Dizziness may be caused by any disturbance in the inner ear, the balance nerve or its central connections. This can be because of a disturbance in circulation, fluid pressure or metabolism, infections, neuritis, drugs, injury, or growths. An extensive evaluation is required to determine the cause of dizziness. The tests necessary are determined at the time of examination and may include detailed hearing and balance tests, x-rays, and blood tests. A general physical examination and neurological tests may be advised.
Causes of Dizziness
As we get older, blood vessel walls tend to thicken because of an aging process known as arteriosclerosis. This thickening results in partial occlusion, with a gradual decrease of blood flow to the inner ear structures. The balance mechanism usually adjusts to this, but at times persistent unsteadiness develops. This may be aggravated by sudden position changes such as getting up quickly or turning suddenly. Treatment of dizziness because of changes in circulation consists of anti-dizziness medications to suppress the symptoms and enhance the effectiveness of the brain centers in controlling the symptoms. People with this type of dizziness should avoid drugs that constrict blood vessels, such as caffeine and nicotine. Emotional stress, anxiety, and excessive fatigue should also be avoided as much as possible. Increased exercise will often aid in the suppression of dizziness in many patients by stimulating the remaining function to be more effective.
Benign Positional Vertigo (BPPV)
Postural or positional dizziness is a common form of balance disturbance caused by circulatory changes or loose calcium deposits in the inner ear. It is characterized by sudden, brief episodes of imbalance when moving or changing head position. It is commonly noticed when lying down, arising, or turning over in bed. This type of dizziness is rarely progressive and usually responds to treatment, but it may recur. Treatment usually consists of exercises designed to provoke the dizziness until it fatigues. This type of exercise may be recommended by your physician to cause the positional dizziness to run its course more quickly. Occasionally, postural dizziness may be permanent and surgery may be required.
Some individuals develop imbalance as a result of the aging process. In many cases this is caused by circulatory changes in the small blood vessels supplying the inner ear and balance nerve mechanism. Fortunately, these disturbances, although they may persist, rarely become worse. Postural or positional vertigo is the most common balance disturbance of aging, but may develop in younger individuals as a result of head injuries or circulatory disturbances. Dizziness upon change of head position is a distressing symptom, which is often helped by vestibular exercises.
Temporary unsteadiness when arising from bed in the morning is not uncommon in older individuals. At times this feeling of imbalance may persist for an hour or two. Arising from bed slowly usually minimizes the disturbance. Unsteadiness when walking, particularly on stepping up or down, or walking on uneven surfaces, develops in some individuals as they progress in age. Using a cane and learning to use the eyes to help balance is often helpful.
Rarely allergies may cause dizziness and vertigo. Allergies are usually diagnosed by obtaining a careful history and occasionally performing a series of skin tests with inhalants, food, and blood tests. Treatment usually consists of elimination of the offending agents or, if this is not possible, stimulating immunity with allergy shots.
Head injuries occasionally result in dizziness of long-standing origin. If the trauma is severe, it is usually caused by the combined damage to the inner ear, balance nerve, and central nervous system. Lesser injury may damage any one or a combination of these components. The unsteadiness is prolonged at times, and may be associated with hearing loss and head noise as well as other symptoms.
Labyrinthine dysfunction describes one of the non-specific conditions where the inner ear is not functioning properly. Although the cause is often unknown, viral illnesses, medication, and trauma are known at times to cause this condition. In order to reach this diagnosis definitively, hearing and balance testing must be done. Symptoms may be highly variable. They can range from occasional unsteadiness to episodic vertigo or constant unsteadiness. Hearing loss is occasionally present. Initially, treatment is the prescription of one of a wide variety of possible medications. Occasionally, vertigo exercises are helpful. When vertigo cannot be controlled with medication or exercises, surgery is sometimes indicated.
Endolymphatic hydrops describes increased fluid pressure in the inner ear, and is similar, but not related to, glaucoma of the eye fluids. The symptoms are highly variable and the patient may have one symptom or a combination. Often there is a combination of hearing changes, disequilibrium, motion intolerance, or short dizzy episodes. There may be tinnitus and/or a pressure feeling in the head or ears. Endolymphatic hydrops may progress to Meniere’s disease in some patients. The treatment of endolymphatic hydrops is similar to that for Meniere’s disease. Medications are first used. Diuretics (water pills) are almost always used to decrease the fluid pressure in the inner ear. In addition to diuretics, other medications may be indicated, depending on the cause of symptoms in each patient’s case. If these fail, surgery is sometimes indicated.
Meniere’s disease is a common cause of repeated attacks of dizziness, and is thought to be caused by increased pressure of the inner ear fluids because of impaired metabolism of the inner ear. Fluids in the inner ear chamber are constantly being produced and absorbed by the circulatory system. Meniere’s disease is usually characterized by attacks consisting of vertigo (spinning) that varies in duration from a few minutes to several hours. Hearing loss and head noise, usually accompanying the attacks, may occur suddenly. Violent spinning, whirling, and falling associated with nausea and vomiting are common symptoms. Sensations of pressure and fullness in the ear or head are usually present during the attacks. The individual may be very tired for several hours after the overt spinning stops. The treatment of Meniere’s disease may be medical or surgical, depending upon the patient’s stage of the disease, life circumstances, and the condition of the ears. The purpose of the treatment is to prevent the hearing loss, and stop the vertigo (spinning). Treatment may consist of medication to decrease the inner ear fluid pressure or prevent inner ear allergic reactions. Meniere’s disease may be caused or aggravated by metabolic or allergic disorders. Special diets or drug therapy are indicated at times to control these problems. On rare occasions we may use gentamycin injections which selectively destroy balance function. This treatment is reserved for patients with Meniere’s disease in their only hearing ear or with Meniere’s disease in both ears. Surgery is most successful in relieving acute attacks of dizziness in the majority of patients. Some unsteadiness may persist over a period of several months until the opposite ear and the central nervous system are able to compensate and stabilize the balance system.