Tag Archives: health

Health of Orchestra Musicians

OCSM Looks at the Health of Orchestra Musicians

by Robert Fraser, President Organization of Canadian Symphony Musicians

When I began my studies many years ago, I had no idea of the physical hazards of musical performance. Overuse injuries, hearing loss, unsafe performance environments—these were all very new to me and there was relatively little research or remedy in this area. I had never even heard of the drug Inderal and was astonished when my first-year music history teacher mentioned in class how many musicians took it.

Fast-forward to 2018 and there is still much work to be done. While we continually work to improve our physical safety in the workplace, dangers to our personal well-being in the form of harassment still abound, and the demands of our profession can take a toll on our psychological health. In this column, I want to draw your attention to two significant surveys, both conducted in the UK but very relevant to our position in North America.

Early last month, a few news outlets reported on survey results released by the Incorporated Society of Musicians (www.ism.org), a UK-based organization. The survey is ongoing and can still be accessed through their website. I would invite readers to look at both the survey and the report on the initial period of responses from last November. The most telling statistic, and the one that was shared in all the press articles, is that almost 60% of the respondents reported some form of sexual harassment in their musical workplace, and of those 60%, a large majority of respondents who revealed their gender were female. (The survey gives respondents the option to not reveal gender or to choose  transgender; 71.71% identified as female and 10.53% chose not to identify gender.)

The report states that there were more than 250 voluntary respondents to the survey during this period. While this is not a large sample, it is telling nevertheless. It makes me wonder what the responses would be if such a survey was conducted through AFM player conference orchestras.

Another survey, done in 2016 by Help Musicians UK, was entitled Music Minds Matter (www.musicmindsmatter.org.uk) and it presents itself as being “the world’s largest known study of musicians’ mental health.” Of the 2,211 respondents, 71.1% believed they had experienced panic attacks and/or high levels of anxiety and 68.5% reported they had experienced depression—making musicians three times more likely to experience depression and anxiety than the public at-large.

Respondents to the survey listed a number of reasons for ill mental heath.

To quote directly from the summary report:

  • Poor working conditions including: difficulty sustaining a living, anti-social working hours, exhaustion, and the inability to plan their time/future
  • A lack of recognition for one’s work and the welding of music and identity into one’s own idea of selfhood
  • The physical impacts of a musical career, such as musculoskeletal disorders
  • Issues related to being a woman in the industry—from balancing work and family commitments, to sexist attitudes, and even sexual harassment

In October 2017, a follow-up to the Music Minds Matter survey (Phase 2) included in-depth interviews with 26 of the survey’s respondents. Again, quoting from the report, three suggested areas for change were:

  • Education
  • A code of best practice
  • A mental health support service for those working in music

At the last OCSM Conference in August, the delegates adopted a resolution to address all three of these areas. We resolved to “encourage orchestra managers to become familiar with The National Standard of Canada for Psychological Health and Safety in the Workplace. This document can be found at the website of the Mental Health Commission of Canada. It is a daunting document (more than 70 pages), but I encourage all our members to find and download it. Point it out to your locals, your orchestra committees, and your human resources personnel. This is one area where union-management collaboration and cooperation is a must. Having research and well-documented plans for implementation will help, but the road to good mental health and safety in the workplace will not be easy.

On behalf of the 1,200 members of OCSM, I wish you all a prosperous and healthy 2018, and to my colleagues in the symphony world, an exciting second half of your season.

New Occupational Health and Safety Rules Protect Alberta Workers

For decades, Alberta has suffered higher worker injury rates than other jurisdictions in Canada. Bill 30 updated Alberta’s Occupational Health and Safety (OHS) Act for the first time since its introduction back in 1976.

“These long overdue Occupational Health and Safety changes will put workers at the center of the workplace health and safety equation by building an OHS system on three fundamental worker rights: the right to know about workplace hazards, the right to participate in workplace health and safety programs and policies, and the right to refuse unsafe work,” says Alberta Federation of Labour President Gil McGowan.

Other key changes in the new legislation include broader workers compensation coverage for workers who are either injured or killed on the job, as well as the continuation of pay and benefits when stop-work orders are issued.

More Workers Financially Stressed

According to the 2017 Global Benefits Attitudes Survey released in late November by Willis Towers Watson, only about a third of all US employees are satisfied with their financial situation. The results demonstrate a reversal from improvements in employee attitudes since 2009.

Of the 4,983 participants surveyed in July and August, 59% say they worry about their future financial state, compared to 49% just two years ago.

A growing proportion, 34%, say current financial concerns—stagnate wages, health care costs, and the erosion of pension plan coverage—are negatively affecting their lives and ability to do their best work.

Seven out of 10 report high or above average stress levels and 30% describe their health as poor. In contract, those who have no money problems were in very good health (55%) or good health (35%), with just 5% reporting high stress.

Pain

A Drug-Free Way to a Pain-Free Back

by Marc Brodsky, MD, and Craig Holiday Haynes

Chronic lower back pain may be the result of trauma or repetitive overuse injuries of the spine, intervertebral discs, ligaments, joint capsules, and muscles. Posture and psychological stress may also contribute. In a musician, lower back pain can be debilitating, interfering or worsening with activities related to playing an instrument.

While narcotic (opioid) pain medications can make life more comfortable, they come with inherent risks: accidental overdose, risk of dependence and addiction, side effects (sedation, dizziness, nausea, constipation, respiratory depression, etc.), and the need for increasingly stronger doses. In October 2017, the US President directed the Department of Health and Human Services to declare the opioid crisis a public health emergency. It is important to explore alternative treatments before turning to prescription drugs.

Case Study

One 52-year-old jazz drummer developed lower back pain after a motorcycle accident. He described shooting pains in his legs that interfered with his ability to play drums and to go on tour. An MRI revealed a herniated disc in his lower back. After disc surgery, the pain that traveled to his legs improved, but he continued to have pain across his lower back. The drummer got relief from his pain with trigger point injections, along with acupuncture, chiropractic, and massage treatments. He treated pain flare-ups with a self-care program that included acupressure and swimming exercises. 

Integrative Medicine Approach

Drug-free treatments to activate natural healing and restore resiliency may relieve pain and suffering and optimize quality of life. Self-care nonpharmaceutical treatments and techniques without side effects or risk of addiction are particularly important for performers. 

Myofascial trigger points are irritated spots in the fascia surrounding skeletal muscle. These small patches of clenched muscle fibres are sensitive and cause aching and stiffness. They often are a major factor in common problems like lower back pain and neck pain. Most minor trigger points are self-treatable.

 

Pain

A hands-on physical exam may locate trigger points in the muscles that, when pressed, cause pain in the lower back. For those experiencing lower back pain, pressure points are most commonly found in two muscles, the quadratus lumborum (left) and gluteus maximus (right).

Pain Relief Through Acupressure Points

Acupressure points take advantage of the body’s natural muscle relaxant and stress reliever. Since acupressure points and trigger points in the muscles overlap, you may get relief from your pain by utilizing exercises that press acupressure points in your back and legs. Try the exercises below for relief of lower back pain.

Exercise One

PainPain

Place two tennis balls in a stocking and press them against a wall with your back using the weight of the body. Press for the duration of about 15 seconds, one to three times per day.

 

Exercise Two

Pain

Press your finger into a point at the bottom part of the calf muscle.

Press each of the acupressure points for the duration of three relaxing breaths (about 15 seconds), one to three times each day. If lower back pain persists, see a medical professional.

 

 

 

10 Tips To Reduce Back Pain

1) Maintain a healthy weight.

2) Regularly take part in exercises
that strengthen your back and
core muscles.

3) Lift your equipment properly—always bending your knees and squatting to pick up heavy items.

4) Know your limits and don’t be shy about asking for help.

5) Use good posture throughout
the day.

6) Stretch your muscles.

7) Don’t carry a briefcase or heavy purse long distances as it changes your balance. Instead, use a
backpack.

8) Make sure your mattress is firm enough to support your back.
Soft mattresses can push it out
of alignment.

9) Get plenty of sleep.

10) Quit smoking.

As always, if back pain continues, see a specialist.

Health Care

Health Care Update: Association Health Plans

This article focuses on health care issues currently being considered by Congress and the Trump Administration.

Affecting Repeal and Replace

For eight years, conservatives in Congress have voted several times on the repeal and replacement of the Affordable Care Act (ACA), maneuvering through numerous legislative procedural actions that, even today, have not yielded success. Based on a campaign promise to eliminate the ACA, the Trump White House has worked closely with House and Senate leadership to craft new proposals that have resulted in intraparty roadblocks by Republican caucus members.

Democrats held firm to the premise that the ACA need not be repealed or replaced in total. Their belief is that the act should be reworked to help repair many of the adverse provisions that are most harmful to health care consumers.

The latest congressional vote on ACA repeal and replace took place in September, after the August congressional recess. The slim margin in the US Senate left no room for party defections. However, in the final vote, three Republicans voted with Democrats to defeat the bill on the Senate floor.

President Donald Trump says “Obamacare” is dead and gone. However, open enrollment continues as the bill remains in effect until the federal government comes up with a replacement Congress can agree on.

Association Health Plans

Faced with health care defeat in Congress, the White House remains determined to pull out a political victory, focused on keeping the Republican election promise to its constituency. The White House placed the blame for the congressional failure of repeal and replace squarely at the feet of Republican Senate leadership, vowing to push the health care issue until a new proposal is in place.

The most recent health care replacement proposal came October 12 when Trump announced his plan to reintroduce Association Health Plans (AHPs), a system that was proven unsuccessful in the 1980s. A February 2004 GAO Report entitled Private Health Insurance, outlines the negative intricacies that confront AHPs. These include market failures such as insolvency and fraud.

Trump noted that this plan is designed to spur competition in the individual insurance market, while giving small businesses the opportunity to come together in trade groups to form plans across state lines. He plans to affect this plan by having federal agencies, such as the US Treasury, Health and Human Services, and Labor Departments, ease rules wherever possible to make it work. In other words, he will be using the regulatory system to avoid further missteps by Congress.

AHPs have often been referred to as watered down plans that provide limited coverage. The American Academy of Actuaries
(www.actuary.org/content/association-health
-plans-0) makes the case for the importance of consistent rules between plans that compete to enroll the same participants, discussing the adverse effects of the lack of coordination.

Support for this idea comes mostly from within the administration, while outside think tanks, along with some members of Congress, oppose the proposal.

A spokesperson for the nationally recognized Center on Health Insurance Reforms at Georgetown University states concerns about insolvency and fraud. After Trump’s announcement, the health care industry issued a statement that fell short of an endorsement, noting that the complexity of the issue would need further study. The executive order will take time to implement.

During the week of October 8, Trump kept his promise to cut off cost sharing reduction payments to insurers that help low income Americans reduce their out-of-pocket health insurance costs. The following week, that move was countered by a bi-partisan plan developed by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), which was supported by the president, but then a day later denounced as a bailout to insurance companies.

The AFL-CIO continues to study the AHP issue and has decided not to release a statement until affiliates have had a chance to study the proposal and weigh in. The AFM is taking a similar position, working with the AFL-CIO Health Care Task Force before encouraging locals to take a stand.

Easing Jet Lag: A Biochemist Weighs In

A touring musician is no stranger to the pitfalls of air travel—cramped economy seating, lost and mishandled luggage, and perhaps one of the worst is the dreaded jet lag. Combating daytime fatigue and nighttime insomnia, in severe cases, it can take days to revert to a normal sleep schedule.

Scientists are beginning to understand more about how human circadian rhythms work. Their studies may eventually lead to therapeutic “cures” for jet lag. Researchers at the Salk Institute have found two receptors in the nuclei of human and mouse cells that control sleep and metabolic cycles.

Also, this year the Nobel Prize for Physiology or Medicine was awarded to Jeffrey C. Hall, Michael Rosbash, and Michael W. Young for their research about biological clocks. Brian Crane, Cornell biochemist and a colleague of Young, broke down why people become jet lagged in the first place and possible solutions for weary travelers.

What is jet lag?

Jet lag is associated with physical symptoms, but on a molecular level, it’s your body struggling to adapt to the new day-night cycle wherever you’re staying. “In most of your cells there’s a molecular oscillator—a little clock that keeps track of time,” explains Crane. Your biological clock cannot be changed as simply as winding the hands to match the time zone. “The clocks in your eyes and brain adapt quickly, but they have to train your peripheral clocks—in your liver, intestines, and heart. So, you get jet lagged because different parts of your body think it’s different times of day.”

What can you do to fight jet lag?

While it is tempting to hop straight into bed after a long, exhausting flight, Crane advises you should adapt your biological clock as soon as possible and try to adjust to the new day-night cycle wherever you are. “In mammals, there’s a lot of feedback between physical activity and your clocks,” he says. He suggests being outside and active during the new “daytime” despite fatigue, as well as forming a new eating schedule. “If you’re jet lagged you feel hungry at odd times, you can reset your appetite hormones by eating at the right time for where you are, even if you’re not hungry.”

Crane suggests travelers should not stay awake late at night. This is not always feasible for musicians, but at least avoid caffeine or midnight Internet browsing. “Stay away from computer screens at night. [Eyes] are typically blue light sensitive. Computer screens, which contain a lot of blue light, are good at delaying your clock,” he says.

While ditching screens before bed is the best option, there are apps that can control the amount of blue and white light your devices emit. In addition, light therapy boxes, often used to combat Seasonal Affect Disorder (SAD), are effective solutions to getting daytime light exposure, if you cannot get outside during the day. This can impact the body and mind beyond resetting clocks. “Mammals have really strong rhythms. If we’re out of whack with when we eat and when we sleep, it has big ramifications on our wellbeing,” Crane notes. “Getting people on a good day-night cycle where they see light at the right times and reset their rhythms has shown to be useful for proper mental health.”

There are also options available for those interested in over the counter treatments for their jet lag issues. Widely available, Melatonin—the hormone that contributes to sleep—has varying success from person to person. Melatonin’s effect on the body is “more of a downstream thing” Crane describes. “The central clocks in the brain cause the pineal gland to release melatonin and then the melatonin entrains the peripheral clocks.”

Advancements are on the horizon. Melatonin agnates—artificial compounds that bind to the melatonin receptors better than melatonin does, therefore making the compounds more effective than melatonin—are in clinical trials according to Crane.

Why is it harder to recover from flights traveling east?

This is a puzzling effect of flying. Since the body has a cycle of a little more than 24 hours it’s easier to adapt to a longer day, when traveling west, than when the day shortens when traveling east, according to University of Maryland physicist Michelle Girvan in a 2016 interview with the New York Times.

As far as specific causes on the biochemical level, Crane says molecular biology doesn’t have an exact answer yet. “I’m not sure we completely understand. For some reason [biological clocks] reset more easily from delays than they do advances,” says Crane.

Music Induced Hearing Disorder

Hearing Protection Is Key for Today’s Orchestra Musicians

Studies have shown that musicians have more than three times the average risk for hearing loss. The risk of developing a music induced hearing disorder (MIHD) should be a major concern for orchestra musicians. According to Heather Malyuk, AuD, who has worked with both Chicago Lyric Opera Orchestra and National Symphony Orchestra, orchestra exposure to sound is difficult to study due to variables in repertoire and orchestra size. However, more than half of orchestra musicians surveyed have experienced MIHDs.

“These musicians are highly susceptible to MIHDs, including tinnitus (ringing in the ears), hyperacusis (sensitivity), diplacusis (detuned pitch perception), and distortion,” she says. MIHDs are more likely than modest hearing loss to affect a musician’s career, yet they are seldom discussed.

“It’s easy to forget musicians are everyday people susceptible to other causes of hearing loss such as disease, poor vascular health, sudden loss, genetics, strong medications, and lifestyle choices,” she says. “Musicians’ brains are amazing in their plasticity to adapt and adjust to changes in hearing. They are often afraid to discuss hearing for fear of losing work or negative perceptions from peers. Hopefully, that will change. If we are open and educated about these issues as a group, we can more effectively prevent them.”

Music Induced Hearing Disorder

Though hearing damage is often associated with louder instruments, every instrument group is at risk. “Injury is not from volume alone, but volume and length of exposure time. Practice, rehearsal, and performance create many hours of exposure,” she explains. “The US doesn’t have regulations or safety scales unique to music, but musicians can use the scales designed for industry workers to effectively protect hearing.” These scales measure noise levels in decibels (dBA).

The Occupational Safety and Health Administration (OSHA) regulatory scale states that 90 dBA of sound is safe for eight hours. The safe time is halved every time the sound intensity increases by five decibels. The National Institute of Occupational Safety and Health (NIOSH) scale is more stringent, starting at 85 dBA for eight hours, with the safe exposure time halved every time the sound intensity increases three decibels. (See table.) Musicians should consult with specialized audiologists to assess their risks.

Members of symphony orchestras are exposed to all kinds of noise in their daily lives, plus the sound of all the other instruments in the orchestra. (See sample noise level charts.) Adding to this is the current popularity of pop stars guest performing with orchestras. “Pops-style concerts have changed the way orchestral musicians listen and protect themselves. They are a driving factor in the pursuit of hearing wellness,” Malyuk says.

According to Malyuk, more must be done to protect orchestra musicians. “Occasionally hearing protection is provided, often in the form of foam, universal fit earplugs. Orchestras are not required to provide hearing protection, so it is a nice gesture, but often an incorrect one, as these are virtually unusable in professional orchestral environments,” she says. They are not designed for music and don’t have a flat frequency response (dampening high pitches more than low pitches), making it difficult for musicians to hear subtle nuances of music.

Other “engineering controls” are sometimes implemented to protect hearing. “Baffles can be used, but they are often expensive, tricky to deploy, and vary in terms of attenuation, depending on make and positioning. In theory, changing orchestral seating can reduce levels by a few decibels, but this affects instrumental balance for the audience,” she explains. Solutions like rotating string players and limiting louder repertoire are also not feasible in the orchestra setting.

“Giving the auditory system breaks is healthy, but it all comes down to repertoire and sound levels,” she says. “If decibel measurements can be taken on each individual player, then educated choices about breaks can be made. However, that can be costly and time consuming, and orchestras can’t conduct such a study on each piece of music.”

In-ear monitors (IEMs), when used correctly, help many musicians to hear themselves and their colleagues accurately, while also protecting hearing. “It’s possible for orchestras to use IEMs, but logistical issues stand in the way. For musicians to have personal audio mixes, extra gear is needed,” says Malyuk. “Two members of the National Symphony Orchestra have used ambient IEMs for pops performances, and I’ve fit several musicians with these devices as active variable level earplugs, used without a monitor feed. But, filtered earplugs are currently the best option for orchestral players because they are less expensive and less cumbersome.”

Some musicians are resistant to earplugs due to past experiences. “I’ve found that this is usually because they’ve been fit incorrectly,” she says. “It takes a knowledgeable, specialized audiologist to choose the best quality filter, select usable but effective attenuation, and take accurate ear impressions. Just like any area of health care, audiology has specialties.” She recommends an annual wellness visit with a specialized audiologist to check for MIHDs and hearing loss and to learn about the latest protective measures like filtered earplugs.

More often hearing protection is becoming a subject of orchestra committee discussions. “Recently, the affordability and necessity of hearing wellness programs for orchestra members has been a focus in negotiations. Education is needed in this area and that falls on the shoulders of orchestra committees, who are often underequipped for that task,” says Malyuk. This is an area where trained audiologists can assist, providing current research, cost points, and risks, as well as information regarding wellness programs and hearing protection options.

“A common arrangement I have seen within collective bargaining agreements is a reimbursement program. Musicians pay for the wellness visit and custom hearing protection costs and are reimbursed a certain, agreed upon percentage. Annual hearing wellness care is not only best for the musicians, but it also helps protect employers (such as orchestra management) from potential legal action for hearing injury,” she says. “Musicians are small muscle athletes and, as such, need annual care for their most valuable instrument—their ears.”

Heather Malyuk, AuD has spoken at ICSOM and ROPA conferences. Her clinic, Soundcheck Audiology (www.soundcheckaudiology.com), features concierge services for orchestras, supporting musicians through hearing wellness and MIHD prevention.

Employer Fined Following Workplace Death

Contractor Mark Welty of North Country Services was fined $280,000, plus $12,000 in penalties to the Alaska Division of Workers’ Compensation Benefits Guaranty Fund and a $2,000 fine from the Municipality of Anchorage after employee Nicholson Tinker was killed on the job.

Welty unlawfully classified Tinker as an independent contractor in an attempt to avoid the responsibility of providing a safe and healthful work environment, along with basic employee injury and death benefits.

Tinker was killed when a cinderblock wall collapsed on him during a demolition. Welty acted with plain indifference towards the health and safety of his employees—lack of proper structural assessment, inadequate bracing and shoring for the wall, and lack of safety training for the employees.

“I hope this sends a clear message. When employers like Mark Welty endanger their workers and unlawfully classify them as independent contractors, our department will seek the strongest penalties possible,” says Alaska Labor Commissioner Heidi Drygas.

Ophthalmologist

When Should You Visit an Ophthalmologist?

As musicians, most of us rely on our eyes to read music, monitor audience response, and collaborate with colleagues. Vision is something that many of us take for granted until we begin to lose it. By the year 2020 it is estimated that 3.36 million people will have primary open-angle glaucoma (POAG) and about half will be unaware they suffer from this disease, even though early detection and treatment can prevent or delay vision loss. And, while diabetic retinopathy is a leading cause of blindness, many patients with diabetes do not receive evaluation and treatment in time to minimize vision loss.

Most people who require corrective vision visit their local optometrist annually or semi-annually to update their prescription. This type of examination, focused on the management of vision changes, is called a refractive examination. However, it is also important to periodically schedule an eye exam with a medical doctor specializing in eye care (or ophthalmologist) for a diagnostic eye examination. Only an ophthalmologist is qualified to provide the full range of eye care, from treating eye diseases with medicine to performing eye surgery to prescribing corrective lenses.

The American Academy of Ophthalmology recommends that healthy individuals with no signs or risk factors for eye disease get a baseline eye examination at age 40. This is a time when early signs of disease or changes in vision are likely to occur. People with certain risk factors—diabetes, high blood pressure, family history of eye disease, or those taking certain medications—should schedule earlier and more frequent exams.

The examination will likely include:

• Medical history

• Visual acuity

• Evaluation of your pupils’ response to light

• Evaluation of peripheral vision

• Ocular motility test to evaluate movement of the eyes

• Tonometry, or eye pressure test, for
glaucoma

• Use of a slit lamp to examine the front part of the eyes for cataracts, scars, or scratches to the cornea

• Examination of your retina and optic nerve for signs of disease

This initial examination will likely take about 45 to 90 minutes. The doctor may suggest additional testing using specialized imaging techniques. Based on the initial screening, the ophthalmologist will advise you as to how soon you should schedule your next examination.

In addition to a baseline exam at age 40, the American Academy of Ophthalmology suggests that you should visit an ophthalmologist immediately if you experience decreased vision, changes in vision, or physical changes to the eye.

10 Tips for Healthier Vision

1) Stop smoking. Smoking raises the risk of macular degeneration and speeds up damage when you do have the disease.

2) Wear sunglasses. Ultraviolet radiation from the sun increases your chances of developing macular degeneration. Look for sunglasses labeled UV 400 that also cover the sides of your eyes.

3) Exercise. As your heart strengthens it pumps more oxygen-rich blood to your eyes. Also, obesity puts you at higher risk of macular degeneration.

4) Monitor your blood pressure. High blood pressure can damage blood vessels and your heart’s ability to carry a steady stream of oxygen-rich blood to your eyes.

5) Use better lighting. Avoid fluorescent bulbs and other light sources that mimic the damaging rays of the sun. Incandescent and LED lights are safer. Use drapes and shades to cut glare.

6) Eat healthy. Leafy greens contain antioxidants and other nutrients that support eye health. Fish like salmon, trout, sardines, tuna, and mackerel are rich in omega-3s, which boosts eye health. Saturated and trans fats can increase macular degeneration damage.

7) Take supplements. Some vitamin and mineral formulas (AREDS and AREDS2) may slow macular degeneration. Consult your physician to find out if these are right for you.

8) Monitor your cholesterol. LDL “bad” cholesterol can build up in your eyes and form deposits called drusen that affect your vision.

9) Visit an eye doctor. Vision loss from macular degeneration does not
occur right away. Stay on top of it with regular visits, if you notice vision changes.

10) Look into vision rehabilitation. A team of specialists can work with you to make the most of the sight you have.

Vertigo

When Vertigo Rocks Your World

Vertigo

Vertigo is a tilting, spinning sensation of being off-balance. You may feel like the world is spinning around you even when you are standing perfectly still. Vertigo symptoms are caused by a disturbance to equilibrium, and may be accompanied by nausea and headache. More than 2 million people visit their doctors each year complaining of dizziness or vertigo, and while it’s generally a harmless symptom, you can imagine how it could be debilitating and stop a performer in her tracks.

To better understand the cause of vertigo you need to look at the anatomy and function of the ear. Sound waves travel through the outer ear canal until they reach the eardrum. There, sound is turned into vibrations, which are transmitted through the inner ear via three small bones (the incus, malleus, and stapes) to the cochlea, and finally to the vestibular nerve, which carries the signal to the brain. A collection of semicircular canals (canalis) positioned at right angles to each other inside the inner ear act like a gyroscope for the body. These canals, combined with sensitive hair cells within the canals, provide us feedback regarding our position in space. When there is a disturbance in this system, it can cause vertigo.

Common Types and Causes of Vertigo

  • Benign paroxysmal positional vertigo (BPPV): This type of vertigo is caused by tiny calcium particles (canaliths) that clump in the canals of the inner ear, which sends signals to the brain about movements relative to gravity to keep your balance. This type of vertigo is most commonly felt when tilting the head or climbing in and out of bed.
  • Meniere’s disease: This inner ear disorder is thought to be caused by a buildup of fluid, which alters the pressure in the ear. Along with vertigo, symptoms can include ringing in the ear (tinnitus) and hearing loss.
  • Vestibular neuritis or labyrinthitis: This inner ear problem is caused by an infection (usually viral). The infection inflames the inner ear around the nerves that are important for helping the body sense its balance.

Less frequent causes of vertigo include head or neck injury, brain problems (stroke or tumor), certain medications, and migraine headaches. In many cases vertigo will go away with no treatment. When necessary, what treatment is used depends on the cause of the vertigo.

Common Treatments

  • Canalith repositioning maneuvers: Performing a series of specific head and body movements can relieve the symptoms of BPPV by shifting the calcium deposits out of the ear canal and into an inner ear chamber where they can be absorbed by the body. While the movements are safe and effective, you may need a doctor or physical therapist to teach you the techniques. Also, if you are uncertain which ear is affected your doctor can let you know.

Epley maneuver is the most common, and provides relief to 90% of BPPV sufferers.

1) Sit on the side of your bed. Turn your head 45 degrees to the side of the affected ear (not as far as your shoulder).

2) Quickly lie down on your back, with your head on the bed (still at a 45-degree angle). Place a pillow under you so it rests between your shoulders rather than under your head. Wait 30 seconds.

3) Turn your head halfway 90 degrees in the opposite direction without raising it. Wait 30 seconds.

4) Turn your head and body on its side in the same direction, so you are looking at the floor. Wait 30 seconds.

5) Sit up slowly but remain on the bed for a few minutes.

6) Repeat before going to bed each night until you’ve gone 24 hours without dizziness.

     Half somersault or Foster maneuver

1) Kneel down and look up at the ceiling for a few seconds.

2) Touch the floor with your head, tucking your chin so your head goes toward your knees. Wait about 30 seconds or until any vertigo stops.

3) Turn your head toward the affected ear. Wait 30 seconds.

4) Quickly raise your head so it’s level with your back while you’re on all fours. Keep your head at that 45-degree angle. Wait 30 seconds.

5) Quickly raise your head so its fully upright, but keep your head turned to the shoulder of the side you’re working on. Then slowly stand up.

6) Repeat this a few times for relief, resting for 15 minutes in between.

  • Vestibular rehabilitation: This physical therapy may be recommended by your physician if you have recurring vertigo. It is aimed at helping to strengthen the vestibular system and its function in sending signals to the brain about head and body movements relative to gravity.
  • Medication: In cases where vertigo is caused by an infection or inflammation, antibiotics or steroids may reduce swelling and cure the infection. For Meniere’s disease, diuretics may be prescribed to reduce fluid build-up pressure. In some cases, medications are taken to relieve the nausea associated with vertigo.

Occasionally vertigo can be a symptom of a more serious problem. It’s always advisable to visit your physician when you are experiencing any medical condition.