Dizziness and Vertigo

 

Dizziness

The inner ear serves two important purposes: hearing and balance.  Dizziness and vertigo for all intents and purposes are virtually the same.  While one is more for imbalance, and the other is room spinning both are worked up similarly.  Problems of balance and dizziness/vertigo can be caused by many different things, and from many different body systems.  While the ear is usually the first step in working up dizziness, the other potential areas to look into are the eyes, the brain, the heart, the vascular system, the peripheral nervous system, and the musculoskeletal system.  The inner ear serves two important purposes: hearing and balance. Your inner ear monitors directions of motion, movement, and orientation. Experiencing a false sensation of spinning or whirling is known as vertigo, which can occur when the signal to the brain is blocked or misfires. In addition to feeling dizzy, symptoms can include headache, nausea, sensitivity to bright light, tinnitus, motion sickness, fainting, and clumsiness.

Dizziness can be a symptom of a more serious medical problem, such as abnormal blood pressure, heart problems, stroke or metabolic disorders. If you experience lightheadedness or room spinning vertigo, it is important that you see a physician as soon as possible.

When it comes to working up Dizziness / Vertigo, the first thing to discuss is how and when it began, as well as surrounding factors in health and environment.  This is followed by a thorough physical exam.  If the diagnosis is not apparent yet, this is usually followed by a Dix Hallpike vertigo test and possibly an Audiogram.  These two tests will hopefully be able to point to a diagnosis and a particular ear that is the problem.  If these tests are not helpful in determining the diagnosis, then typically an MRI and or Videonystamograghy is needed to further workup the problem.

What are ear-related disorders of balance and vertigo?

  • Benign Paroxysmal Positional Vertigo (BPPV): BPPV occurs when tiny calcium crystals in the ears loosen and move in the wrong part of the ear. Patients may experience sudden, short bursts of dizziness as a result of head movement that can last a few seconds to minutes.  A simple test in the office can help diagnose this benign condition.  Furthermore, it can usually be treated with a five-minute non-invasive maneuver in the office that usually works quickly.
    Inflammation of the inner ear: Labyrinthitis and Vestibular Neuronitis are the most common inflammatory conditions of the inner ear.  The inflammation can be caused by a viral illness or from autoimmune problems.  In most cases, the history and a hearing test can be diagnostic.  These problems are typically self-limited but can be treated with medications to speed up recovery.
  • Meniere’s Disease: Meniere’s Disease is characterized by long periods of dizziness, lasting from 30 to 60 minutes or more. Patients often experience tinnitus, hearing loss and a feeling of fullness in the ears. Again, the history and a hearing test can be helpful in diagnosing Meniere’s Disease.  Though there is no known cause or cure for Meniere’s Disease, medication and lifestyle changes can help reduce the severity of the symptoms.
  • Acoustic Neuroma: an acoustic neuroma is a benign growth on the nerve that connects the inner ear to the brain. This can cause feelings of dizziness. Typically, the patient also report hearing loss and or tinnitus that accompanies the dizziness.  For most patients, a hearing test and MRI are needed to diagnose this condition.  Depending on the patient’s age, hearing test and other co-morbidities, various treatment options are available, from observation to radiation to surgery.
  • Migraines: Vestibular migraines can cause a feeling of imbalance and vertigo, often accompanied by tinnitus or hearing loss. Migraine-related vertigo may occur with or separate from the migraine headache.  In this condition, all testing is normal.  In patients with suspected migraines, a prompt referral to a neurologist is warranted.
  • Anxiety:  Anxiety can be one of the most common causes of dizziness.  In fact, the stress of any kind (physical and/or emotional) can be taxing on the vestibular or balance system.  Furthermore, anxiety regarding a separate balance disorder can sometimes prolong the balance problem.  Treatment of the anxiety component can often facilitate the recovery of an unrelated balance disorder.

For further reading, please see below.

https://vestibular.org/

https://balanceanddizziness.org/