FOR MORE THAN TWENTY YEARS, Dallas radio personality Kevin McCarthy has made a respectable living simply by being in a good mood—and by rubbing it off on the rest of us. The 46-year-old KLIF-AM morning talk show host is perpetually sunny, the sort of person who’s difficult even to imagine sick. So when he came down with a debilitating illness in early l994, friends like me were not only sympathetic but also a little shocked, especially when we found out what ailed him. Thankfully, it wasn’t anything terminal; some might not even have called it serious. But it definitely was mysterious: Kevin had a bad case of vertigo.
Vertigo is one of those conditions with which most of us can claim only a passing familiarity. Something about dizziness and the sensation of falling from extreme heights. Heckuva Hitchcock thriller of the same name. Actually, vertigo—the word literally means “the hallucination of motion”—is the most dramatic of a family of infirmities involving the body’s equilibrium system. Some 20 million Americans suffer from balance disorders, which cause, among other things, about 200,000 hip fractures a year.
A sense of disequilibrium can be a secondary symptom of many other afflictions—hypertension, anxiety, eyesight problems—but can also be caused by a disruption of the normal operation of the inner ear, the tiny and exquisite set of organs within the temporal bone of the cranium that keeps our heads on straight. The inner ear has two main parts: the cochlea, which translates airborne sound waves from the middle ear into fluid-borne waves of energy, then transduces those waves into electrical impulses so sound can be interpreted; and the vestibular system, three fluid-filled semicircular canals that are responsible for our innate sense of balance. Because these structures are so minute, it is often difficult if not impossible to diagnose precisely how and where the inner ear might be affected.
The best known of the balance disorders is pure vertigo, the feeling that the room is spinning even when you’re standing perfectly still; it can be caused by an inflammation (a virus or other infection) or a structural defect (a tumor, an abscess, a traumatic injury) in the inner ear. My wife had a nasty case about a year ago, the result of an inner ear virus that shorted out her equilibrium system. Though she was laid up for about a week with acute nausea, the condition eventually passed and is not likely to recur.
Other disorders, however, are subtler, more chronic, and ultimately more insidious. Kevin McCarthy found that out the hard way during a drive home up the Dallas North Tollway on Saint Patrick’s Day 1994. “I felt just slightly dizzy,” he recalls, “like when you step off a ship onto firm ground. I was dissociated, and I had heart palpitations—it was like an out-of-body experience.” When he got home later that day, the sensation abated, but it returned a few days later with more intensity. After that it began to reoccur frequently, particularly when he had no visual frame of reference (say, whenever he drove on a freeway overpass). Eventually the attacks caused him to be so unsteady afoot that he had to stabilize himself on the nearest wall. That begat sometimes fierce bouts of nausea, which only heightened his anxiety.
Fearing a serious problem with his nervous system, Kevin visited a neurologist, who pronounced him sound after a high-tech exam. But the episodes continued, so he went to see an ear, nose, and throat specialist. The specialist concluded that Kevin was probably suffering from an inner ear virus and that, like my wife, he would have to wait it out. In the meantime, he gave Kevin a small dose of Valium to calm him down.
The Valium helped some, but the attacks of dizziness and nausea didn’t entirely relent—and they were beginning to take a toll on Kevin’s day-to-day life. Some days he just couldn’t get out of bed. The drive from his home in far north Dallas to KLIF’s studio near downtown was torturous. Occasionally, the vomiting was so bad that he would have to be hospitalized. He couldn’t decide whether it was better to be a little sick all the time or very sick when he least expected it. “I was sick of being sick,” he says. He was also sick from being sick. He began to lose the hearing in one ear. The vomiting had severely irritated his esophagus, forcing him to take acid inhibitors. And he grew so depressed that he went on Prozac. “All of which can have the side effect of making you dizzy and nauseous,” Kevin notes dryly.
By the end of spring—three months after the first attack—he’d had enough of waiting the alleged virus out and paid a visit to otolaryngologist William Meyerhoff, an internationally known expert in balance disorders at the University of Texas Southwestern Medical Center at Dallas. Meyerhoff put Kevin through even more tests and took an extensive medical history, hoping to find a head trauma or something similar that might have sufficiently disturbed his equilibrium. He suspected the problem was perilymph fistula, a tiny structural defect of the membrane that separates the middle and inner ear; it results in a damaging exchange of fluid between the two chambers and, consequently, the sort of disequilibrium that plagued Kevin.
Meyerhoff’s hunch was confirmed when Kevin’s evaluation was completed. The results of his magnetic resonance imaging showed an absence of disease and no larger structural defect. He had a hearing loss of the high and low frequencies only—a peculiar symptom of perilymph fistula. A highly refined test that measures the electrical impulses produced by the cochlea revealed the distinctive pattern of an inner ear suffering a fistular defect. Also, after much prompting, Kevin remembered falling in his kitchen a few years before. The impact had been strong enough to knock him out, which made it more than forceful enough to cause a crack in his delicate inner ear tissue. “One of the key parts of this diagnosis is that