Focused On Care

Vertigo

The term dizziness is a loose term used to describe feelings of imbalance, lightheadedness, feeling faint, woozy, or feeling like you’re on a boat.   The term vertigo, refers more specifically to the feeling that you are spinning or moving even when you are still. 

Dizziness is a fairly common reason adults visit their doctor.  Although dizziness can be uncomfortable and perhaps even alarming, dizziness is usually not a sign of a life threatening condition.

When to See a Doctor

If you are experiencing dizziness along with the following symptoms, it is advised that you seek immediate medical care.

  • Sudden and severe headache
  • Chest pain
  • Difficulty breathing
  • Numbness or paralysis of extremities or facial numbness
  • Fainting
  • Double vision
  • Rapid or irregular heartbeat
  • Confusion or blurred speech
  • Seizures
  • Sudden change in hearing

CAUSES

The vestibular system (organ of balance) is located in the inner ear.  The vestibular system works in conjunction with our eyes and proprioception abilities (perception or awareness of our bodies in space) in order to keep us feeling balanced and steady.  If there is an issue with any of these senses, dizziness can occur.

Examples of Vestibular Causes of Dizziness

Benign paroxysmal positional vertigo (BPPV):  This is one of the most  common causes of dizziness among adults and is the most treatable.   BPPV is a form of positional vertigo, characterized by the feeling of vertigo triggered by sudden movement of your head (if you were to turn your head).  It is trigged by the dislodging of inner ear “crystals” made of calcium carbonate, which falsly create movement of the fluid in the inner ear.  This induces a false sense of movement, leading to the sense of vertigo.  The vertigo usually lasts minutes, and people with BPPV usually feel normal in between episodes. 

Vestibular Neuronitis or labyrinthitis:  This is a neural infection of inner ear (viral or bacterial) which causes the nerve of the ear to become inflamed, leading to a sense of imbalance.  This kind of dizziness can occur in conjunction with hearing loss and tinnitus (often with a sudden onset).

Meniere's disease:  This is a condition involving abnormal fluid buildup within the inner ear, usually effecting only one ear.  Symptoms of this condition include vertigo, fluctuating hearing loss, sensation of pressure or fullness in the ear and tinnitus (usually roaring). Meniere’s disease can come and go and you may experience symptoms for several weeks or months.

Acoustic neuroma: This is a tumor (most often benign) that grows along the nerve tissue in the inner ear.  Other symptoms may include tinnitus (ring in the ears) and hearing loss. Once the tumor is removed, the vertigo typically subsides.

Vestibular Migraine:  This type of migraine effects balance and vision but does not always occur alongside a headache.  Symptoms of vestibular migraine include imbalance or dizziness, pressure within the head or ear, light and/or sound sensitivity and tinnitus.

Other causes of dizziness or vertigo

It is possible to experience imbalance or vertigo even with our vestibular system is functioning normally.  Issues related to the circulatory system, neurological system, and dehydration can also cause you to feel dizzy.

Exampled of Non-Vestibular Causes of Dizziness:

  • Sudden or dramatic drop in blood pressure (e.g. sitting up or standing up too quickly)
  • Issues related to the circulatory system) e.g. cardiomyopathy (disease of the heart muscle), heart attack,  and transient ischemic attacks can cause dizziness
  • Medication side effects (e.g. antidepressants, seizure medications and sedatives).
  • Anxiety disorders: Some patients with anxiety disorders experience dizzy-like symptoms such as lightheadedness and woozy feelings.
  • Low blood sugar (hypoglycemia): Generally occurring in patient’s with diabetes, low blood sugar can cause feelings of lightheadedness and weakness
  • Cerebellar hemorrhage: This is a type of intercranial bleeding that occurs within the brain tissue.  This is by far the most serious condition that can cause vertigo. A cerebral hemorrhage is a life-threatening condition and can occur during an accident (car accident, skiing accident, falls where you land on your head or hitting your head.)
  • Hormonal changes such as experienced during pregnancy

Testing

Since the balance organ is located in the inner ear, seeing an audiologist and/or ENT specialist is a good first step to locating the problem.  A detailed history is extremely helpful when trying to determine the cause of dizziness.  Different sensations of dizziness (feeling lightheaded, floaty, general unsteadiness on your feet, spinning, etc.) in conjunction with other symptoms such as pressure in the ear, hearing loss and tinnitus, will help determine whether the dizziness is coming from the vestibular system.

If it is suspected that the ear is the root cause of dizziness, tests may be ordered.

Common tests of vestibular related dizziness:

Audiometry:  After a medical history is taken, a full diagnostic hearing test is usually the first step in evaluating dizziness.  Many forms of dizziness effect the ear and hearing as well.  Therefore, hearing tests can give valuable clues as to what is causing the dizziness. 

Dix-Hallpike Maneuver:  This is a body maneuver that is used to diagnose benign paroxysmal positional vertigo (BPPV).  If positive for BPPV, this movement will induce dizziness, and specific eye movements known as nystagmus will be observed. 

Videonystagmography (VNG):  This is a comprehensive balance test which focuses on the function of the  inner ear’s vestibular system.  During VNG testing patients are asked to do different visual tasks to test for proper vestibular and eye coordination, and positional movements to look for triggering body movements.  In addition, the balance system of each ear is indirectly stimulated and the vestibular system’s response is measured.  This gives detailed information of the function of each ear’s balance organ.

Treatments:

Treatments for dizziness depend on the root cause of dizziness. 

Epley Maneuver:  This maneuver is performed as a treatment for BPPV.  Similar to the Dix-Hallpike maneuver, the Epley maneuver involves moving the body in specific directions.  The goal of this maneuver is to move the loose crystal out of the vertigo inducing position.

Vestibular Rehabilitation: Depending on the cause of dizziness, vestibular rehab may be recommended.  Vestibular rehab is similar to physical rehabilitation, often performed by a physical therapist (PT).  A specialized PT will target the specific symptoms of dizziness you are experiencing to help you compensate and correct for your imbalance.

 It is vital to receive a proper diagnosis for your dizziness before seeking treatment.  If you are experiencing any form of dizziness, please schedule an appointment with us today.