Why do I feel so dizzy all the time?
Dr Martin Scurr has been treating patients for more than 30 years and is one of the country's leading GPs. Here he tackles dizziness...
Do you have any information on labyrinthitis? Having been struck down by it out of the blue and prescribed seasickness tablets on the assurance that time will cure it, a few facts on why and how it occurs would be very reassuring! Corinne Lovell, Ringwood, Hampshire.
Dr Scurr says... Labyrinthitis is the term used for symptoms caused by a problem in the labyrinth, which forms part of the inner ear and plays a vital role in controlling your balance and posture - so when it's faulty, you may suffer a disabling sense of dizziness.
This is not the same as the dizziness you experience when feeling faint. It's more like a staggering unsteadiness, which can also cause nausea - like having seasickness on dry land.
Because this sensation can last for days, if not weeks, it can be very destructive to everyday life, so it's important to work out exactly what has caused it so you can deal with it.
Labyrinthitis is a cause of dizziness, like a staggering unsteadiness, which can also cause nausea
The labyrinth is a set of three fluid-filled tubes - or canals. While these deal with balance, the other part of the inner ear, the cochlea, deals with hearing.
Doctors use the word labyrinthitis as a general way of saying - something has upset the balance mechanism. The most common causes are self limiting, which means they will go away without any medical intervention and are not serious.
The first and most common is benign positional vertigo. In this condition, brief episodes of sudden giddiness occur, as if the whole world is going round.
For example, you might be in bed and roll over to turn on the light, or turn round to reach for the seat-belt in the car, and then it happens. These bouts never last more than about a minute, but keep happening with head movements.
This is the only symptom and patients usually recover without treatment within days or weeks (although many doctors prescribe anti-motion sickness drugs). The problem occurs when crystals form in the canal fluid; as you move your head, these crystals tumble about, causing the sensation.
We don't know why these crystals form, although special exercises taught by a physiotherapist can get rid of them.
The second and less common form of labyrinthitis is Meniere's disease. This occurs as a result of changes in pressure in the canal fluid, causing dizziness, hearing loss and tinnitus (a ringing or buzzing in the ear).
Again, the reason for these pressure changes is not known. The attack should settle within a week or two - but drugs can be helpful in relieving the symptoms, especially nausea.
Other, rarer causes of dizziness include vestibular neuronitis, a virus infection of the nerves supplying the labyrinth; you'll also experience a severe cold or flu-like symptoms, but the condition usually resolves as the other symptoms such as cough and temperature also subside.
An even more unusual condition is called purulent labyrinthitis, a bacterial infection of the inner ear - now rare since the ready use of antibiotics for middle-ear infections. Patients who have this are very ill indeed.
It's most likely you have had benign positional vertigo - although described by your GP as labyrinthitis. I hope these descriptions help you to tolerate it and be safe in the knowledge that it will, eventually, go away.
What do you think about colonic irrigation? I had it done recently and have been advised to keep having it on a regular basis - is this necessary? I'm not constipated and don't seem to suffer from digestive problems, but I did feel much better afterwards. (I am 27 and in good health.) Shelley Davidson, London.
Dr Scurr says... My opinion is that colonic irrigation is nature's way of telling you that you have too much money to spend. And most of my colleagues share that view.
Colonic irrigation - essentially cleaning out the colon - is an alternative therapy that appears to be based upon the notion that there are toxic waste products sitting in our large intestine.
The argument is that washing out these substances helps with a range of conditions, including migraine, irritable bowel syndrome, allergies, and other long-term illnesses.
However, there is no evidence that this process does any good at all, and, in fact, can be harmful.
I have seen, within the past five years, a patient who had to be admitted to hospital for emergency treatment following rupture of the large intestine during a colonic irrigation procedure.
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The patient had developed acute peritonitis, an infection of the abdominal cavity due to intestinal contents leaking out through the breach in the wall.
Such an infection can be fatal. In my patient, the symptoms of severe pain and high temperature started within hours of the so-called treatment, and neither the specialist who cared for her, nor I, were surprised we had seen such an episode.
This is because the large intestine, or colon, is a delicately balanced and well-adjusted part of the digestive tract.
The colon's task is to store faeces until it is appropriate to dispose of the waste, and to re-absorb water - no actual digestive processes take place in the colon. We meddle with the function of this at our peril.
In the Seventies, there was a vogue for vaginal douching but this soon disappeared when it became known that regular practice gave women abnormally high levels of vaginal infections.
This was because they were washing out friendly, protective bacteria. It may well be just the same with colonic irrigation.
If you feel better after the enema session, it is probably because of the placebo effect. After all, as you have said, you do not have any digestive problems.
Edzard Ernst, the first professor of complementary medicine in the UK, has told us that colonic irrigation is unpleasant, ineffective and dangerous. I agree, and if it ain't broke, then don't fix it.
By the way...
Should dermatologists have to wear surgical gowns? Admittedly, it's not a question that's likely to pop into the layman's mind - but maybe it should.
A friend who works as a hospital dermatologist (a skin specialist) has been told that she and her colleagues must now wear surgical scrubs as their daily uniform.
They already did, of course, when they were operating in theatre, but most of dermatology is an office job. Yet they're still expected to be 'gowned up' every day.
You may well think that all of this makes sense in an era of concern about hospital-acquired infections. If this really is about cleanliness, then wearing scrubs will make little difference if the patients themselves have been sitting in waiting rooms in their street clothes.
And where are the changing rooms? My colleague is expected to change from her normal clothing once she arrives in her consulting room - hardly good sense as she will have carried all the microbes from the outside world into the room with her clothes anyway.
What about those who cycle to work? Any chance of a shower before changing into scrubs? No, sir.
Not only are we in an era of worry about resistant infections but we are also in an era of evidence-based medicine - making clinical decisions on the basis of the best available evidence about effectiveness.
So where is the evidence that dermatologists working in normal 'street' clothes cause more infections in their patients than those working in freshly laundered scrubs? There is none.
Maybe it is time managers, too, practised a bit of evidence-based decision-making.