(Health Korea News / Lim Hae-ri) Many people complain of dizziness for various reasons. Why does dizziness occur? Experts say that the most common cause is ear disease. This is because the ear functions to maintain our body’s balance. Benign paroxysmal positional vertigo and Meniere’s disease cause problems in this function, accounting for more than half of patients complaining of dizziness. We will learn about the two most common diseases that cause dizziness with Professor Byun Jae-yong of the Department of Otorhinolaryngology at Kangdong Kyung Hee University Hospital.
About 57% of patients with vestibular dysfunction have benign paroxysmal positional vertigo (BPPV) or Meniere’s disease
In 2023, more than 660,000 patients visited hospitals due to BPPV and Meniere’s disease. According to the Health Insurance Review & Assessment Service, the two diseases accounted for about 57% of the total 1,171,481 patients with vestibular dysfunction (disease classification code H81), one of the main causes of dizziness in 2023. Of these, the number of patients with BPPV (disease classification code H811, benign paroxysmal vertigo) was 481,096, which was about 2.7 times higher than the number of patients with Meniere’s disease (disease classification code H810) in the same year, 181,442.
The detached otolith moves with the change of position, causing dizziness.
Benign paroxysmal positional vertigo and Meniere’s disease may look similar, but they are completely different diseases. Benign paroxysmal positional vertigo is a disease in which calcium-made otoliths in the otolith organ in the ear fall out for some reason and enter the semicircular canal, one of the balance organs, stimulating the nerves and causing dizziness. When you move your head or change your posture, the fallen otoliths also move and stimulate the nerves, causing rotational vertigo. The symptoms are usually very short, and the dizziness goes away when you stop moving your body. Since otoliths do not affect the cochlea, they do not cause auditory problems such as hearing loss, tinnitus, or aural fullness.
Inferring various causes of vertigo based on patient distribution
Benign paroxysmal positional vertigo is a disease whose cause is unknown. Instead, the cause is often inferred based on the gender and age of the patients. According to the Health Insurance Review & Assessment Service, in 2023, approximately 48% of all benign paroxysmal positional vertigo patients were middle-aged or older (over 50 years old), accounting for the largest proportion of female patients. This data and the fact that vertigo is a lump of calcium are widely supported by the association with diseases such as vitamin D deficiency or osteoporosis.
Professor Byun Jae-yong said, “In addition, otoliths can fall out if blood circulation is not smooth,” and “Since blood circulation is often poor after middle age, it is believed that blood circulation is also related, and viral infection is also identified as one of the causes.”
Treatment by moving the otoliths that cause dizziness
BPPV is treated with ‘substitution’, which removes the otolith that has fallen into the semicircular canal and causes dizziness, to a place called the utricle that does not stimulate the nerves. In order to perform substitution, it is most important to confirm the location of the otolith. To do this, the location of the otolith is confirmed by a nystagmus test that stimulates the semicircular canals and reads the eye movement signals. About 95% of patients who receive substitution see an improvement in symptoms, but in very rare cases, treatment such as semicircular canal occlusion is performed to prevent the otolith from touching the nerves.
Meniere’s disease, vertigo with hearing loss
Meniere’s disease is caused by increased endolymph in the cochlea and semicircular canals of the ear for various reasons, which increases the pressure in the ear. Professor Byun Jae-yong said, “Meniere’s disease is also accompanied by auditory symptoms such as hearing loss and tinnitus,” and explained, “Unlike benign paroxysmal positional vertigo, it is a disease caused by increased pressure in the ear, so the symptoms do not go away even if you move your body.” Vertigo accompanied by hearing loss and tinnitus can last for more than 20 minutes, and in severe cases, for up to 3-4 hours.
Beware of Meniere’s Disease in Summer… The exact cause is unknown
The exact cause of Meniere’s disease has not been identified. Like BPPV, Meniere’s disease also has a higher proportion of female patients (about 70% of all Meniere’s disease patients as of 2023, source: Health Insurance Review & Assessment Service). However, unlike BPPV, Meniere’s disease is believed to be related to autoimmune diseases. Meniere’s disease should be taken extra care during the hot summer. Meniere’s disease is caused by an increase in endolymphatic fluid, and there is research that shows that endolymphatic fluid increases relatively in hot weather, increasing the prevalence of Meniere’s disease. Many studies are currently being conducted on the cause of Meniere’s disease.
Chronic disease that is difficult to cure… requires constant management
Meniere’s disease is a chronic disease, so it is difficult to cure. The goal of Meniere’s disease treatment is to reduce the amount of endolymph. It is mainly controlled using diuretics. The symptoms can be alleviated by improving lifestyle habits such as controlling endolymph with diuretics and limiting salt intake (less than 1.5 g per day). Since a connection with migraines has also been consistently suggested, it is necessary to maintain regular eating and sleeping habits and manage overwork and stress. Professor Byun Jae-yong emphasized, “Meniere’s disease and BPPV both have high recurrence rates,” and “If you have suffered from the disease even once, you need consistent management.”
Outdoor activities are recommended for BPPV, and beware of CATS for Meniere’s disease
Since both BPPV and Meniere’s disease have high recurrence rates, moderate exercise and a healthy diet are essential. In particular, patients with BPPV often avoid outdoor activities due to fear of dizziness that may occur at any time, but it is known that the recurrence rate decreases when the body absorbs vitamin D through sunlight. Professor Byun Jae-yong explained, “I tell patients with Meniere’s disease to be careful of ‘CATS’. If they avoid caffeine, alcohol, tobacco, salt, and stress, they can also reduce the risk of Meniere’s disease.” He also advised, “Since the causes of dizziness are diverse, symptoms should be diagnosed through consultation with a specialist.”
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