Dizziness

Dizziness is not a disease itself but rather a symptom that can result from various conditions. The term encompasses several distinct sensations that people often struggle to describe accurately. Your sense of balance depends on input from multiple systems: your inner ear, eyes, sensory nerves, and brain. When any of these systems malfunction or send conflicting signals, you may experience dizziness.

The inner ear plays a crucial role in balance. It contains tiny organs called the vestibular system that detect head movement and position. Your eyes help determine where your body is in space, while sensory receptors in your skin, joints, and muscles send signals about body position. Your brain processes all this information to maintain balance and orientation.

Dizziness can significantly impact quality of life, increasing fall risk and limiting activities. It's one of the most common reasons people visit doctors, especially among older adults. While usually not serious, persistent or severe dizziness warrants medical evaluation to identify and treat underlying causes.

Inner Ear Disorders

• Benign Paroxysmal Positional Vertigo (BPPV): Most common cause of vertigo, crystals in inner ear displaced
• Meniere's Disease: Fluid buildup causing vertigo, hearing loss, tinnitus
• Vestibular Neuritis: Viral infection of vestibular nerve
• Labyrinthitis: Inner ear infection affecting balance and hearing
• Acoustic Neuroma: Benign tumor on vestibular nerve
• Otosclerosis: Abnormal bone growth in middle ear

Cardiovascular Causes

• Orthostatic Hypotension: Blood pressure drop when standing
• Arrhythmias: Irregular heartbeats affecting blood flow
• Heart Failure: Reduced cardiac output
• Heart Attack: Can present with dizziness
• Anemia: Low red blood cells reducing oxygen delivery
• Dehydration: Reduced blood volume
• Blood loss: Internal or external bleeding

Neurological Causes

• Migraine: Can cause vertigo even without headache
• Stroke or TIA: Disrupted blood flow to brain
• Multiple Sclerosis: Can affect balance centers
• Parkinson's Disease: Movement disorder affecting balance
• Brain Tumor: Rare but serious cause
• Concussion: Head injury affecting balance
• Epilepsy: Some seizures cause dizziness

Metabolic and Systemic Causes

• Low Blood Sugar (Hypoglycemia): Especially in diabetes
• Thyroid Disorders: Both overactive and underactive
• Electrolyte Imbalances: Sodium, potassium abnormalities
• Kidney Disease: Toxin buildup affecting balance
• Liver Disease: Can cause various neurological symptoms
• Vitamin Deficiencies: B12, D deficiencies

Medications and Substances

• Blood Pressure Medications: Can cause orthostatic hypotension
• Sedatives and Tranquilizers: Affect central nervous system
• Antidepressants: Common side effect
• Anti-seizure Drugs: Can affect balance
• Antibiotics: Some can damage inner ear
• Alcohol: Direct effect and withdrawal
• Recreational Drugs: Various effects on balance

Other Causes

• Anxiety and Panic Attacks: Can cause lightheadedness
• Hyperventilation: Changes blood chemistry
• Motion Sickness: Conflicting sensory inputs
• Pregnancy: Hormonal changes and blood volume
• Aging: Multiple systems decline
• Eye Problems: Vision changes affecting balance

Dizziness often occurs with other symptoms that can help identify the cause:

• Nausea and Vomiting: Common with vertigo
• Headache: May indicate migraine or other conditions
• Hearing Changes: Hearing loss, tinnitus (ringing)
• Vision Changes: Blurring, double vision
• Weakness: May suggest neurological cause
• Sweating: Often with presyncope
• Palpitations: Heart rhythm problems
• Shortness of Breath: Cardiovascular causes
• Confusion: Serious causes
• Ear Fullness: Inner ear problems
• Fatigue: Various causes
• Anxiety: Can cause or result from dizziness

Medical History

Your doctor will ask about:

• Exact sensation you're experiencing
• Duration and frequency of episodes
• Triggers or relieving factors
• Associated symptoms
• Medical conditions and medications
• Recent illnesses or injuries
• Family history

Physical Examination

• Vital signs: Blood pressure lying and standing
• Neurological exam: Balance, coordination, reflexes
• Ear examination: Check for infection or abnormalities
• Eye movement tests: Nystagmus evaluation
• Heart examination: Listen for murmurs or irregularities
• Dix-Hallpike maneuver: Test for BPPV

Diagnostic Tests

• Blood tests: Check for anemia, thyroid, glucose
• Electrocardiogram (ECG): Heart rhythm
• Hearing tests: Audiometry if hearing affected
• Electronystagmography (ENG): Eye movement testing
• MRI or CT scan: Brain and inner ear imaging
• Vestibular testing: Balance system evaluation
• Tilt table test: For orthostatic problems

If diagnosed with BPPV, specific head movements can help reposition crystals in the inner ear:

Epley Maneuver

• Sit on bed with legs extended
• Turn head 45 degrees to affected side
• Quickly lie back with head hanging slightly off bed
• Hold for 30 seconds
• Turn head 90 degrees to opposite side
• Hold for 30 seconds
• Roll onto side, then slowly sit up

Important: Have someone assist you the first time. Stop if symptoms worsen.

• Stay hydrated: Drink adequate fluids daily
• Rise slowly: From lying or sitting positions
• Avoid sudden movements: Turn your whole body, not just head
• Manage blood pressure: Monitor and treat if needed
• Control blood sugar: If diabetic
• Review medications: Discuss side effects with doctor
• Limit alcohol: Can affect inner ear
• Reduce stress: Practice relaxation techniques
• Get regular exercise: Improves balance and circulation
• Ensure good lighting: Reduce fall risk
• Use assistive devices: Cane or walker if needed

Safety Measures

• Remove throw rugs and clutter
• Install grab bars in bathroom
• Use night lights
• Wear low-heeled shoes with good support
• Avoid driving during episodes
• Sit while showering if needed

Coping Strategies

• Join support groups
• Learn relaxation techniques
• Maintain social connections
• Consider counseling for anxiety
• Keep a symptom diary
• Communicate with employers about needs

Schedule an Appointment For:

• Recurring episodes of dizziness
• Dizziness lasting more than a few days
• Dizziness affecting daily activities
• New or different pattern of dizziness
• Dizziness with hearing changes
• Falls or near-falls due to dizziness
• Dizziness after starting new medication
• Chronic conditions with new dizziness