. in severe cases. In addition to causing great physical discomfort, the above symptoms can also cause psychological panic. The first thing most people think of is: Am I suffering from a cerebral infarction? Is it insufficient blood supply to the brain? Or have cervical spondylosis?

When 46-year-old Ms. Wang got up one morning, she suddenly felt the whole bed spinning like a roller coaster, and she fell to the ground. Ms. Wang was sent to the hospital by her family for an MRI examination, and the results showed that “everything in her brain was normal.” After being referred to the otolaryngology department, the doctor diagnosed her with benign paroxysmal positional vertigo (BPPV), also known as otolithiasis.

What is otolithiasis? Why do otoliths fall off?

The otolaryngologist told Ms. Wang that in our ears, there is a structure called the utricle plaque. There is a layer of otolith membrane on its surface, which adheres to many calcium carbonate crystals, called otoliths. The main function of otoliths is Let the human body sense linear acceleration. For example: even if we are dozing off when riding in a car, we can still feel the brakes. This is the otolith transmitting information. Otoliths are only 20 to 30 microns in size and cannot be seen with the naked eye. They can only be seen under a microscope.

The reason why otolithiasis occurs is usually due to fatigue, trauma or other unknown reasons. The otoliths peel off from the patient’s vestibule and migrate into the lymph fluid of the semicircular canals of the inner ear, thereby irritating the semicircular canals, affecting the balance function, and causing severe pain. dizziness.

Although the name sounds unfamiliar, otolithiasis accounts for about 30% of all vertigos and is a common vertigo disease. Wu Yuanding, deputy chief physician of the Department of Otolaryngology and Head and Neck Surgery at Peking University First Hospital, said that when talking about diseases that cause vertigo in the past, many people’s first reaction was Meniere’s disease, but in recent years, the incidence of otolithiasis has been higher than Meniere’s disease. The incidence of AIDS is much higher, and otolithiasis can occur in children from a few years old to elderly people in their 80s and 90s, with the largest number of affected people being adults between 30 and 60 years old.

When otolithiasis attacks, patients often feel dizzy, or objects shake left and right. Along with dizziness, they may also experience nausea, vomiting, palpitation, sweating, and a sallow complexion. In severe cases, diarrhea may occur. The dizziness of otolithiasis is closely related to position changes. The most common ones are dizziness when getting up or lying down, and attacks when turning to the left or right. The duration is not long, probably a few seconds, usually no more than 1 minute. No matter how severe the vertigo is, the patient is always conscious and has no other symptoms such as tinnitus or deafness.

Regarding the mechanism and triggering factors of otolith loss, doctors believe that it may be related to the following conditions:

1. Mental and psychological factors such as fatigue, staying up late, stress, nervousness, anxiety, etc.; 2. Peripheral circulation blood supply disorders caused by hypertension and diabetes cause otolith organ ischemia; 3. During menopause, estrogen levels drop, leading to calcium deficiency. ; 4. Aging of the otolith apparatus, leading to degenerative changes in utricle spots or saccule spots; 5. Low serum vitamin D levels, osteoporosis, etc.; 6. Secondary factors such as head trauma, severe head vibration, and surgery , ear diseases (such as sudden deafness, vestibular neuritis, mastoiditis, otitis media, labyrinthitis, Meniere’s disease, etc.) secondary to otolith loss.

Otolithiasis is a benign self-limiting disease, so there is no need to worry too much

Tang Xin?, Shanghai Jiao Tong University School of Medicine, said that there is no need to worry too much about otolithiasis, because according to its scientific name “benign paroxysmal positional vertigo”, the following information can be obtained: benign – this disease is a self-limiting disease, even if It will heal on its own without treatment, and will not cause damage to the body, nor will there be any sequelae (the biggest hazard is falls and accidents caused by vertigo attacks, which may cause damage to the body); paroxysmal – this disease is Sudden, which can appear and disappear suddenly. Symptoms appear during the attack and can be completely normal when relieved (but may also recur); positional – the onset of this disease is related to changes in body position, more precisely. Related to changes in head position.

Tang Xin reminded that if the vertigo is caused by changes in body position, you will not feel dizzy if you don’t move; the duration of each vertigo should not exceed 1 minute (the duration of spinning when looking at things); there will be no hearing loss, tinnitus, ear stuffiness, headache, or limb pain. If there are other accompanying symptoms such as dyskinesia, loss of consciousness, etc., then it is most likely to be otolithiasis. Please go to the otolaryngology department for treatment.

Tang Xin reminded that when otoliths fall off, the dizziness usually stops within half a minute. Because vertigo in the inner ear is a very strong spinning sensation, patients often experience panic, cold sweats, rapid heartbeat, or even high blood pressure. At this time, you need to stay calm, fix your head posture, and wait for the dizziness to pass. After the onset of otolithiasis, as long as the head position remains unchanged, the symptoms will generally resolve on their own if they last no more than 1 minute. Even without any treatment, it will heal on its own within 1 month and will not cause physical damage, but it is necessary to prevent falls caused by vertigo attacks.

Early treatment of otolithiasis can shorten the course of the disease

Feng Yanmei, chief physician of the Otolaryngology Department of Shanghai Sixth People’s Hospital, said that the general self-healing time of otolithiasis is usually about two weeks. The self-healing time of young people is relatively short, and obvious improvement may occur in 7 to 10 days. Older patients may take longer to heal on their own, usually 3 to 4 weeks or longer. Although some patients may recover on their own, it is still recommended to treat it as early as possible, which can shorten the course of the patient’s disease and prevent recurrence of the disease.

Feng Yanmei emphasized that early treatment of otolithiasis can also avoid falls and other side injuries caused by otolithiasis. Because patients with otolithiasis may experience rotational dizziness when their heads turn, they are at increased risk of falling, and some patients may suffer head trauma or fractures after falling. Therefore, early diagnosis and early treatment of patients with otolithiasis can shorten the course of the disease and reduce the occurrence of complications.

Otolithiasis can be treated through reduction, drugs, surgery and other methods.

1. Drug treatment: It can relieve the symptoms of vomiting and dizziness. Older patients also need to take drugs to improve inner ear microcirculation to assist treatment.

2. Manual reduction: It is a common and effective method to treat otolithiasis at present. Clinically, nearly 95% of patients with otolithiasis can recover through manual reduction. Manual reduction is not suitable for patients with cervical spondylosis to avoid cervical vertebra dislocation, which may lead to serious consequences. Manual reduction must be performed by a professional doctor.

3. If multiple reductions fail, surgery may be considered: including semicircular canal tamponade, endolymphatic sac decompression, labyrinth resection and other methods.

Otolithiasis is like a cold. There is still a risk of recurrence after treatment. The recurrence rate of otolithiasis is about 15% per year, and about 37% to 50% in 5 years. There is currently no medical method that can prevent the recurrence of otolithiasis. If similar symptoms recur, the patient only needs to see a doctor in time for reset and treatment and find the triggers for recurrence. The patient does not need to have any additional psychological burden.

These people are more likely to develop otolithiasis

Song Haitao, chief physician of the Department of Otolaryngology at Beijing Hospital, said that otolithiasis is related to upper respiratory tract infection, increasing age, aging or degeneration of the ear labyrinth, and also to insufficient blood supply to the inner ear caused by arteriosclerosis, hypertension, diabetes, etc.

Generally speaking, people with the following conditions are prone to developing otolithiasis:

People over 40 years old. The peak age of onset of otolithiasis is generally between 40 and 60 years old, which may be related to chronic vestibular ischemia in this age group. In addition, age will cause the local structures of the inner ear to age or degenerate, and the otoliths will easily fall from their original positions.

People who are stressed and weak. Long-term exposure to stress, poor sleep, excessive fatigue and other adverse living conditions may cause spasm and ischemia in the small arteries of the inner ear, leading to otolithiasis.

Lowering your head to play with mobile phones, using computers, and being in poor head posture for a long time will also aggravate vasospasm and cell ischemia in the inner ear, making it easier for otoliths to fall off and cause disease.

Osteoporosis patients. Osteoporosis is only one cause of otolith loss. Since otoliths contain calcium carbonate crystals, if osteoporosis occurs, local structural changes will increase the risk of otolithiasis. Women with weak constitutions also belong to the high-risk group, and women are more likely to suffer from otolithiasis than men (the ratio is close to 1.6 to 2:1).

People with migraines. 26% of patients with otolithiasis are migraine patients. Vestibular migraine is a clinical phenomenon of otolithiasis, which often occurs simultaneously with benign paroxysmal positional vertigo caused by otolithiasis.

People affected by trauma or surgery. External force hitting the ear, ear surgery, neck injury due to sudden acceleration or deceleration of the car while riding in a car, all of which can cause otoliths to fall out, leading to otolithiasis.

People with vestibular neuritis. Vestibular neuritis caused by viral infection is often accompanied by otolithiasis. When the vestibular otolith apparatus is edematous, “small crystals” may also fall off. Generally, patients may develop otolithiasis within one year of the onset of vestibular neuritis.

Doctors particularly remind that young people’s occurrence of otolithiasis is closely related to their lifestyle. Staying up late, playing with mobile phones, and not liking exercise can lead to ear ischemia. In addition, factors such as poor eating habits, lack of awareness of health care, and high pressure in life may induce otolith loss and form otolithiasis.

Pay attention to 6 things to help avoid otolithiasis

1. Maintain healthy living habits: maintain a regular schedule, quit smoking and drinking, and do not watch TV, computers, or mobile phones excessively for a long time.

2. Remove the cause: Remove otitis media, vestibular neuronitis, noise, drug poisoning and other factors in a timely manner.

3. Balance work with rest: avoid excessive fatigue and major mood swings.

4. Actively prevent and treat risk factors: Middle-aged and elderly people often have cardiovascular and cerebrovascular disease risk factors such as hypertension, diabetes, and hyperlipidemia, which are key factors leading to insufficient blood supply to the inner ear. Timely prevention and treatment is recommended.

5. Prevent and treat osteoporosis in time: Endocrine changes after menopause in women lead to osteoporosis, fractures and frequent otolithiasis attacks. Women should pay attention to a reasonable diet, appropriate sunbathing, and increased exercise.

6. Patients who have had otolithiasis attacks should pay attention: During the high-incidence period, if the dizziness is more obvious on which side of the body, they should try to avoid lying on the affected side. Movements should be as slow and steady as possible, and avoid movements such as raising the head to dry clothes, lowering the head to tie shoelaces and other movements that change the body position significantly.

Doctors remind that although otolithiasis is not life-threatening, symptoms such as visual rotation and dizziness will not only make patients feel nervous, but also may cause danger when engaging in certain high-risk operations or driving. Therefore, it is necessary to actively cooperate with the doctor for treatment after the onset of the disease. In addition, you should exercise more regularly to keep your balance function in good condition, which can also play a certain role in preventing the occurrence of otolithiasis.

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Common misunderstandings about otolithiasis

Otoliths are earwax. Perhaps when people think of otoliths, they first think of earwax. Otoliths are actually calcium carbonate crystals in the inner ear, which play a role in sensing our body. When the otolith moves out of its proper place, we experience the illusion of motion and vertigo begins.

Easily misdiagnosed. Many people diagnosed with “cervical spondylosis” and “insufficient blood supply to the brain” are actually otolithiasis. Several studies have shown that otolithiasis ranks first among the diseases that cause vertigo. In terms of incidence, otolithiasis should be excluded first in cases that need to be diagnosed as vertigo.

A normal otolith examination rules out otolithiasis. Since otolithiasis is a self-limiting disease, the otoliths can reset themselves as we move. Therefore, positive test results can generally only be obtained in the early stages of the disease or when symptoms are obvious. A negative otolith report does not rule out otolithiasis, and a comprehensive judgment needs to be made based on the course of the disease and symptoms. If the symptoms improve, it can only be speculated based on the clinical manifestations and a possible diagnosis of otolithiasis can be given.

Complete recovery will occur once the otoliths are reset. Indeed, the most effective treatment for otolithiasis is otolith repositioning. However, otolith repositioning is not permanent. Generally speaking, symptoms can be reduced by 70% to 80% after effective reduction, and residual symptoms require medication or vestibular rehabilitation training to improve. There are also some patients who develop chronic dizziness due to fear of recurrence of vertigo, that is, persistent postural-perceptual dizziness.

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