Dizzy triathlete-evidence supporting vestibular etiology.

Iida‐Kaisa Manninen,Timo Hirvonen,Tuomas Hyytiä,Laura K Mäkinen,Karin Blomgren,Topi Jutila,Tuomas Klockars

doi:10.1111/sms.14041

Iida‐Kaisa Manninen, Timo Hirvonen + Show 5 more

Open Access

https://doi.org/10.1111/sms.14041

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Abstract

Dizziness during or after the swimming leg is a common complaint among triathletes. We hypothesized that the dizziness is caused by asymmetrical cooling of the vestibular organ. This caloric response is characterized by involuntary eye movements called nystagmus. Altogether, 125 triathletes completed an electronic questionnaire. Fifteen triathletes who had frequently experienced dizziness during the swimming leg agreed to take part in a cold water swimming test. The test comprised two cold water swimming legs, first without earplugs and then with earplugs to prevent a potential caloric response. Eye movements and possible nystagmus were recorded immediately after the swimming legs. A majority (87%, 109/125) of athletes had experienced dizziness during triathlon races or training. Of these, almost all (97%, 106/109) experienced it during or after swimming. Dizziness affected the triathlon performance in half of the athletes with dizziness (50%, 51/102). Fifteen athletes participated in a cold water swimming test. During the first leg (without earplugs), 11/15 athletes (73%) experienced dizziness. Of these, six had nystagmus (55%), four had uncertain nystagmus (36%), and one did not have nystagmus (9%). Only one of these athletes experienced dizziness during the second leg with earplugs. The prevalence of dizziness among triathletes is notable. A large part of the dizziness is likely to be caused by caloric reaction of the vestibular organ. We recommend earplug usage for triathletes suffering from dizziness during the swimming leg.

Highlights

Triathlon is an endurance sport consisting of swimming, cycling, and running
Dizziness especially during or after the swimming leg is a common topic in various triathlete Internet forums, eg, Facebook groups
The etiology of dizziness during swimming is unknown: benign paroxysmal positional vertigo, cervicogenic dizziness, and caloric reaction have all been suggested as the cause of dizziness.2–5 In addition, motion sickness, orthostatic hypotension, and caloric reaction are common hypotheses in Internet triathlon forums

Summary

| INTRODUCTION

Triathlon is an endurance sport consisting of swimming, cycling, and running. Due to the nature of the sport, medical complaints are common during races. Dizziness comprises 20% of all medical contacts during half-or full-distance triathlon.[1] In addition, dizziness especially during or after the swimming leg is a common topic in various triathlete Internet forums, eg, Facebook groups. The etiology of dizziness during swimming is unknown: benign paroxysmal positional vertigo, cervicogenic dizziness, and caloric reaction (after mastoidectomy) have all been suggested as the cause of dizziness.2–5 In addition, motion sickness, orthostatic hypotension, and caloric reaction are common hypotheses in Internet triathlon forums. Caloric response is caused by asymmetrical warming or cooling of the external auditory canal This produces stimulation or inhibition of the same-side vestibular organ, resulting in dizziness.[6,7] Caloric response as the cause for dizziness. Our hypothesis was that earplug usage would prevent dizziness by obviating the caloric reaction

| MATERIALS AND METHODS

| RESULTS

Findings

| DISCUSSION