Drop Attacks in Vertigo Patients

If you have vertigo, you will have noticed that your balance can be so impaired that you may fall.  There are lots of other reasons for falls (fainting, for example), but if the fall is due to the inner ear there is one important characteristic:  you don’t lose consciousness before the fall.  In fact, unless you hit your head during the fall and get knocked out, you will be able to remember everything that happened before and during the fall.  This helps to signal that it was due to the inner ear. The inner ear can make you fall in more than one way, so the treatment depends on the type of problem you have. 

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The most common reason for a fall is the vertigo itself. If you have BPPV, for example, you might see the room spinning violently when you tip your head upward or arise from your bed.  If the room is dark, or you have nothing nearby to hold onto, this can make you fall.  When a spinning sensor in your ear turns ON suddenly, your body reacts by counter-balancing because it feels like you are spinning.  This is just an illusion, so all the reflexes to counter-balance instead throw you off to one side.  Once you have had several spells, you become less likely to fall because you learn to use touch to correct for these inappropriate reflexes. 

If your inner ear is destroyed by a virus or an injury, it is hard to walk at first because the environment will be spinning for the first few days.  Usually by touching a wall or other support surface you can remain upright.  However, even once the nystagmus and vertigo have declined, you may still fall if you close your eyes or enter a dark room.  When the gravity sensors of one ear are destroyed, the horizon will not seem level and will look a bit tilted.   You may feel as if you are being pulled to one side. Vision helps keep this feeling of tilt under control.  In darkness, however, you can’t use vision, and the inner tilting feeling becomes more intense.  Even a week after such an injury, closing your eyes can cause you to fall to the ground like a log, although to you it will feel like the ground came up and slapped you.  As the amount of tilt you see gradually declines over a few weeks, so will the tendency to fall over. 

Drop attacks are a late-stage effect of Meniere’s disease, which can gradually destroy all balance sensors, including the gravity sensors.  These attacks are very sudden.  It will feel like the ground came up and hit you, with very little feeling of falling.  This probably happens due to a mechanical deformation of the gravity sensor, causing it to suddenly generate a feeling of extreme tilting.  The world will appear to tip up sideways, and your attempt to stay upright will cause you to overcorrect and fall.  These attacks are so sudden and violent that you can be injured.  The treatment is to see an otologist to consider ablative surgery (destroying the balance function of the ear) so that no more attacks can occur.