MichaelV

"Going round and round in circles.

By MichaelV


Dizziness, whenever it strikes is deeply unpleasant. We have all experienced it at one time or another, be it the woozy lightheadedness of a head cold to the “spinning top” effect of more serious conditions. In its peculiarly vicious way, dizziness, or vertigo as some prefer to call it – can take us from feeling a million dollars one minute to unutterable, shocking misery the next. And people live with it for years, decades even, and there appears to be nothing anyone can do about it. Or is there?

Dizziness is a common symptom in doctor’s surgeries. It is an imprecise condition and usually goes away on its own. There are many conditions which can cause dizziness – labrynthitis, often as a result of infection, benign paroxysmal vertigo (when minuscule crystals are dislodged in your cochlea or inner ear), perilymphatic fistulas (small ruptures in the membranes between the ear chambers) and the more chronic and serious Meniere’s syndrome which often leads to deafness in one or both ears. All of these conditions can produce acute vertigo attacks – often accompanied by chronic fatigue, headaches and vomiting - and doctors prescribe many different drugs to combat the symptoms. But when a patient presents himself to a doctor, the GP may send him on to an ENT specialist who will conduct a battery of tests. If he finds a distinct injury or defect, he may try to treat it with a variety of procedures. Often, though, a specialist will find nothing specific and diagnose a generic condition – often BPV – and usually gives the patient exercises which teach the brain to compensate for the disequilibrium. And then you are, more or less, on your own to cope.

But there are other, less easily defined, but no less profound reasons for persistent or intermittent vertigo. And it all has to do with the bones and spinal membranes in your head and neck. Worryingly, the various professions involved seem, at least on the surface, not to be talking to each other about it or more worryingly, not to even know about it.

Allow me to give a brief summary of my own story.
A history of neck problems meant that I had been used to a moderate level of dizziness and nausea for many years (yes, the neck can cause dizziness). In January, I visited the dentist to have a molar on my lower jaw (mandible) extracted. The dentist had to exert great pressure on my jaw in order to free the tooth and my face had to be flooded with anesthetic. Within two hours I was picking up the children, numbed and swollen. I noticed my daughter was speaking with a voice which suggested she needed to clear her throat. I asked her to do so – she did so – but nothing changed. Then my son’s voice sounded the same – robotic, like two voices, one high pitched, and one low. Music, especially high frequencies were like wind up gramophones and oddly, everyone I spoke to on the phone sounded as if they had a badly stuffed up nose! It was only in the ear on the side of the dental extraction.

I put it down to the high levels of anesthetic that had been pumped into my jaw and deduced that its effect had spread to my ear. I waited for it to wear off. It did not. And worse, I went into a spin of epic proportions that night. I visited the doctor the next day and, diagnosing labrynthitis, he prescribed Betahistine, a drug thought to reduce the pressure in the inner ear and relieve vertigo. I felt better. But then the audio effect returned and two days later off I went again. It was unremittingly awful – the room and everything in it spinning past me, my eyes jumping from place to place uncontrollably (a condition known as nystagmus) as they tried to halt the rapid procession of the world in front of them.

My GP did not feel worried by any of this and was not even compelled to send me to an ENT. He understood my panic and felt this was the best way to reassure me. It would go away in time – maybe months, but it would go away. The dentistry on the day it all began seemed significant and I asked him if it might be so. “It might be”, he suggested, and talked loosely of the nerves that could be affected by treatment in this area (subsequent chats with various people showed this be an enlightened comment on the matter). He was sympathetic and reassuring but he was not unduly concerned and to be fair to him, had little at his disposal with which to solve my problem.

I needed to know more and the internet provided plenty of information about vestibular (the balance system) disorders, but on the MSN “ClubSpin message board (droll huh?) I read about the horrendous lives people with vestibular disorders were living. One thing kept cropping up – “TMJ disorder” or temporomandibular joint disorder (TMJD).

The TMJ basically holds your lower jaw to your head and it is an incredibly complex and important joint. But further research showed me that this joint was connected and affected by many important nerves and blood vessels. Importantly it is deeply affected by the sphenoid (one way of relieving my dizziness was to squeeze my head hard at the temples and I later learned this was affecting the sphenoid which is a bat-winged shaped structure at the base of the skull.) And vitally, the TMJ is attached to the temporal bone – which houses the gubbins of the inner ear. Could the force of pressure on my jaw have caused a lesion or misalignment of the TMJ thus putting pressure on the particular cochlear nerve which just happens to run through a fissure behind the TMJ? The more I read the more I was convinced it could.

But I spoke to my dentist, who also treats TMJ conditions – he had personally never heard of dizziness associated with it? But I knew that vertigo is the third most common symptom of TMJ disorder. I had some sympathy with the dentist because all he had done was pull a tooth that needed pulling – and had done it well – yet here was I examining the possibility with him that in doing so he may well have ruined my life!

Most doctors, if they ever knew such detailed and minute anatomy have forgotten it. ENT’s tend not to consider TMJ disorder if evidence from people visiting them is anything to go by. And tinnitus, another symptom of TMJ and which itself is associated with vertigo, is often treated as a generic vestibular disorder. Further, many people I spoke to who were suffering with TMJ problems, vertigo and pain, reported having chronic neck conditions or injuries for years – and crucially, aggressive dentistry. More was to come. I read a research paper in which twenty people being treated for tinnitus, but who showed no symptoms of TMJ (jaw pain, locking, cracking or popping of the joint etc) were examined and thoroughly tested for TMJ using scans and other diagnostic tools. Of the twenty, NINETEEN were found to have signs, of one degree or another, of TMJ. Those people were treated for TMJD using physiotherapy, splints and other manipulation and of the nineteen, many had all signs of tinnitus and vertigo eradicated. The researchers, from Stanford University, suggested in conclusion, that audiologists should compile questionnaires for patients to determine any links with TMJD. It is not clear if the advice is being taken.

It was time to take a different approach. From years of neck problems, I knew and trusted osteopaths, but more importantly, cranial osteopaths who undergo at least 18 months of further training and specialize in the bones of the neck and head. I found one locally and he immediately confirmed my suspicions when firstly, he told me he regularly treats TMJ and vertigo problems, more often than not solving them, and secondly, fully explained the mechanics of the head and neck and how they directly affect the structures of the temporal bone and thus the inner ear. It was, I thought, so blindingly obvious. I was further astounded when he produced a book, first written in the 1950’s, which not only described the condition, the causes and the treatments, but had a DIAGRAM of a tooth extraction (incidentally in the precise position of my extracted molar) and how it may affect the TMJ, the temporal bone and the resultant symptoms, which of course, included tinnitus and vertigo.

My cranial osteopath’s treatment up to now has consisted of realigning the bones in my neck and head which have been slowly pulled askew by the tensed muscles in my head, neck and jaw. This tension affects the spinal fluid which also runs close to the cochlea under a membrane. Fluctuations in this spinal fluid caused by “blockages” for want of a better word, create “wave” like effects in the cochlea and so inducing vertigo. There are also effects on the Eustachian tubes which explain the “popping ears” so often associated with TMJD. It is somewhat more complex than I have described but that is it in a nutshell. After three visits my vertigo has almost vanished and the episodes of “dodgy ear” as I call it are much reduced. On reading the text books I discovered that cranial osteopaths claim to be able to affect the seriousness and course of even the awful Meniere’s syndrome (there is no real “cause” for Meniere’s and is still somewhat shrouded in mystery – it is also incurable, apparently).

This all leads me to one conclusion; that there may be thousands of people out there living with tinnitus, vertigo and chronic headaches who do not in fact have vestibular disorders but a mechanical defect in their head or neck. And little seems to be being done with regard to the various professions – dentists, ENT specialists, oral surgeons even – discussing it and pointing the finger to what on the surface appears to be a simple physiological condition and which can very often be cured. So to the patient, I would suggest the following should they suffer an attack of vertigo or tinnitus;

- see your doctor and if possible have him rule out obvious infections of the ear.
- if he sends you to an ENT specialist, go, so that any obvious disorders of the vestibular system can be ruled out or in, and then properly treated.
- if the ENT can find no obvious cause, turn your attention elsewhere and consider the following; have you ever had a neck injury or whiplash?; have you recently had dental work or surgery?; do your jaws ache, crunch, pop or even lock up totally?; do you have stiff neck with headaches located around the temples, back of the head or top of the head?

If you have any of the above symptoms, then you may not have to live with the misery of tinnitus or vertigo. Once obvious or serious conditions have been ruled out, visit an osteopath. It could change your life. "