1) Periodic episodes of rotatory vertigo or dizziness.
Periodic attacks of vertigo (the so-called Ménière's
"attack") is the most disruptive of the symptoms to
the patient. It is usually the vertigo attack which causes the
patient to seek medical treatment. Typically, vertigo occurs in
the form of a series of attacks over a period of weeks or months,
interspersed by periods of remission of variable duration. The
attack consists of a period of dizziness or vertigo (dizziness
may include a feeling of unsteadiness; the term vertigo is normally
reserved for the perception of spinning).
The sensation of spinning may produce nystagmus (a beating of
the eyes from side to side), nausea, vomiting, sweating and all
the symptoms normally associated with extreme motion sickness.
The onset of vertigo may be preceded by a sensation of fullness
or pressure in the ear, increased hearing loss and tinnitus, as
described below. The onset is frequently sudden, reaching peak
intensity within minutes and lasting for an hour or more before
subsiding. Unsteadiness may persist for the following hours or
days.
Vertigo must be one of the worst chronic afflictions to affect
the body. The vertigo patient perceives either that the world
is spinning around them or that they themselves are spinning.
With many other disabilities, some portion of a normal life can
be continued. Vertigo disrupts virtually every aspect of life,
since the patient loses the ability to do anything normally, especially
when movement is involved.
In addition to the obvious hazard of falling, moving around is
hampered by the fact that even small head movements often make
the spinning sensation worse.
The resulting nausea, sweating and vomiting combine to make
the patient subjectively very "ill". Vertigo can totally
incapacitate the individual, so they cannot function. Often the
patient will confine themselves to bed until the symptoms subside.
Most normal individuals probably cannot appreciate the devastating
impact of this condition. Most of us are familiar with mild forms
of vertigo or dizziness (from fair rides, excessive alcohol consumption,
etc.). If you haven't recently experienced vertigo, try the following
experiment (in a large open space, on a soft surface such as grass).
Take hold of a heavy object at arms length (my son recommends
a school backpack full of books) and spin around, leaning slightly
backwards to balance the bag. Spin around 10-20 times at a rate
of about 2 revolutions /second.
Alternatively, if you don't want to injure yourself by falling
over, sit in an "executive" swivel chair and have someone
spin you around as fast as they can without the chair becoming
unstable, for 20-30 seconds. In both these cases, you will experience
rotatory vertigo for a few seconds when you stop rotating. You
will have the sensation you are still spinning, your eyes will
exhibit nystagmus (a beating from side to side) and if you continue,
you may experience nausea.
Based on this experience, you now partially understand the problem.
There are additional factors which the patient must deal with.
One is that their vertigo may last from hours to days, compared
with the few seconds you experienced. With the brief episode you
experienced, the vertigo declined quickly with time. For a patient,
the vertigo may be sustained or even increase in intensity over
a few hours.
Another difficulty the patient may have is that the vertigo can
be made worse by "external" stimuli, such as head movements
or loud sounds. Even TVs and radios may have to be avoided. It
should also be considered that in this exercise, you had control
over your situation and you knew you could stop when you wanted.
You also knew that you would be fine tomorrow.
The Meniere's patient has to deal with a lack of control of their
situation, except for the limited control provided by taking anti-vertiginous
drugs. Even when the symptoms have passed, they must face the
stress and uncertainty of when the next episode will occur, and
whether it will be more or less severe than previous ones. It
is generally true that most people underestimate how disruptive
episodic rotatory vertigo can be to an individual's life.