Suddenly the world was spinning. What happened?

Author: Wang Ningyu, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Member of the Otorhinolaryngology and Head and Neck Surgery Committee of the Chinese Medical Association

Reviewer: Liu Yuhe, Chief Physician, Beijing Friendship Hospital, Capital Medical University

Vice Chairman of the Science Popularization Branch of the Chinese Medical Association

If someone told you that there are some "little stones" hidden deep in our ears, would you be surprised?

To be precise, the "little stones" in our ears are actually some carbonates in the human body. They contain a large amount of minerals and are a kind of tissue organ in the human body whose composition is close to that of stone. However, if we really call it a stone, it would be a bit far-fetched, so we just name it otolith symbolically.

1. Why do otoliths make us feel dizzy?

Otoliths are in our inner ear. The main structures in the inner ear include the cochlea, vestibule, and semicircular canals. Under normal circumstances, otoliths are distributed in the vestibule and can help the vestibule maintain the normal sense of balance of the human body.

Otoliths are constantly changing, they may become loose, grow, and decay. When otoliths are ischemic and aging, they may fall off, and most of them will be captured by related tissues, organs, and cells, and then digested.

However, if the detached otoliths are large in size, or are not captured by cells in time after detachment, they may move to the semicircular canals along with the endocardial lymphatic circulation. The semicircular canals are responsible for the balance of the human body, so the arrival of otoliths will affect the function of the semicircular canals. At this time, we may be sitting well, but suddenly we may feel dizzy, and then we may fall or lie directly on the bed. This is what we often call otolithiasis. In a nutshell, the pathology and displacement of otoliths cause the dizzy otolithiasis.

Figure 1 Original copyright image, no permission to reprint

The incidence of otolithiasis is relatively high. Statistics show that in our lifetime, 2.4% of people may experience such benign, paroxysmal, positional vertigo, especially the elderly, where one in every 10 people will develop the disease. In terms of the ratio of men to women, the incidence rate in women is slightly higher, which is related to the decrease in estrogen secretion levels after menopause, which makes calcium loose and easy to fall off.

2. What is the difference between otolithiasis and Meniere’s disease?

The onset of otolithiasis is often related to changes in body position. The patient will suddenly experience very strong vertigo, which is the spinning feeling we mentioned above, which may last for 5-20 seconds.

In addition, patients may also experience nausea and vomiting, pale complexion, profuse sweating, and nystagmus, which means that the eyeballs will slowly move involuntarily in one direction. After reaching a certain position, our brain will discover the problem and correct it, and the eyeballs will quickly return to the starting position, repeating this process and forming nystagmus.

However, during this process, the patient's consciousness is often unimpeded, his hands and feet can move, and he does not have symptoms such as tinnitus, deafness, and stuffy ears.

Relatively speaking, there is another disease with similar symptoms that also often causes dizziness, that is Meniere's disease. How do we distinguish between the two?

The vertigo caused by Meniere's disease can last longer, often lasting dozens of minutes or even hours, and is accompanied by stuffy ears, hearing loss, tinnitus, and often occurs unilaterally and recurs repeatedly.

Therefore, when we experience dizziness, we can make a rough identification based on the key points mentioned above to determine whether we have otolithiasis or Meniere's disease. If we cannot judge it ourselves, we can also go to the hospital for body positioning examination, hearing test, etc. to make the identification.

3. Who is more likely to suffer from otolithiasis?

The vestibule, where the otoliths are located, is an organ with very active metabolism. If a person has metabolic abnormalities such as high blood pressure, hyperlipidemia, diabetes, and vascular sclerosis, the incidence rate may increase.

Women are more likely to develop the disease than men, and the elderly also have a 10% incidence rate.

There is also a theory that diseases that require a lot of head movement can also make otolithiasis more likely to occur. For example, the incidence of otolithiasis in patients with Parkinson's disease is higher than that in normal people.

Figure 2 Original copyright image, no permission to reprint

So, can ear diseases such as otitis media cause otolithiasis? Theoretically, the relationship between the two is not very close. Usually, the onset of otolithiasis has nothing to do with the original ear disease.

Picking your ears will not cause otolithiasis. When we pick our ears, we only touch the external auditory canal, while otoliths are deep in the inner ear, so there is no connection between the two.

4. What should you do when otolithiasis suddenly occurs?

We remind everyone that if patients with otolithiasis develop vertigo, they must first stop, stop while walking, and pull over while driving. If you are alone at home, you can lie down first, then slowly change your position and try to stand up gradually. If you can still make a phone call, you should immediately notify your family, friends, and colleagues by phone and ask them to come to help as soon as possible.

In addition, patients should also go to the hospital for examination and treatment as soon as possible, because vertigo symptoms can be caused by many diseases, and may even be caused by intracranial hemorrhage. Once the judgment is wrong, it may lead to a big mistake. Moreover, although otolithiasis does not cause any serious disease, it often recurs and greatly affects life.