Monday, May 02, 2016

Things I didn't learn in medical school: Vertigo

About two years ago I had a sudden onset of vertigo. Between my wife (a family doc), my family doc, and me (also a family doc, albeit lapsed) we couldn’t tell whether it was “viral” labyrinthitis or “benign” positional vertigo. The more I read and experienced the less I felt there was a clear difference; there’s an ENT folk belief that the “benign” condition follows the “viral”.

Yes, the “quotes” are there for the usual reason. The more I get to experience diseases from the inside (yay oldness) the more my textbooks seem delusional. The semicircular canals (labyrinths) have a circumference around a cm. I couldn’t find any diameter on the average cross-section diameter of the actual canal, but illustrations suggest it’s on the order of microns. Even the very best research scanners cannot resolve these canals, much less the microscopic hair cells within them. The otoliths within our utricle and saccule are about 3 to 30 microns and can only be seen with a high resolution microscope. 

We really have very little idea what’s going on in the canals of someone with vertigo. We’re making this stuff up. (Hain’s article is more honest than most.)

My acute vertigo lasted a day or so. I had to delay a trip and I put off driving for several days. It was just as unpleasant as one might imagine, but short-lived. Many people live with far worse vertigo for much longer. 

Except it wasn’t as short-lived as I expected. After the first few days I couldn’t induce the characteristic nystagmus eye movements but I still felt “off”. I could induce a feeling of imbalance by shaking my head. My walking required much more attention than I was used to, though I had no problems with running. I couldn’t close my eyes and balance on a single leg (bit of a severe test for many at my age).

Most days I no longer notice these symptoms. I think that took about a year of extremely slow improvement with occasional worsening; Epley exercises (there are many variants) might have helped. I don’t know if the (presumed) insult to the hair cells resolved or my brain compensated for them or both; I suspect it was at least as much compensation as it was healing. I don’t think my closed eye single leg balancing is as good as it once was. I’ve taken a step to the fall-prone imbalance of infirmity (yay, age).

Living inside my relatively minor (so far) experience with vertigo taught me two things I didn’t learn from my textbooks. One is that our classifications of transient vertigo (positional, inflammatory, viral, etc) are probably bogus (not the only example). Another is that the symptoms may take months (years?) to resolve - or adapt to. Even knowing this I couldn’t easily find references on duration of post-vertigo symptoms, I found very few references, and they seemed to only deal with acute symptoms.

Our system of producing and disseminating medical knowledge is quite broken.

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