tag:theconversation.com,2011:/us/topics/vertigo-29923/articlesVertigo – The Conversation2021-03-22T13:22:47Ztag:theconversation.com,2011:article/1575222021-03-22T13:22:47Z2021-03-22T13:22:47ZCOVID associated with hearing loss, tinnitus and vertigo – new study confirms link<figure><img src="https://images.theconversation.com/files/390838/original/file-20210322-17-1sakyvp.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4743%2C3164&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frustrated-elderly-woman-suffering-deafness-trying-748946563">shurkin son/Shutterstock</a></span></figcaption></figure><p>Some viruses, such as <a href="https://www.who.int/pbd/deafness/world-hearing-day/WHD2016_brochure_EN.pdf?ua=1">measles, mumps and meningitis</a>, can cause hearing difficulties, but what about SARS-CoV-2, the virus that causes COVID-19?</p>
<p>In the first few months of the pandemic, a <a href="https://doi.org/10.1080/14992027.2020.1776406">rapid systematic review</a> of COVID-19 and hearing difficulties revealed a possible link between COVID-19 and audio-vestibular symptoms (hearing loss, tinnitus and vertigo). However, both the quantity and quality of the early studies were low. Now that the pandemic has been with us for over a year, more studies have been published and researchers have been able to estimate how common these symptoms might be.</p>
<p>My colleagues and I have identified about 60 studies that report audio-vestibular problems in people with confirmed COVID-19. Our analysis of the pooled data, published in the <a href="https://www.tandfonline.com/doi/full/10.1080/14992027.2021.1896793">International Journal of Audiology</a>, reveals that 7%-15% of adults diagnosed with COVID-19 report audio-vestibular symptoms. The most common symptom is tinnitus (ringing in the ears) followed by hearing difficulties and vertigo.</p>
<h2>Tinnitus</h2>
<p>Tinnitus is a common condition, affecting around 17% of all adults. Most people with tinnitus also have hearing loss, suggesting a close link between the two. In fact, tinnitus is often the first warning that, for instance, exposure to loud noise or drugs that are toxic to the ear has damaged the hearing system. Interestingly, <a href="https://www.nice.org.uk/guidance/ng188">there are reports</a> that tinnitus is a common symptom of long COVID, which is where symptoms last weeks or months after the infection has gone.</p>
<p>The hearing organ is clearly extremely sensitive because <a href="https://doi.org/10.1371/journal.pone.0035238">almost everyone</a> will experience temporary tinnitus if they are in a very quiet environment. There are also strong links between <a href="https://doi.org/10.1016/j.heares.2015.08.014">tinnitus and stress</a>. If people lie awake at night, stressed and anxious because of an impending deadline, financial concerns or bereavement, it is not uncommon that they will find themselves attending to noises in their ears. </p>
<p>This usually becomes less bothersome when the source of the stress and anxiety is removed. Surprisingly, there are no clinical tests that can diagnose tinnitus, so hearing specialists rely on self-reports.</p>
<p>Why tinnitus is being reported in people with confirmed COVID-19 is unclear. It is possible the virus attacks and damages the auditory system. On the other hand, the mental and emotional stress of the pandemic may be the trigger. But we need to be careful when interpreting these findings as it’s not always clear if studies are reporting existing or new symptoms. What is lacking are good-quality studies that compare tinnitus in people with and without COVID-19.</p>
<h2>Hearing loss and vertigo</h2>
<p>Hearing difficulties associated with COVID-19 have been reported across a wide age range and COVID-19 severity, ranging from mild (and managed at home) to severe (requiring hospitalisation). There are several case reports of sudden loss of hearing in one ear, often accompanied by tinnitus.</p>
<p>Sudden hearing loss occurs in around <a href="https://doi.org/10.1159/000091198">20 per 100,000 people each year</a>. It is treated with steroids to reduce swelling and inflammation in the inner ear. But the treatment only tends to work if it is started soon after the hearing loss occurs. </p>
<p>We know that viruses can cause sudden hearing loss, so SARS-CoV-2 may be responsible for the <a href="https://www.tandfonline.com/doi/full/10.1080/14992027.2020.1776406">case reports</a> of hearing loss in COVID patients. Yet the number of COVID-19 cases worldwide is so high that it is difficult to say with any great certainty if the cases of sudden hearing loss are higher than what we would generally expect to see each year.</p>
<p>Another commonly reported symptom of COVID-19 is dizziness. It can be quite difficult to differentiate this from the rotatory vertigo that is characteristic of damage to the balance system in the inner ear. However, the best estimate is that rotatory vertigo occurs in around 7% of COVID-19 cases.</p>
<h2>Start of our understanding</h2>
<p>Given the importance of providing timely evidence to inform health services, the information from this new systematic review is to be welcomed, but so far, the evidence is based on surveys and case reports. It is important not to diagnose audio-vestibular symptoms where they do not exist or where they are coincidental, given the high rates of COVID-19 in the population. However, the findings of the review might simply reflect the start of our understanding of this emergent health condition.</p>
<p>What is lacking are carefully conducted clinical and diagnostic studies that compare a sample of people who tested positive for COVID-19 and a sample of non-COVID controls. To that end, we are leading a year-long study to investigate the long-term effect of COVID-19 on the audio-vestibular system among people who have been previously in hospital with the virus.</p><img src="https://counter.theconversation.com/content/157522/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Munro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Up to 15% of adults diagnosed with COVID report audio-vestibular symptoms.Kevin Munro, Ewing Professor of Audiology, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/673762016-10-31T04:28:55Z2016-10-31T04:28:55ZHealth Check: why do we get dizzy?<figure><img src="https://images.theconversation.com/files/142457/original/image-20161020-15097-1e9xt2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While dizziness might be annoying when mild and infrequent, it can also be severely debilitating and impairing. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=365594900&size=medium&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQ3Njk2NjYzOCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMzY1NTk0OTAwIiwiayI6InBob3RvLzM2NTU5NDkwMC9tZWRpdW0uanBnIiwibSI6IjEiLCJkIjoic2h1dHRlcnN0b2NrLW1lZGlhIn0sIjMzTDBsS1dXWERQVHJLWTZYQVF0eXJYT28wZyJd%2Fshutterstock_365594900.jpg&racksite_id=ny&chosen_subscription=134&license=multi_share&src=NL5zzDYW-Az81-EDgJ1u6g-1-15">from www.shutterstock.com.au</a></span></figcaption></figure><p>Many people in their lifetime experience a sudden feeling of dizziness, be it head spinning, light-headedness, a floating sensation or a loss of balance, sometimes associated with nausea. In fact, dizziness is a frequent complaint. </p>
<p>It is estimated <a href="https://www.ncbi.nlm.nih.gov/pubmed/10798469">30% of the general population</a> have experienced moderate to severe dizziness at least once in their lifetime, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/18955641">nearly 2% of adults</a> seek medical attention annually for a new symptom of moderate to severe dizziness or vertigo.</p>
<p>The prevalence of symptoms of dizziness is particularly high among older people, with between 10% and 30% thought to suffer. Dizziness can be extremely distressing and physically debilitating and can markedly impair quality of life. In older people, in particular, experiencing dizziness makes the sufferer twice as likely to report disability, worsening of depressive symptoms, reduced participation in social activities, poor health and falls.</p>
<p>People generally find it hard to describe their dizziness symptoms and use vague terms such as floating, spinning, unsteadiness and giddiness. This imprecise symptom description is a major reason why dizziness is complex to assess and treat.</p>
<p>Doctors describe it as a feeling of altered orientation in space and classify it into four main subtypes: </p>
<ol>
<li>unsteadiness caused by leg weakness and impaired sensation </li>
<li>dizziness from severe anxiety </li>
<li>light-headedness</li>
<li>vertigo</li>
</ol>
<h2>Why do we feel dizzy?</h2>
<p>Vertigo is diagnosed when patients express having the illusion of head or body spinning. Vertigo tends to be caused by the inner ear (vestibular) - most commonly by the displacement of calcium crystals (small stones in the inner ear whose movement informs the eyes and the brain of horizontal or vertical movements) from their correct chambers in the inner ear – a condition called Benign Paroxysmal Positional Vertigo or BPPV. </p>
<p>As the calcium crystals blunder their way through one of the three inner ear canals, they activate very thin nerve cells (known as hair cells) connected to the brain and the eyes. The hair cells are highly sensitive to any slight movement and their signals to the brain normally reflect head movements and enable eye movements and body posture to be instantly adjusted.</p>
<p>In BPPV, the hair cells incorrectly inform the brain of head movement. This differs from the information provided by the eyes causing disorienting head movement or dizziness. Closing the eyes removes one of the disagreeing sensory inputs and the dizziness subsides.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=631&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=631&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=631&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=794&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=794&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=794&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<p>Similar feelings of head spinning can also be caused by other inner ear conditions, including vestibular nerve or inner ear infections (neuritis) or blocked vestibular canals, affecting the nervous pathway (called a “reflex”) that links the inner ear and the eyes.</p>
<p>The role of this reflex is to keep stable and clear vision when the head is moving, especially at fast speeds, for instance when walking quickly, running or even sitting in a car on a bumpy road. If this reflex isn’t functioning properly, vision is like watching the world as it appears on a poor quality homemade video: shaky and unstable.</p>
<p>Almost as frequent is the feeling of light-headedness people experience when getting up after lying on the couch or a bed quickly or from standing up from a chair after sitting for a long time. </p>
<p>In this instance, blood has pooled in our legs and the heart does not increase its beating rate sufficiently to compensate for the increase in blood pressure needed for standing up. This inadequate blood pressure regulation results in too long a time lag for providing the brain with oxygenated blood and dizziness occurs.</p>
<h2>How to treat dizziness</h2>
<p>Treatments for dizziness include physical manoeuvres such as moving the crystals back into their chamber for BPPV, blood pressure medication management and balance training. Many middle-aged and older sufferers, however, often find it hard to receive a correct diagnosis and are unable to gain relief from their symptoms. </p>
<p>This may be due to the unavailability of diagnostic tests for some inner ear conditions, the off-and-on nature of the problem making it hard to pinpoint, more than one issue leading to the problem and health care providers being only being able to diagnose one or two of several possible causes.</p>
<p>At NeuRA we are completing a study evaluating a one-stop assessment and treatment for dizziness. If successful in reducing dizziness episodes and handicap, we hope to make this strategy available for incorporating in clinical services.</p><img src="https://counter.theconversation.com/content/67376/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Lord receives funding from the NHMRC and ARC, Australia </span></em></p><p class="fine-print"><em><span>Jasmine Menant receives funding from the NHMRC, Australia. </span></em></p>It is estimated 30% of the general population have experienced moderate to severe dizziness at least once in their lifetime.Stephen Lord, Senior Principal Research Fellow, Neuroscience Research AustraliaJasmine Menant, Senior Research Officer, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/633202016-08-02T05:17:39Z2016-08-02T05:17:39ZThe great movie scenes: Hitchcock’s Vertigo<figure><img src="https://images.theconversation.com/files/132726/original/image-20160802-17183-igp1ul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">James Stewart and Kim Novak in Vertigo (1958).</span> <span class="attribution"><span class="source">Alfred J. Hitchcock Productions</span></span></figcaption></figure><p><em>What makes a film a classic? In a new monthly column, film scholar Bruce Isaacs looks at a single sequence from a classic film and analyses its brilliance.</em></p>
<hr>
<figure>
<iframe src="https://player.vimeo.com/video/177016469" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Vertigo, 1958.</span></figcaption>
</figure>
<p>We start with Alfred Hitchcock’s <a href="http://www.imdb.com/title/tt0052357/">Vertigo</a> (1958) – recently voted the <a href="http://www.bfi.org.uk/news/50-greatest-films-all-time">greatest film ever made</a> in a Sight & Sound poll. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-great-movie-scenes-hitchcocks-psycho-and-the-power-of-jarring-music-97325">The great movie scenes: Hitchcock's Psycho and the power of jarring music</a>
</strong>
</em>
</p>
<hr>
<p>In this fabulously stylised scene, set at Ernie’s restaurant, Scottie (James Stewart) lays eyes on the enigmatic Madeleine (Kim Novak) for the first time.</p>
<hr>
<p><em><strong>See also:</strong></em> <br></p>
<hr>
<p><a href="https://theconversation.com/the-great-movie-scenes-antonionis-the-passenger-65395">The great movie scenes: Antonioni’s The Passenger</a>
<br>
<a href="https://theconversation.com/the-great-movie-scenes-eternal-sunshine-of-the-spotless-mind-74166">The great movie scenes: Eternal Sunshine of the Spotless Mind</a>
<br>
<a href="https://theconversation.com/the-great-movie-scenes-steven-spielbergs-jaws-79043">The great movie scenes: Steven Spielberg’s Jaws</a>
<br>
<a href="https://theconversation.com/the-great-movie-scenes-hitchcocks-psycho-and-the-power-of-jarring-music-97325">The great movie scenes: Hitchcock’s Psycho</a>
<br>
<a href="https://theconversation.com/the-great-movie-scenes-the-godfather-98173">The great movie scenes: The Godfather</a>
<br>
<a href="https://theconversation.com/the-great-movie-scenes-stanley-kubricks-2001-a-space-odyssey-100170">The great movie scenes: Stanley Kubrick’s 2001: A Space Odyssey</a></p><img src="https://counter.theconversation.com/content/63320/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Isaacs does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What makes a film a classic? In a new monthly column, film scholar Bruce Isaacs analyses a single sequence from a great film. Here, we look at a scene from Vertigo.Bruce Isaacs, Senior Lecturer in Film Studies, University of SydneyLicensed as Creative Commons – attribution, no derivatives.