Jarred Cosart injury: Explaining the inner ear vertigo conditions

The Miami Marlins have had a world of problems with injuries, especially to the stating rotation. One of the players who was hurt all season long essentially was Jarred Cosart, the player the Marlins acquired in last season's ugly Colin Moran trade. It was bad enough that the Marlins fell for Cosart's intriguing ERA but terrible peripheral numbers. It was much worse that the righty starter subsequently suffered acute onset of vertigo that has kept him out of the majors essentially since late June.

The Fish have sent Cosart around to various doctors and they think they have found a cause for his issues with vertigo.

The inner-ear disorder is causing a nerve on his right side to be less response than his left side. The impacted nerve, Cosart says, affects "balance and gravity."

Being able to pinpoint the issue has been a relief for the Texas native, who is confident his recovery shouldn't be a long process.

It is possible that Cosart has been dealing with this issue all season long.

Initially, when we first heard of these issues, I had presumed that Cosart had acute labyrinthitis secondary to vestibular neuritis, which is an inner ear inflammation of the eighth cranial nerve. The eight nerve, called the vestibulocochlear nerve, which is the nerve that controls both hearing and balance. Those two things are tightly associated, and a minor viral illness of the sinuses or upper respiratory tract can slither its way into the ear and affect the nerve. Had that been the case, it would have taken only at most a few weeks to recover.

However, after his two-week stay on the disabled list, Cosart then "relapsed" and continued to feel symptoms. This makes things feel a little more chronic than a simple viral infection. This indication that he could have been dealing with it the entire year also points to a more chronic cause. Longer-lasting causes of vertigo include things like Meniere's disease or vestibular Schwanoma. At this point, I am presuming the Marlins have considered an MRI of the brain or that Cosart has not complained about other things such as headaches that could lead to the diagnosis of Schwanoma, which is a tumor of the nerve cells in the eighth nerve that could be causing pressing of the nerve.

At this point, I am presuming the diagnosis the doctors found is likely Meniere's disease. Meniere's disease is an idiopathic, or not-explained, cause of vertigo that leads to an increase fluid buildup in the inner ear, where the nerve hangs out. That fluid presses up on the nerve and causes both hearing symptoms like ringing in the ears or hearing loss and vertigo. I have not heard any complaints of hearing issues from Cosart, but clearly those would be secondary to the dizziness that would affect his game. The symptoms are periodic or episodic, so it is not as though Cosart's world is spinning at all times, but if anything occurs during a game, you can see how that would be concerning for a pitcher who needs to locate to be successful.

Finding a diagnosis, unfortunately, is not a guarantee to provide relief. Meniere's disease is a chronic recurrent disease with "spells" occurring off and on. Over time, the disease is said to stabilize on its own, but it could leave the patient with more permanent hearing impairment or balance issues. If it does not recover or stay stable on its own, it usually is manageable with medications. Medications that force fluid out of the body, called diuretics, are often used every day to prevent exacerbation of symptoms. Dietary and lifestyle changes can also help prevent symptoms. When symptomatic, patients can take benzodiazepenes, a form of anxiety medication, to control symptoms. However, these things may not ever fully go away.

The consequences of this are not too bad for Cosart if he can keep symptoms under control, but thus far he has spent more than a month away from the majors for the same problem. If the dizzy spells are bad enough that he cannot pitch through them, that would be yet another strike on another awful trade by the Marlins' brass. The Fish cannot afford to keep losing players to chronic injuries, and given their investment in Cosart, they really need to find a way to control his symptoms if this keeps happening. Cosart has looked awful through nine starts in 2015, and Miami is hopeful they can curb this problem and get another piece back into the fold.