How long do spells last?

Earlier blog pages have discussed the different feelings of dizziness that the inner ear can generate:  spinning, tilting or rocking, and elevator sensations.  The most common sensation indicating an inner ear problem is a feeling of whirling.  The inner ear has three sensors for spinning, the semicircular canals.  Because your head is firmly connected to your neck, every time you move your head on your neck, the head rotates to some degree.  It rotates in three-dimensional space, so three sensors can fully detect any rotation.  There are three major directions of rotations:  yaw, which is horizontal turning back and forth (detected by the horizontal semicircular canals);  pitch, tipping or nodding the head up and down (detected by the vertical semicircular canals);  and roll, tilting the head so the ear tips down toward the shoulder on either side (detected by the otolith organs).  Natural head turns tend to mix the various directions (like looking up and to the side for example), so all of the sensors in both ears are being used to feel and respond to these motions. 

When an ear is going bad, the most frequent symptom is spinning.  Sometimes this is felt inside the head, and other times it can be so strong that the eyes actually move, and the whole world appears to be whirling.  This is also the most unpleasant sensation the ears generate because it is often accompanied by nausea.    The brain pathways for the inner ears can also create a spinning feeling, but the ear is much more commonly the cause than the brain.  The duration of the repeated spells can help break down the most common causes:

Seconds:  BPPV, sleep apnea

Minutes:  Transient ischemic attacks (mini strokes)

Hours:  Meniere’s disease, severe sleep apnea

Days:  Migraine

Abnormal tilting or elevator sensations come from the gravity sensors of the ear (the otolith organs, the utricle and saccule).   These organs sense accelerations in a straight line, like taking off in an airplane, speeding up or slowing down while driving, and going up or down in an elevator.   When they go bad, they can create the same feeling even though you are not moving.  Most of the spells coming from repeated malfunctions in these sensors are fairly short, lasting for seconds only.  Common causes for the short spells are semicircular canal dehiscence and Meniere’s disease. Rocking feelings are also commonly associated with migraine.  When there is a very prolonged or continuous rocking sensation, as if on a boat, mal de debarquement syndrome may be the cause.

Published by Vertigone

I translate the medical world of dizziness for non-medical people

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