Dizziness is defined as feelings of unsteadiness, wooziness, and lightheadedness; and sensations of moving, spinning, floating, swaying, tilting, or whirling (sensations known as vertigo). These sensations occur even when standing still or lying down.
More than 4 out of 10 people experience an episode of dizziness significant enough to send them to a doctor. Dizziness changes your sense of balance and can increase your risk of falling.
What causes dizziness?
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 is generally not serious. However, it may be the result from problems associated with the inner ear, brain, or heart. It can also be the result of medications.
One of the most common causes of dizziness is inner ear disorders. These disorders include:
General location of inner ear disorders.
Semicircular canals: Benign positional vertigo.
Vestibular nerve: vestibular neuritis and acoustic neuroma.
- Meniere’s syndrome -- This syndrome is associated with the fluid balance-regulating system in the ear. Meniere’s syndrome usually only occurs in one ear. Symptoms include episodic attacks of tinnitus (ringing in the ear), ear fullness, muffled or distorted hearing, hearing loss, and severe attacks of vertigo together with nausea and vomiting. Attacks usually happen suddenly and last from 20 minutes to 24 hours. Treatment methods include changes in diet (eg, following a low-salt diet and limiting the use of alcohol and caffeine), changes in medications, and quitting smoking. Anti-nausea and anti-vertigo medications are other treatments. An injection of a steroid or of gentamicin (an antibiotic) directly into the ear is another treatment method. Surgery may be recommended if medical treatment is not successful.
- Benign paroxysmal positional vertigo -- Benign paroxysmal positional vertigo (BPPV) results from damage to the delicate sensory units of the balance portion of the inner ear. Symptoms of BPPV include a spinning sensation, dizziness, a sense of imbalance, and lightheadedness brought on by changes in head and body position, such as tipping the head backward. Nausea may also occur, but hearing loss or tinnitus is not associated with this condition. Vertigo can vary in intensity from mild to severe and usually lasts only a few minutes. A series of simple, in-office head and body repositioning maneuvers can result in a full recovery.
- Vestibular neuritis (labyrinthitis) -- This condition is caused by the inflammation of the nerve cells in the inner ear that control balance. The main symptom is sudden occurrence of vertigo, which lasts from one to seven days. In most cases, this condition is caused by a viral respiratory infection like the flu. Treatments include medications to relieve the symptoms of nausea and dizziness. Significant recovery is achieved after six to eight weeks of a balance rehabilitation program. Surgery is rarely needed.
- Acoustic neuroma -- This is a benign tumor that most commonly grows on the nerve in the inner ear that controls balance. Tinnitus is usually the first symptom, after which gradual hearing loss may occur. Vertigo is usually not present. You and your physician can discuss treatment options.
Other causes of dizziness
Medications are a common source of dizziness. The medicines can include drugs to treat seizure disorders (eg, carbamazepine, phenytoin), drugs to help calm or sleep (sedating drugs/antidepressants), and even drugs used to treat inner ear infections (eg, gentamicin, streptomycin).
Alcohol consumption is another cause of dizziness.
Tips to reduce falls include:
- Sit on the edge of the bed for several minutes in the morning before standing up.
- Change positions or turn slowly and have something nearby to hold onto.
- Never walk in the dark. Keep walkways well lit. Install night lights in all rooms. Always turn on a light before entering a dark room.
- Keep medical conditions under control by taking prescribed medications and/or following a prescribed diet.
- Learn and practice exercises that can improve balance, such as Tai Chi or yoga.
- Use a cane or walker for more severe walking problems.
- Wear low-heeled shoes, walking shoes, or other flexible shoes with good traction.
- Install hand grips in baths and showers.
- Always use handrails when walking up and down stairs.
- Remove home hazards such as floor throw rugs, loose electrical cords, stools or other small pieces of furniture that can trip people, and all other floor clutter.
- Ask your primary care doctor to refer you to a vestibular rehabilitation program. These individualized balance-retraining exercise programs teach ways to decrease dizziness, improve balance, and improve overall ability to perform activities of daily living.
- If you have dizziness or vertigo, avoid activities such as driving until your doctor gives you approval. Also, avoid any heights, such as climbing a ladder, as they can put you in danger.
When should I see my doctor?
If you are feeling dizzy, it is important to see your primary care doctor for a thorough exam.
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