Thorough Examinations for Causes of Dizziness

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This woman in her 50s had been enjoying a calm and peaceful life until one day,

something happened that turned her life upside down.

It felt like I was spinning 360 degrees,
as if rotating inside a capsule.

Even when lying down, it was like
I was upside down.

She was suddenly afflicted with vertigo.

It's estimated that about 30 percent of people worldwide experience vertigo or dizziness

at some point in their lives.

And this can greatly disrupt basic daily activities.

One study found that over 25 percent of those affected had to change jobs,

while 21 percent gave up working altogether.

Japanese medical professionals are working on more effective ways to treat the symptoms.

And we are going to report on their efforts from a hospital where doctors carry out rigorous testing

to identify the causes and work on the latest treatments.

Nara Medical University Hospital has a rare facility with a team of doctors and physical therapists

who specialize in treating dizziness.

They're led by Kitahara Tadashi.

It is said up to 40 percent of patients complaining of dizziness

are told that the cause of their symptoms cannot be determined.

Kitahara's team actively accepts patients who were unable to receive a diagnosis at other hospitals.

It has successfully identified the cause in 97.5 percent of those cases.

Professor Kitahara thank you so much for your time.

I think you've everybody knows someone close to them who has been affected by dizziness or vertigo.

So what actually is dizziness and what actually is vertigo?

When you move your eyes intentionally,
you don't feel dizzy.

But if your eyes move involuntarily,
things around you appear to be moving.

That makes you feel dizzy.

This footage shows the eye movements of someone who is experiencing dizziness.

The involuntarily movement is due to a condition called nystagmus.

However, dizziness is not an eye disease.

It is known that 70-75% of dizziness
is caused by the inner ear.

This means otolaryngological dizziness
is the most common form of dizziness.

Deep in the ear is an area called the inner ear.

It has two main functions.

The part known as the cochlea detects sound.

And key to our discussion today are the semicircular canals - sensors that assist in maintaining balance.

The semicircular canals consist of three tubes called the anterior, posterior and lateral canals.

As the name suggests, they're semicircular in shape.

They detect the rotation of the head in three-dimensional space.

The anterior canal detects forward and back head movement,

the posterior canal senses tilting,

and the lateral canal identifies rotational movement.

Information from each canal is transmitted to the brain.

The brain then sends commands to the eyes and the limbs to keep balance.

In other words, if there is a problem with the semicircular canals, the brain cannot give accurate commands.

As a result, the movement of the head and that of the eyes go out of synch.

This is how dizziness occurs.

There are several different diseases that cause dizziness.

This woman in her 40s was suddenly struck by severe dizziness in 2012.

I was in bed around 2:00 a.m., and everything
was spinning, as if I were on a roller coaster.

It was going around and around,
and my eyes couldn't focus.

I closed my eyes, but it wouldn't stop.

She immediately went to a local hospital but wasn't able to get an accurate diagnosis.

For the next nine years, she went from one hospital to another, unable to find relief.

I figured I'd be told the same thing:
"Cause unknown. Try this prescription."

I kept wondering, "Isn't there a doctor
who can help me and cure my disease?"

In 2021, in her desperate search for a cure, she found Nara Medical University Hospital - her last hope.

For patients with dizziness of unknown causes, Kitahara recommends a week-long hospital stay.

This is to conduct as many as 23 examinations related to dizziness,

such as assessments of hearing ability and sense of balance.

Over 40 types of diseases are accompanied by dizziness.

Some can be life-threatening, such as stroke.

Therefore, Kitahara and his team examine the condition of not just the inner ear, but also the brain.

A patient last week had a brain tumor.

Really?

Sometimes there are cases like that,
so we have to be careful.

However, the test results for the woman didn't show anything abnormal.

Patients usually come to us
when their dizziness has eased.

During such periods, test results come out normal.

This makes it hard to find out
what's causing their symptoms.

Appropriate treatment cannot be determined without identifying the cause of the dizziness.

Medical interviews can provide important clues.

Fortunately, the woman had kept detailed records of her symptoms.

When I first felt like I was spinning,
I was looking to my right.

It didn't happen when I was facing the other way.
So, all night long, I kept looking to my left.

So as long as you did that, you didn't feel dizzy.

What caught Kitahara's attention was that she felt the spinning sensation

only when she was looking in a particular direction while lying down.

He also noted that the symptoms would temporarily subside after a month or two.

The professor also learned that she first experienced dizziness after giving birth.

Pregnancy, childbirth, or any other
changes or disruptions to the balance

of female hormones can lead to
abnormalities in calcium metabolism.

The tests show no abnormalities,

so, considering what you just said,
it may be a problem with ear stones.

You may have a disease called BPPV.

BPPV, or benign paroxysmal positional vertigo,

is the most common cause of vertigo, or dizziness involving a spinning sensation.

At the base of the semicircular canals are the otolith organs.

On top of the otolith organs are approximately 100,000 calcium carbonate particles

called otoliths, or ear stones.

BPPV occurs when ear stones become dislodged, often due to calcium depletion or stress,

and fall into one of the semicircular canals.

When standing, the detached ear stones remain in place and do not cause vertigo.

However, when lying down or in other positions where the inner ear is tilted for long periods,

these ear stones can roll into the semicircular canals and cause vertigo.

Normally, ear stones are broken down in about a month,

so treatment usually involves improving blood flow to the inner ear with medication.

However, if other ear stones enter the canals, the vertigo can recur intermittently.

In 2019, Kitahara proposed a new and unique method of treating this vertigo called "head-up sleep."

Patients simply sleep with their upper body raised at an angle of about 45 degrees.

Ear stones enter the canals when
you lower your head to sleep.

The key is to prevent the detached ear stones
from entering the semicircular canals.

So if you sleep with your upper body raised,
you can be freed from vertigo.

A trial on 44 BPPV patients resulted in a roughly 50-percent reduction in the severity of vertigo half a year later.

The woman who underwent the examination also experienced a sharp decline in vertigo

since she started sleeping with her head up.

It's amazing. My life has really changed.

If you sleep slightly elevated, is it good to do this generally to prevent these little crystals little stones

from migrating to the to where they shouldn't be?

If you overdo head-up sleep, you won't feel rested.

This could affect your work the next day, so
there's no need to strictly follow through with it.

But some people may have regular ear-stone trouble.

Even if they're fine now, they may
worry that the symptoms will recur.

For such people, it's good to get
head-up sleep regularly.

Although I suggest an angle of
45 degrees, it doesn't have to be exact.

But the more elevated the angle,
the more effective the method.

Dizziness that originates from the inner ear can have other causes as well.

In 2022, Soma Michiko in her 50s was suddenly struck with severe vertigo.

I was sitting on the sofa after finishing some
housework, when I suddenly felt very dizzy.

I couldn't tell which direction was
up or down, left or right.

It felt like I was spinning 360 degrees,
and I had no idea what was happening.

Soma was rushed to a hospital, where she underwent various tests, but the cause remained unclear.

She later visited several different hospitals.

However, her condition did not improve.

Previously, Soma was active.

But she became unable to walk without support.

She started shutting herself in at home.

I worried about my future, wondering
if I'd ever find the right treatment.

I didn't want to spend my life
just lying in bed or sitting around.

I felt so sad, as if I'd lost
all the things I enjoyed doing.

Two months after the symptoms started, Soma was tested at Nara Medical University Hospital.

One of the tests on her semicircular canals uncovered the cause of her symptoms.

It requires goggles, which have a camera that captures eye movements in increments of a millisecond -

something that the naked eye cannot do.

The patient is told to keep looking at a red dot in front of them.

The head is then jerked.

When the head is turned, the eyes can keep looking at the dot by moving in the opposite direction.

If the eyes move at the same timing and speed as the head,

it suggests that the semicircular canals are functioning normally.

By moving the head left and right, the examination checks the lateral canals in both ears.

A jerk in the lower-left position is used to examine the left anterior canal,

while that in the upper-right position can check the right posterior canal.

The lower right is for the right anterior canal, and the upper left is for the left posterior canal.

This test can pinpoint exactly which semicircular canal is abnormal.

This is the result for a person with healthy semicircular canals.

The lower line shows the speed of the head movements,

while the upper line represents that of the eye movements.

Because the eyes move in sync with the head, the lines form mirror images of each other.

Soma's result shows that her eye movements lagged significantly.

Her right posterior canal was found to be dysfunctional.

This indicates that her vertigo was caused by head movements in the upper-right direction.

Unfortunately, once a canal's function is lost, there's no way to restore it.

Therefore, Nara Medical University Hospital is focusing its efforts on rehabilitation.

We have patients repeat the movement
that causes their dizziness.

We want them to get used to it,
so it doesn't cause their symptoms.

Repetition is key.

Kitahara and his team believe that through rehabilitation,

the brain and eyes will learn to compensate for the disfunction of the semicircular canals.

This movement makes me dizzy,
no matter how many times I do it.

Soma worked intensively on moving her head to the upper right, a direction she had trouble with.

Before rehabilitation, I thought I shouldn't move,
because the dizziness was severe and unbearable.

By training a little hard, patients have
an easier time in their everyday lives.

That's the aim of rehabilitation.

Every patient is given support by a physical therapist for six months.

It's important that patients can do this
without coming to me for support.

In fact, you're doing very well.
You get a perfect score!

He's been encouraging and supporting me.
It has been a great help.

Soma managed to complete her six-month period of rehabilitation, raising the difficulty level in phases.

This graph shows her test results before treatment.

This one is after six months.

Before rehabilitation, her eye movements occurred much later than her head movements.

But afterward, her eye movements became more in synch with her head movements.

This is because the brain heightened its ability to supplement the eye movements,

and that helped to ease her dizziness.

10 months after she started rehabilitation, Soma can now walk without clinging to a wall.

Her condition has improved enough for her to return to her job.

She can work standing for eight hours, if necessary.

Whether I'm at home or working,
I can do things the way I want to.

I couldn't be happier now that
I can spend my days as I like.

Among the inner ear-related causes of dizziness, the second-most common one after BPPV is Meniere's disease.

What actually causes Meniere's disease?

The inner ear contains lymph. When too much of
this liquid accumulates, Meniere's disease occurs.

In the past, there was no reliable test for it.

But now, the disease can be detected by
injecting a contrast agent and taking an MRI.

Examination technology has advanced.

This MRI image shows the inner ear, circled in red.

Due to the contrast agent, it appears white when normal.

However, Meniere's disease patients have excessive secretion of lymph in their inner ear.

That prevents permeation of the contrast medium, making their inner ear appear dark.

Meniere's disease is common in women in their 30s and 40s.

Stress is believed to be a major cause.

Generally, patients are treated with medication.

In severe cases, they undergo surgery to have the lymph drained.

But if excessive lymph secretion happens again, symptoms can recur.

In 1998, Kitahara devised a unique method to enhance the healing effects of the surgery.

It involves permeating steroids into the affected area after the lymphatic fluid was removed.

In 2007, he was awarded a prize for the method from the International Society of Otologic Surgery and Science.

Professor, how successful is the surgery?

After the surgery, some people who had dizziness
every month now only have it once a year.

Some people have had no dizziness for 20 years.

In general, over 80% of people
have become free of dizziness.

That's incredible.

That's what we've seen so far.

I mean that's incredibly impressive 80% of people

who, you know, resolve their Meniere's disease because it has such a huge impact on quality of life.

Yes, that's right. It's not a life-threatening disease.

But if you can't work or travel with friends,
it will eventually affect you mentally.

Our aim is to free people of dizziness
during important periods of their lives.

Do you have any sort of a final message for people suffering from dizziness

or vertigo or perhaps Meniere's disease?

If the cause is investigated
thoroughly, it can be diagnosed.

With a diagnosis, you can get an established
treatment for your disease, so don't be afraid.

It's important to go to a hospital where you can
receive proper examination and diagnosis.

Japanese cuisine contains many nutrients that are effective against dizziness.

Let's see what sorts of food can help prevent it.

Calcium and vitamin D are helpful
in preventing ear stone-related dizziness.

This dish here is Shirasu with Tofu.

These small fish are abundant in calcium and vitamin D, which enhances the absorption of calcium.

I think you mentioned the keepings with the people who don't, for example, who are allergic to dairy and milk.

I mean tofu is a great source of calcium.

And then you have little, for example often they don't have the little white fish overseas,

but things like sesame seeds, even canned salmon with bones, canned sardines with bones, are great source of calcium.

Kitahara says eating fish is also important for other reasons as well.

The inner ear contains many very small blood
vessels, so it is important to improve blood flow.

It's key to eat foods that can achieve that.

Blue-backed fish such as sardines are rich in polyunsaturated fatty acids called DHA and EPA, which enhance blood flow.

And here they're actually served with ginger.

And ginger is another fantastic herb for circulation.

This is great with the ginger.

You can't just eat these for one to two days
and expect health benefits.

It is important to continue eating them every day.

By doing so, you can prevent
dizziness and loss of balance.

If you fall, break a bone, and become
bedridden, you could end up with dementia.

Such a negative spiral can be prevented
if you eat these types of food.

So, I highly recommend meals like these
in stress-filled, fast-aging society.

Professor Kitahara's key message to his patients is not to be excessively afraid of vertigo or dizziness,

while that maybe inevitable to the age or other reasons,

there is so many effective strategy for treatment.

And identifying the cause and right treatment is the first step in coping with it.