Dizziness is a common problem experienced by most people at some point during their lifetime. It can be described as lightheadedness, a feeling of imbalance or a false sensation of movement (vertigo). While most people suffer from dizziness occasionally, others have continuous symptoms of imbalance. Most people find their dizzy symptoms to be quite distressing and even anxiety provoking. It impacts their daily life, even if they do not experience symptoms every day, because it affects their confidence in their ability to maintain their balance and avoid injury to themselves or others.
Even though the sensation of dizziness is quite common, it can be associated with many different disorders, and determining the cause of dizzy symptoms can be complicated and often frustrating for the patient. The sensation of dizziness can arise from problems in the vestibular system (in the inner ear), sensory abilities in the feet and spine, or vision, or when the brain is unable to correctly interpret the information it receives from the ear, sensory system or vision.
Inner Ear Disorders
There are many different disorders of the inner ear that can cause dizziness The most common one is benign paroxysmal positional vertigo, or BPPV. This disorder occurs when small crystals called otoconia, which are normally found in the inner ear, become displaced from their normal location. Individuals with BPPV have episodes of intense spinning vertigo, often accompanied by nausea and vomiting, that lasts for a number of seconds and occurs whenever the patient moves a certain way. Movements that commonly cause dizziness are lying down or rolling over in bed, looking up to get an object off of a high shelf, or lying back when having one’s hair washed at the hairdresser. BPPV most often resolves on its own over a period of weeks. However, it can be treated more quickly using positioning maneuvers performed by a physician or occupational or physical therapist who is trained in vestibular therapy.
Labyrinthitis is an infection or inflammation of the inner ear that leads to severe spinning vertigo lasting from a few hours to a few days. This condition is accompanied by hearing loss in one ear that is often permanent. Vestibular neuritis, which is similar to labyrinthitis, is related to infection or inflammation of the balance (vestibular) nerve. It also causes severe spinning vertigo lasting hours to a few days; however, there is no associated hearing loss. Initial treatment for both of these conditions may include steroids and/or medications taken short-term to reduce the sensation of vertigo. Once the severe vertigo subsides, many people continue to have a general sense of imbalance, and may even experience brief episodes of vertigo when turning their head quickly. These milder symptoms are almost always successfully treated with vestibular therapy.
Meniere’s disease is a rare disorder affecting the inner ear. The cause of Meniere’s disease is not known, but is thought to be related to an imbalance of the fluids in the inner ear. Meniere’s is characterized by episodes of vertigo that last at least 20 minutes and less than one day. The vertigo occurs in combination with fluctuating hearing loss, tinnitus (a roaring or buzzing sound in the ear), and a sense of fullness in one ear. There are many different treatment options for Meniere’s disease, ranging from lifestyle changes to medications to – in extreme cases – surgery.
Other Causes of Dizziness
Two other common causes of dizziness that are not disorders of the inner ear are anxiety and vestibular migraine, which may involve dizziness without a headache. With both, symptoms can vary considerably in terms of severity, duration and character of the dizziness. There is no diagnostic test for either anxiety or migraine. Typically, the evaluation includes a hearing test and a balance test to rule out an inner ear disorder. Management of these disorders often includes the care of one or more of the following: a neurologist, an otolaryngologist with specialty training in balance disorders, a psychiatrist and a physical or occupational therapist trained in vestibular therapy.
Evaluation and Management of Dizziness
Comprehensive evaluation and management of a patient with dizziness often includes:
• one or more visits with a physician specializing in balance disorders
• a hearing evaluation
• testing of balance function
• vestibular therapy
Physicians involved in the care of dizzy patients are most frequently neurologists or otolaryngologists who have subspecialty training in vestibular disorders. Many patients have improvement or resolution of their symptoms with a combination of vestibular therapy and medical management. Surgery is rarely recommended, but when necessary typically leads to significant relief of symptoms.
Dr. Budenz is an assistant professor in the department of otolaryngology at New York Medical College and has served as an instructor for courses attended by surgeons from around the world. She received her medical degree from the University of Michigan Medical School, followed by a surgical internship and otolaryngology residency at New York University. After residency training, she completed both a National Institutes of Health-funded research fellowship and a clinical fellowship in otology, neurotology and skull base surgery at the University of Michigan.
To schedule an appointment at the Phelps Balance Center, call 914-366-1170.