Dizziness and Vertigo
Basics
While the word "dizziness" is often used to describe a feeling of faintness or loss of balance, true dizziness, or vertigo, is a false sensation that you or your environment are moving or spinning. The classic case of vertigo involves being in a high place and feeling like you are falling when you are not. A person suffering a bout of vertigo might also perceive that his surroundings are spinning —as if on a merry–go–round — even though he or she is stationary. Nausea and vomiting can accompany vertigo, which may last as little as a few moments or as long as a few days. Complaints of "dizziness" usually are not vertigo.
Dizziness is one of the top reasons that Americans go to their doctors, and is responsible for more than 5 million physician visits every year.
Causes
During vertigo, the sensory organs that control balance and spatial orientation — usually those situated in the inner ear — send confusing signals to the brain [Figure 1].
Abnormalities in the inner ear, in the nerves that connect it to the brain, or in the brain itself may be responsible for vertigo. The most common cause of vertigo is labyrinthitis, a viral or bacterial infection of the system of fluid–filled tubes and sacs that make up the inner ear (labyrinth). Conditions that affect the inner ear, such as Meniere's disease and benign paroxysmal positional vertigo (BPPV), are other possible causes. In Meniere's disease, swelling in the ear canal damages hair cells that respond to motion. In BPPV, debrisin the ear canal interferes with spatial orientation.
Brain infections, tumors, head trauma, and seizures can all bring on vertigo. Blood flow interruptions to the ear or brain (such as those that occur during a transient ischemic attack or mini–stroke) sometimes cause vertigo.
Certain drugs can induce vertigo Table 01. Alcohol and the antibiotics streptomycin and gentamycin have been known to damage the inner ear. People taking diuretics and other medications that lower blood pressure sometimes get vertigo when they stand up too quickly. Drugs used for depression, anxiety disorders, and psychosis — as well as the conditions themselves — may also provoke an attack.
Table 1. Drugs That Can Cause Dizziness
| Drug class |
|---|
| Aminoglycosides |
| Antihypertensive, diuretic, or dopaminergic agents |
| Vasodilators |
| Phenothiazines |
| Tranquilizers, antidepressants |
| Anticonvulsants |
| Hypnotics |
| Analgesics |
| Alcohol |
| Caffeine |
| Tobacco products |
Motion sickness is a fairly common cause of vertigo. Some people are sensitive to the rocking on a boat (seasickness), as the inner ear's equilibrium mechanisms may have trouble adjusting to unfamiliar head movements. With car sickness, the eyes and ears send conflicting messages to the brain. Both can cause a nauseating, whirling sensation that leads to vomiting.
Symptoms
A person's specific symptoms will indicate if the vertigo originates in the inner ear or brain, or if it is caused by another problem Table 02.
Hearing loss, ringing in the ear (tinnitus), nausea, and vomiting all indicate that an inner ear problem is causing vertigo. With Meniere's disease, for example, vertigo comes on suddenly, and is accompanied by tinnitus and hearing impairment. Bouts last for a few minutes to a few hours, and often include nausea and vomiting. Vertigo strikes suddenly in labyrinthitis as well, and gets progressively worse as the hours go by. Stomach upset is common, and the vertigo typically worsens with head movement. BPPV is triggered by changes in head position. For example, getting out of bed or bending over may trigger it.
Headaches, loss of coordination, slurred speech, impaired vision, and weakness in an arm or leg suggest that vertigo is brain–based.
Faintness or light–headedness might indicate a circulation problem. If circulation problems are the cause, the vertigo will worsen with standing, and will improve with reclining.
Confusion and panic — or a general "foggy" feeling — may indicate that the cause is psychiatric in nature.
Table 2. What Symptoms Reveal
| Symptom | Source | Possible cause(s) |
|---|---|---|
| Spinning | Inner ear | Infection, nerve inflammation, benign paroxysmal positional vertigo, Meniere's disease, motion sickness |
| Faintness | Cardiovascular system | Transient disturbance in brain function caused by lack of blood flow and oxygen to the brain due to low blood pressure |
| Confusion | Psychiatric disorder | Depression, anxiety disorders, psychosis |
| Off balance | Central nervous system | Mini-stroke effecting the balance centers in the brain,head injury, multiple sclerosis, infection causing nerve compression, brain tumors |
Figure 01. The Inner Ear
Risk Factors
Although dizziness affects people of all ages, it tends to be most problematic for older adults. About 20% of sufferers over the age of 60 report that dizziness interferes with their daily lives. BPPV is a frequent complaint among the elderly, while labyrinthitis and motion sickness plague people in every age group.
Diagnosis
While the word "dizziness" is often used to describe a feeling of faintness or loss of balance, true dizziness, or vertigo, is a false sensation that you or your environment are moving or spinning. The classic case of vertigo involves being in a high place and feeling like you are falling when you are not. A person suffering a bout of vertigo might also perceive that his surroundings are spinning —as if on a merry–go–round — even though he or she is stationary. Nausea and vomiting can accompany vertigo, which may last as little as a few moments or as long as a few days. Complaints of "dizziness" usually are not vertigo.
Dizziness is one of the top reasons that Americans go to their doctors, and is responsible for more than 5 million physician visits every year.
During vertigo, the sensory organs that control balance and spatial orientation — usually those situated in the inner ear — send confusing signals to the brain Figure 01.
Abnormalities in the inner ear, in the nerves that connect it to the brain, or in the brain itself may be responsible for vertigo. The most common cause of vertigo is labyrinthitis, a viral or bacterial infection of the system of fluid–filled tubes and sacs that make up the inner ear (labyrinth). Conditions that affect the inner ear, such as Meniere's disease and benign paroxysmal positional vertigo (BPPV), are other possible causes. In Meniere's disease, swelling in the ear canal damages hair cells that respond to motion. In BPPV, debrisin the ear canal interferes with spatial orientation.
Brain infections, tumors, head trauma, and seizures can all bring on vertigo. Blood flow interruptions to the ear or brain (such as those that occur during a transient ischemic attack or mini–stroke) sometimes cause vertigo.
Certain drugs can induce vertigo Table 01. Alcohol and the antibiotics streptomycin and gentamycin have been known to damage the inner ear. People taking diuretics and other medications that lower blood pressure sometimes get vertigo when they stand up too quickly. Drugs used for depression, anxiety disorders, and psychosis — as well as the conditions themselves — may also provoke an attack.
Table 1. Drugs That Can Cause Dizziness
| Drug class |
|---|
| Aminoglycosides |
| Antihypertensive, diuretic, or dopaminergic agents |
| Vasodilators |
| Phenothiazines |
| Tranquilizers, antidepressants |
| Anticonvulsants |
| Hypnotics |
| Analgesics |
| Alcohol |
| Caffeine |
| Tobacco products |
Motion sickness is a fairly common cause of vertigo. Some people are sensitive to the rocking on a boat (seasickness), as the inner ear's equilibrium mechanisms may have trouble adjusting to unfamiliar head movements. With car sickness, the eyes and ears send conflicting messages to the brain. Both can cause a nauseating, whirling sensation that leads to vomiting.
A person's specific symptoms will indicate if the vertigo originates in the inner ear or brain, or if it is caused by another problem Table 02.
Hearing loss, ringing in the ear (tinnitus), nausea, and vomiting all indicate that an inner ear problem is causing vertigo. With Meniere's disease, for example, vertigo comes on suddenly, and is accompanied by tinnitus and hearing impairment. Bouts last for a few minutes to a few hours, and often include nausea and vomiting. Vertigo strikes suddenly in labyrinthitis as well, and gets progressively worse as the hours go by. Stomach upset is common, and the vertigo typically worsens with head movement. BPPV is triggered by changes in head position. For example, getting out of bed or bending over may trigger it.
Headaches, loss of coordination, slurred speech, impaired vision, and weakness in an arm or leg suggest that vertigo is brain–based.
Faintness or light–headedness might indicate a circulation problem. If circulation problems are the cause, the vertigo will worsen with standing, and will improve with reclining.
Confusion and panic — or a general "foggy" feeling — may indicate that the cause is psychiatric in nature.
Table 2. What Symptoms Reveal
| Symptom | Source | Possible cause(s) |
|---|---|---|
| Spinning | Inner ear | Infection, nerve inflammation, benign paroxysmal positional vertigo, Meniere's disease, motion sickness |
| Faintness | Cardiovascular system | Transient disturbance in brain function caused by lack of blood flow and oxygen to the brain due to low blood pressure |
| Confusion | Psychiatric disorder | Depression, anxiety disorders, psychosis |
| Off balance | Central nervous system | Mini-stroke effecting the balance centers in the brain,head injury, multiple sclerosis, infection causing nerve compression, brain tumors |
Figure 01. The Inner Ear
Although dizziness affects people of all ages, it tends to be most problematic for older adults. About 20% of sufferers over the age of 60 report that dizziness interferes with their daily lives. BPPV is a frequent complaint among the elderly, while labyrinthitis and motion sickness plague people in every age group.
To determine what is causing your vertigo, your doctor will start with a careful medical history. Because "dizziness" is a vague term, and because the condition has so many possible causes, your doctor first must determine precisely what you mean by "dizzy." For example, did you feel as if the room was spinning, or did you feel faint? Were you off balance, or did you feel "foggy" in the head? Providing details about when the dizziness began, how long it lasted, and what set it off and/or relieved it are important clues for your doctor. It is also helpful to describe other symptoms you may have had, such as nausea and/or vomiting, headache, loss of hearing, or ringing in the ear. Lastly, your doctor will want to know which, if any, medications you take.
A physical examination will reveal clues about the origin of your vertigo. Irregular eye movements suggest that the problem stems from the inner ear or its nerve connections to the brain. Your doctor may try to provoke rapid to–and–fro flitting movements of eyes (nystagmus) by moving your head a certain way, or by placing some cold water in your ear canal.To test your balance, your doctor might ask you to walk in a straight line; first with your eyes open, and then with your eyes shut. He or she may also have you stand with your feet together, arms extended, and eyes closed. The doctor may also take your blood pressure — while standing and while lying down — for further diagnostic clues.
Lab tests can help your doctor pinpoint the cause of your vertigo. Hearing tests can reveal an associated ear problem that may suggest that the nearby balance portion of the inner ear has been affected. If your doctor suspects an ear or brain infection, he or she might take a fluid sample from your ear, sinuses, or spine. Computed tomography (CT) and magnetic resonance imaging (MRI)scans of the head will show any tumors pressing on nerves, or other abnormalities that could lead to vertigo. If your doctor thinks that your vertigo could be circulatory in origin, he or she may perform an angiogram. For this test, the doctor will inject dye into your blood and takes x–rays in an attempt to find blocked blood vessels.
Prevention and Screening
Treatment
People who experience dizziness accompanied by double vision, limb numbness, or slurred speech should be brought to the hospital immediately. These symptoms may reflect a potentially fatal stroke or tumor, and should be treated as a medical emergency.
If you have BPPV, your doctor can teach you some exercises that will gradually dislodge the inner ear debris causing your vertigo.
Cutting down on your intake of salt may improve vertigo that stems from Meniere's disease. Limiting salt, caffeine, and nicotine is beneficial for vertigo caused by a circulation problem, as these substances impair blood flow.
To prevent motion sickness in the car, sit facing forward with your eyes focused on a fixed point in the distance. Generally, it is a good idea for anyone who suffers from vertigo to avoid sudden changes in body position, and to forego amusement park rides.
Consider using a cane if you need greater stability. If you have vertigo, using a cane may improve your ability to walk more steadily and safely.
Your doctor is the best source of information on the drug treatment choices available to you.
While most vertigo cases do not require such drastic measures, surgery may be an effective last choice for very persistent cases. Conservative surgical approaches aim to adjust the workings of the inner ear, or to selectively destroy certain functions of the inner ear without damaging hearing. A doctor may try techniques that take pressure off nerves, such as inserting shunts and drainage tubes. One modern technique that preserves hearing involves injecting gentamycin into the middle ear. Selective surgery on the eighth–nerve cures vertigo 90% of the time. Hearing loss occurs in under 10% of cases in which this method was used.
A more radical approach involves destroying the offending inner ear organ. This procedure, which is called a labyrinthectomy, has a very high cure rate, but results in deafness.
Small tumors that cause vertigo can be removed using microsurgical techniques. Larger ones require more extensive surgery.
Some herbs provide relief in mild cases of vertigo; however, be sure to talk with your doctor before you use any natural remedy.
Gingko biloba is an herb that boosts circulation to the brain. The herb takes 8 to 12 weeks, however, to take effect.
Ginger may soothe motion sickness on planes, trains, automobiles, and boats. The herb purportedly lessens the dizziness and nausea associated with motion sickness.
Vertigo can usually be controlled. Once the underlying cause has been determined and the correct treatment initiated, vertigo generally abates.
If vertigo has affected your balance, your doctor may refer you to a vestibular therapist. A vestibular therapist will evaluate your balance and gait. He or she will also examine your vestibular ocular reflex and feet, and look at how position changes affect you. The doctor will tailor an exercise program for you to do at home.