Dizziness

Feeling Dizzy?

Dizziness is a symptom, not a disease. It is a warning signal sent by the body to tell us that something is not functioning properly. Dizziness is defined as a disorientation in space, a sense of unsteadiness, a feeling of movement within the head such as giddiness or a swimming sensation, lightheadedness or a whirling sensation known as vertigo.

For the body to feel balanced, the brain requires input from the inner ear, eyes, muscles and joints. Since mechanisms for maintaining balance are so complex, finding the exact cause of dizziness is often difficult and requires input from several medical specialties. Dizziness can result from problems associated with the inner ear, brain or heart.

Dizziness accounts for 10 million visits to U.S. office-based physicians annually and is the third most common reason for seeing a primary care physician. Dizziness is generally not serious, however, it can be the only sign preceding a major stroke. Inner ear disorders account for the majority of balance problems.

Disorders of the Inner Ear

Meniere’s Disease

• This is a problem associated with the fluid balance regulating system in the ear and usually only occurs in one ear.
• The symptoms are tinnitus (ringing in the ear), muffled or distorted hearing, hearing loss and severe attacks of vertigo accompanied by nausea and vomiting.
• Attacks are usually sudden in onset and last from 20 minutes to 24 hours.
• Medical vertigo treatment includes a low-salt diet, a diuretic (water pill) and possible injections of medications into the ear drum or oral medications to combat the nausea.
• Surgery is recommended only if medical treatment is not successful.

Benign Positional Vertigo

• Benign positional vertigo results from damage to the delicate sensory units of the balance portion of the inner ear.
• Symptoms of BPV include a spinning sensation or lightheadedness brought on by changes in head and body position. Nausea may also occur, but hearing loss or tinnitus is not associated with this condition.
• Medication usually is prescribed to relieve symptoms of dizziness and nausea.
• People with BPV achieve total recovery by applying certain balance maneuvers in the office, or by practicing home-based vestibular rehabilitation.

Vestibular Neuritis (Labyrinthitis)

• This condition is caused by the inflammation of the nerve cells in the balance portion of the inner ear.
• The primary symptom is sudden onset of sustained vertigo, which lasts from one to seven days. In most cases, this condition is associated with a viral respiratory infection like the flu or pneumonia.
• Treatment includes medication (orally and sometimes through the ear drum) to relieve symptoms of dizziness and nausea. Surgery is rarely indicated. Significant recovery is achieved after six to eight weeks of home-based balance rehabilitation.

Acoustic Neuroma

• This is a benign tumor that most commonly grows on the balance nerve.
• Tinnitus is usually the first symptom, after which gradual hearing loss may be experienced. Vertigo is usually not present.
• Acoustic neuroma surgery, which involves removal of the tumor, is the recommended treatment.

Autoimmune Inner Ear Disease

• Similar to Meniere’s Disease, this disorder presents with sudden hearing loss in one or both ears.
• This disorder is more common in people with other autoimmune diseases like lupus or arthritis.
• Medical treatment includes tapered steroid therapy over one to two months and is most effective with early diagnosis if the patient is treated within the first few weeks of diagnosis.

Perilymph Fistula

• This disorder may occur after a sudden change in barometric pressure, such as that experienced in airplane landings, scuba diving or a major head injury. The change in pressure can cause a rupture in one of the membranes that separate the middle and inner ear, thus allowing inner ear fluid to escape into the middle ear.
• Symptoms include hearing loss, vertigo or lightheadedness, and ear pressure. Tinnitus also may occur.
• In most cases, the rupture will heal on its own. If it does not heal, surgery may be required.

Dizziness Due to Aging

• As a person grows older, changes occur that affect hearing as well as the system that maintains balance. Forty percent of patients over 60 years old have experienced dizziness severe enough to affect their daily activities.
• The most common symptoms associated with dizziness due to aging include lightheadedness, a spinning sensation, giddiness, wooziness or unsteadiness that occurs when quickly turning or changing positions. One may also sway or veer from side to side when walking.
• Here are a few suggestions that may minimize age-related dizziness:
  1. When getting up in the morning, sit on the edge of the bed for several minutes before standing.
  2. Change positions or turn slowly and have something nearby to hold onto.
  3. Never walk in the dark. Use a night light or turn on the light before entering a dark room.
  4. Use a cane or walker for more severe walking problems. Walking and exercising help to maintain good balance.
  5. Keep other medical conditions under control by taking prescribed medications and/or following any prescribed diet.
  6. If recommended, take advantage of a home-based balance rehabilitation program.

If you are feeling dizzy

If you are feeling dizzy, it is important to see your physician for a thorough evaluation. Included in this evaluation should be:

• A complete medical history
• An audiogram (basic hearing test) and other specialized speech and hearing tests.
• An electronystagmogram or ENG (balance test)
• Two additional and specialized balance tests, rotating chair and posturography.

Depending on what these tests reveal, your physician may recommend a CAT scan (x-ray) or MRI (magnetic resonance imaging). Blood tests to evaluate thyroid function and the immune system also may be recommended, as well as physical therapy evaluation and rehabilitation.

This information is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient.