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Balance, Dizziness and Vertigo

Dizziness and Vertigo

Overview:

Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady. Dizziness that creates the false sense that you or your surroundings are spinning or moving is called vertigo.

Dizziness is one of the more common reasons adults visit their doctors. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition.

Treatment of dizziness depends on the cause and your symptoms. It's usually effective, but the problem may recur.

Symptoms:

People experiencing dizziness may describe it as any of a number of sensations, such as:

  • A false sense of motion or spinning (vertigo)
  • Light-headedness or feeling faint
  • Unsteadiness or a loss of balance
  • A feeling of floating, wooziness or heavy-headedness

These feelings may be triggered or worsened by walking, standing up or moving your head. Your dizziness may have accompanied by nausea or be so sudden or severe that you need to sit or lie down. The episode may last seconds or days and may recur.

Inner ear and balance:

Dizziness has many possible causes, including inner ear disturbance, motion sickness and medication effects. Sometimes it's caused by an underlying health condition, such as poor circulation, infection or injury.

The way dizziness makes you feel and your triggers provide clues for possible causes. How long the dizziness lasts and any other symptoms you have also help pinpoint the cause.

Inner ear problems that cause dizziness (vertigo):

Your sense of balance depends on the combined input from the various parts of your sensory system. These include your:

  • Eyes, which help you determine where your body is in space and how it's moving
  • Sensory nerves, which send messages to your brain about body movements and positions
  • Inner ear, which houses sensors that help detect gravity and back-and-forth motion

Vertigo is the false sense that your surroundings are spinning or moving. With inner ear disorders, your brain receives signals from the inner ear that aren't consistent with what your eyes and sensory nerves are receiving. Vertigo is what results as your brain works to sort out the confusion.

  • Benign paroxysmal positional vertigo (BPPV). This condition causes an intense and brief but false sense that you're spinning or moving. These episodes are triggered by a rapid change in head movement, such as when you turn over in bed, sit up or experience a blow to the head. BPPV is the most common cause of vertigo.
  • Infection. A viral infection of the vestibular nerve, called vestibular neuritis, can cause intense, constant vertigo. If you also have sudden hearing loss, you may have labyrinthitis.
  • Meniere's disease. This disease involves the excessive build-up of fluid in your inner ear. It's characterized by sudden episodes of vertigo lasting as long as several hours. You may also experience fluctuating hearing loss, ringing in the ear and the feeling of a plugged ear.
  • Migraine. People who experience migraines may have episodes of vertigo or other types of dizziness even when they're not having a severe headache. Such vertigo episodes can last minutes to hours and may be associated with headache as well as light and noise sensitivity.

Circulation problems that cause dizziness: 

You may feel dizzy, faint or off balance if your heart isn't pumping enough blood to your brain. Causes include:

Drop in blood pressure. A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in brief lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly. This condition is also called orthostatic hypotension.

Poor blood circulation. Conditions such as cardiomyopathy, heart attack, heart arrhythmia and transient ischemic attack could cause dizziness. And a decrease in blood volume may cause inadequate blood flow to your brain or inner ear.

Other causes of dizziness:

  • Neurological conditions. Some neurological disorders — such as Parkinson's disease and multiple sclerosis — can lead to progressive loss of balance.
  • Medications. Dizziness can be a side effect of certain medications — such as anti-seizure drugs, antidepressants, sedatives and tranquilizers. In particular, blood pressure lowering medications may cause faintness if they lower your blood pressure too much.
  • Anxiety disorders. Certain anxiety disorders may cause light-headedness or a woozy feeling often referred to as dizziness. These include panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia).
  • Low iron levels (anaemia). Other signs and symptoms that may occur along with dizziness if you have anaemia include fatigue, weakness and pale skin.
  • Low blood sugar (hypoglycaemia). This condition generally occurs in people with diabetes who use insulin. Dizziness (light-headedness) may be accompanied by sweating and anxiety.
  • Overheating and dehydration. If you're active in hot weather, or if you don't drink enough fluids, you may feel dizzy from overheating (hyperthermia) or from dehydration. This is especially true if you take certain heart medications.

Risk factors:

Factors that may increase your risk of getting dizzy include:

  • Age. Older adults are more likely to have medical conditions that cause dizziness, especially a sense of imbalance. They're also more likely to take medications that can cause dizziness.
  • A past episode of dizziness. If you've experienced dizziness before, you're more likely to get dizzy in the future.

Complications: 

Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident. You may also experience long-term consequences if an existing health condition that may be causing your dizziness goes untreated.

Evaluating dizziness: 

Because the inner ear is the most common cause of dizziness, the first place to start with an evaluation is often a hearing test. The cochlea, our hearing organ, is contained within the same bony structure as the balance organ. A behavioural hearing test in a sound booth may be followed by an Auditory Brainstem Response (ABR) test. An ABR test non-invasively records brainstem responses to sound stimuli. The brain waves are collected while you rest comfortably with your eyes closed. The presence or absence of hearing loss or auditory brainstem anomalies will provide clues to the audiologist about the cause of your symptoms.

Get help if you notice these symptoms: Spinning or whirling, unsteadiness, disorientation, light-headedness, ringing in the ears, or hearing loss.

Another common test for balance is VNG, or video nystagmography. Usually performed by an ENT physician or an audiologist, a VNG test uses video cameras to record eye movements while a patient tracks a visual stimulus, is moved into different positions and while the ear canals are stimulated with warm and cool air or water. This test gives a broad picture of whether the underlying issue is related to the inner ear or not.

Other tests to evaluate dizziness may be performed by a physical therapist, cardiologist or neurologist. As there are many systems involved in balance, there are many possible underlying causes for dizziness and many medical specialties that may be involved. A very common cause of dizziness that is often overlooked is the interaction of multiple prescription and/or over-the-counter medications. If you have recently changed or added a prescription to your daily routine, be sure to ask your physician about the possibility of dizziness as a side-effect.

Treatments for dizziness:

Appropriate treatment for dizzy symptoms will depend on the underlying cause, so it is important that you see a physician for any of these symptoms. A physician might prescribe something to mitigate the dizzy symptoms temporarily but that medication must be discontinued at least 24 hours prior to an evaluation.

When the cause of the dizziness is determined and treated, the symptom will often go away. For BPPV, dizziness can be treated by a head positioning manoeuvre. In the case of medical conditions, like allergies, thyroid deficiency and diabetes, regulation of the condition will eliminate the dizziness. Many disorders can be treated with medication, surgery, diet, lifestyle changes or some combination of these. There are also physical therapists who specialize in vestibular rehabilitation, which is a treatment for balance disorders that gradually retrains the brain to compensate for lost sensory input from the balance system.