Balance Disorders

Dizziness and Vertigo

It's not unusual to get dizzy from certain activities such as riding on a carousel. But dizziness or vertigo can also indicate a problem in the system that helps us maintain our balance. The National Institute on Deafness and Other Communication Disorders (NIDCD) says this system is complex, involving the brain, the ears, the eyes, as well as the muscles and joints. (Read about "The Ear and Hearing" "The Eye") If something goes wrong in any part of this system, it can lead to a sense of imbalance, unsteadiness or spinning. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) says that dizziness describes a sense of imbalance, while vertigo describes a sense of imbalance with spinning.

Here's how our sense of balance works. Whenever we move, sensory input from our eyes, our muscles and our joints is sent to the brain by the peripheral nervous system (Read about "The Brain" "Nervous System"), telling us that we've moved in a particular way. The brain interprets this information, along with cues from the vestibular system and helps our bodies adjust so that we keep our balance. The vestibular system consists of three semicircular canals within the inner ear. They contain a fluid called endolymph that moves in response to head movement. There are also patches of special nerve cells called hair cells as well as tiny calcium stones called otoconia. When you move your head or stand up, the hair cells are bent by the displacement of the otoconia or movement of the endolymph. This bending of the hair cells transmits an electrical signal about head movement to the brain. This signal travels to the brain along the eighth cranial nerve, which is the nerve involved in balance and hearing. The brain recognizes the signal as a particular movement of the head and is able to use this information to help maintain balance.

Ménière's disease, acoustic neuroma, BPPV, labyrinthitis and other causes

Dizziness or vertigo can occur when sensory information is distorted. For example, when someone reads while riding in a car, the inner ear senses the movement of the vehicle, but their eyes see only the book, which is not moving. The resulting sensory conflict may lead to the typical symptoms of motion sickness. (Read about "Motion Sickness")

But sometimes, dizziness has no apparent cause and it does not go away. NIDCD says a number of conditions can lead to dizziness or vertigo. They include:

• Ménière's disease - AAO-HNS says this condition is associated with fluid buildup in the inner ear. First identified in the 1800's, it can occur along with hearing loss and tinnitus. (Read about "Hearing Loss" "Tinnitus") Episodes are sudden and can last from several minutes to several hours. Hearing loss may be restricted to one ear and can be severe. Patients sometimes feel fullness or discomfort in the ear and may be sensitive to loud sounds. Treatment can include antihistamines, low-salt diet, diuretics and/or antibiotics. (Read about "Sodium" "Antibiotics") Surgery may be needed as well. AAO-HNS suggests that people with Ménière's avoid caffeine, smoking and alcohol, get regular sleep and avoid both excessive stress and fatigue, as much as possible. (Read about "Quit Smoking" "Sleep" "Stress")
• Acoustic neuroma / vestibular schwannoma - This condition is a slow-growing noncancerous tumor on the acoustic nerve. (Read about "Brain Tumors") In addition to loss of balance, it can also lead to hearing loss and tinnitus. (Read about "Hearing Loss" "Tinnitus") Vestibular schwannomas can also press on the facial nerve, causing facial weakness or paralysis on the side of the tumor. According to the Acoustic Neuroma Association (ANA), an acoustic neuroma can also be described as a neurilemoma, neurolemmoma or schwannoma. ANA says most of the time the cause is unknown but it can be caused by neurofibromatosis (NF), particularly the form called NF2. (Read about "Neurofibromatosis") NIDCD says the three options for treating acoustic neuroma include surgical removal, radiation and monitoring. (Read about "Radiation Therapy")
• Benign paroxysmal positional vertigo (BPPV) - In BPPV, tiny particles called canaliths may collect in the canals of the inner ear and push fluids against the hair cells. Patients may notice intense bursts of dizziness when they move their head in a particular way, for example when looking up, or when first getting out of bed. In addition to dizziness, there may also be lightheadedness, nausea and tiredness. NIDCD says its unclear how these calcium carbonate crystals cause BPPV, although it may be related to an inner ear infection, head injury (Read about "Head Injury"), or aging. BPPV can sometimes go away on its own, or it can occur for months or years. Physical therapy (Read about "Rehabilitation") can help patients to relieve symptoms. There is also a procedure called the canalith repositioning procedure. This procedure is initially performed by the patient with a trained therapist or doctor, and consists of several simple head maneuvers. According to the American Academy of Neurology, these maneuvers - done correctly - can move the canaliths to a part of your ear where they won't cause dizziness.
• Labyrinthitis - This refers to an inflammation of the part of the inner ear called the labyrinth. In addition to loss of balance, there can also be hearing loss and tinnitus. (Read about "Hearing Loss" "Tinnitus") The exact cause is unknown. However, the inflammation can often follow an infection, either viral or bacterial. (Read about "Microorganisms") A viral infection can develop following an upper respiratory infection (Read about "Influenza" "The Common Cold") and may go away on its own. NIDCD says bacterial infections are more likely to cause permanent damage and require treatment. Treatment options include vestibular suppressants to reduce symptoms such as nausea, as well as rehabilitation exercises.

The National Institutes of Health say dizziness may also be a sign of a "silent stroke" or transient ischemic attack (TIA). TIA's, which result from a temporary lack of blood supply to the brain, may also cause transient numbness, tingling or weakness in a limb or on one side of the face. Other signs include temporary blindness and difficulty with speech. These symptoms should not be ignored. If a TIA is ignored, a major stroke may follow. (Read about "Stroke")

The National Institute of Neurological Disorders and Stroke (NINDS) says other physical conditions that can cause dizziness include anemia, high blood pressure, diabetes, head injury and reduced blood flow to the brain resulting from atherosclerosis. (Read about "Anemia" "Hypertension: High Blood Pressure" "Diabetes" "Head Injury" "Vascular System" "Arteriosclerosis & Atherosclerosis") NINDS says neurological disorders such as multiple sclerosis, Alzheimer's disease, Parkinson's disease or Creutzfeldt-Jakob disease may also cause dizziness, primarily during walking. However, dizziness is rarely the sole symptom of these nervous system diseases. (Read about "Multiple Sclerosis" "Alzheimer's Disease" "Parkinson's Disease" "Creutzfeldt-Jakob Disease")

Vertigo can also be caused by a variety of drugs including aspirin, antibiotics, caffeine, alcohol, drugs to treat high blood pressure, tranquilizers, sedatives and many others. If you develop vertigo while taking medication, contact your doctor, but don't stop medications suddenly on your own. (Read about "Medicine Safety")

Diagnosis and treatment

Because there are so many potential causes of vertigo, diagnosis can be complicated. NIDCD says an otolaryngologist (a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head and neck) can help to evaluate a balance problem. Diagnostic tests include a hearing examination, blood tests, audiogram, and an electronystagmogram (ENG) which is a test of the vestibular system, as well as imaging studies of the head and brain such as CT scan or MRI. (Read about "Laboratory Testing" "CT Scan - Computerized Tomography" "MRI - Magnetic Resonance Imaging")

NIDCD has the following suggestions, if someone is seeing a doctor because of a problem with dizziness:

• Bring a written list of symptoms and when they started
• Bring a list of medications currently being used
• Be specific when you describe the nature of your symptoms to your doctor. For example, describe how, when and where you experience dizziness

Treatment depends on the cause of the vertigo. If a bacterial infection is present, antibiotics can be used. (Read about "Antibiotics") Other medications may be prescribed as well. Patients may be advised to avoid movements or positions that trigger vertigo.

Physical therapy can also used to treat certain balance disorders. Conditions, such as benign paroxysmal positional vertigo and Ménière's disease are candidates for such therapy. The Vestibular Disorders Association (VDA) says the goal is to retrain the brain to filter out confusing information from the inner ear and to use appropriate information, combined with other senses, such as seeing to diminish or eliminate symptoms. (Read about "Rehabilitation") For benign paroxysmal positional vertigo, there is also a type of therapy called the canalith repositioning procedure, which consists of supervised head maneuvers designed to reposition the small particles that are causing the vertigo. Labyrinthitis may improve with vestibular suppressant medication and rehabilitation exercises. Ménière's disease is often treated with a low-salt diet and diuretics.

In instances where vertigo persists for over a year and can't be controlled by other means, surgery may be advised. Again, vertigo is a complex condition, so make sure you discuss all your options with your physician.

Related Information:

    The Ear and Hearing

    Noise and Hearing

    Speech/Hearing/Smell/Taste Glossary