Dizziness & Vertigo

Dizziness, a blanket term used to describe any feeling of unsteadiness, is one of the leading health complaints in the United States, affecting an estimated nine million people annually. For those over the age of 70 it’s the top reason for a visit to the doctor’s office.

What Are the Causes of Dizziness?  

Dizziness is the result of your brain receiving false signals from the balance system (comprised of the inner ear, eyes and sensory nerves). It senses movement and overcompensates, leading to a spinning sensation, weakness and faintness.

There are many possible causes of dizziness including low blood pressure, anemia, dehydration, heat-related disorders, endocrine system disorders (e.g., diabetes, thyroid disease), heart conditions, high blood pressure, viral and bacterial infections, head trauma, hyperventilation, neurological disorders and certain medications.

Several balance disorders are commonly associated with dizziness and/or vertigo.

• Benign Paroxysmal Positional Vertigo (BPPV) involves brief but intense periods of vertigo that are triggered by specific changes in head position. It occurs when tiny crystals in the otolith organs become dislodged and migrate to the semicircular canals.

• Meniere’s disease is a chronic condition that causes vertigo, tinnitus, fullness in the ear and fluctuating hearing loss that may eventually become permanent. Meniere’s is usually confined to one ear and though its cause is unknown it may be the result of abnormal fluid buildup in the inner ear.

• Labyrinthitis is an inflammation of the inner ear usually caused by an infection. Its symptoms include vertigo, temporary hearing loss and tinnitus.

What Other Symptoms Are Associated with Dizziness?

Patients who experience dizziness report a variety of symptoms depending on the exact nature of their balance disorder. These include:

• Lightheadedness.
• Fainting.
• Unsteadiness.
• Weakness.
• Vertigo (the sensation of movement in your surroundings).
• Confusion.
• Disorientation.
• Blurred vision.

How Is Dizziness Treated?

Treatment for dizziness takes many forms, depending on the cause. Your doctor will try to target the underlying condition in order to reduce or eliminate the symptoms.

Options include medications (antihistamines, sedatives, antibiotics, steroids), physical or occupational therapy, surgery, repositioning exercises, vestibular retraining programs and lifestyle modifications such as dietary changes and elimination of alcohol and nicotine).

Vertigo

Vertigo is a form of dizziness characterized by the feeling that you or your environment is moving or spinning, despite the lack of any actual movement. This sensation is brought on by disturbances in the inner ear or the brain.

What Are the Types of Vertigo?

Peripheral vertigo is associated with problems in the inner ear. The vestibular system sends signals to the brain about the position of the head in relation to movement, enabling us to keep our balance and maintain equilibrium. When these signals are disrupted, vertigo results.

This is often caused by inflammation related to a viral infection and is commonly associated with two conditions: labyrinthitis (inflammation of the inner ear’s labyrinth and vestibular nerve), and vestibular neuronitis (inflammation of the vestibular nerve).

Other causes of peripheral vertigo include benign paroxysmal positional vertigo (BPPV), which occurs when tiny pieces of calcium break off and float in the tube of the inner ear, sending confusing messages to the brain, and Meniere’s disease, which involves excess pressure of the fluid in the inner ear.

Central vertigo occurs when there is a problem in the brain, usually affecting the brainstem or the cerebellum. These parts of the brain are responsible for interactions between the visual and balance systems; any disturbance can lead to vertigo. The most common cause of central vertigo is a migraine headache. Other less common conditions that can trigger central vertigo include stroke, tumors, acoustic neuroma, multiple sclerosis, alcohol and certain drugs.

What Symptoms Are Associated with Vertigo?

Technically speaking, vertigo is a symptom itself. It’s characterized by the sensation that you or the room is moving or spinning. This may be accompanied by additional symptoms such as nausea, vomiting, hearing loss, tinnitus, difficulty focusing or moving the eyes, double vision and a feeling of fullness in the ear.

If you’re suffering from vertigo, your doctor will give you a thorough physical examination and may order a CT scan or MRI.

How Is Vertigo Treated?

Treatment varies depending on the type and severity of vertigo. Some forms disappear without treatment. The most common type, BPPV, responds well to head maneuvers, while other types are successfully treated with medication. When the condition persists, physical therapy can help. 

BPPV

Benign paroxysmal positional vertigo, commonly referred to as BPPV, is a vestibular disorder that causes vertigo. It occurs when calcium deposits in the inner ear become dislodged from the otolithic membrane and settle in the semicircular canals. Any change in the position of the head causes these tiny crystals to shift, triggering dizziness.

What Causes BPPV?  

It isn’t always known what causes these calcium deposits to break loose, though this is commonly the result of a head injury, inner ear infection, damage from ear surgery or prolonged back position associated with bed rest. Migraines might also play a role. Older patients are susceptible to degeneration of the otolithic membrane related to normal aging.

What Are the Symptoms of BPPV?

BPPV is the most common cause of vertigo. The episodes of vertigo may be severe, but usually lasts for less than a minute. Other symptoms include dizziness or lightheadedness, loss of balance, blurred vision, nausea, vomiting and concentration difficulties.

How Is BPPV Treated?

If you are experiencing dizziness and unexplained episodes of vertigo, your doctor will administer tests to determine what is causing your symptoms. A diagnostic physical exam evaluates eye movements in response to specific head movements.

Additional testing such as electronystagmography (ENG) and videonystagmography (VNG) may be used to detect abnormal eye movement; an ENG utilizes electrodes, while the VNG test relies on small cameras.

Fortunately, BPPV is one of the more easily treatable disorders. The standard approach involves a pattern of head movements used to move the calcium particle from the semicircular canal back to the utricle. Called the Canalith Repositioning Procedure (CRP) or the Epley maneuver, this brief procedure takes about five minutes and relieves symptoms in over 85 percent of patients.

If CRP is ineffective, patients may undergo surgery; both posterior semicircular canal occlusion and vestibular nerve section have proven effective, but carry a risk of hearing loss following surgery. Treatment with the antibiotic gentamicin and vestibular rehabilitation may also prove successful. 

Ménière’s Disease

Ménière’s disease is an inner ear disorder that causes fluctuating hearing loss, tinnitus, vertigo and fullness or pressure in the ear. It is the result of excess fluid in the inner ear. There is no cure for Ménière’s disease, but various strategies can help you manage your symptoms.

What Causes Ménière’s Disease?

The exact cause of Ménière’s disease is unknown. It is believed to be associated with a dysfunction of the endolymphatic sac, an organ responsible for regulating the volume and pressure of fluid in the inner ear. Various theories point to circulation disorders, viral infections, head trauma, allergies, migraines and obstructions of the ear canal as possible causes.

It is estimated that Ménière’s disease affects about one out of every 1,000 people, with most patients between the ages of 40 and 60.

What Are the Symptoms of Ménière’s Disease?

People with Ménière’s disease suffer progressive attacks that are often characterized by warning signs in advance. These include loss of balance, dizziness, headache, increased hearing loss and/or tinnitus, sensitivity to noises, and pressure in the ear. During the attack, you may experience episodes of severe vertigo, fluctuating hearing loss, fullness in the ear, and tinnitus. These symptoms may be accompanied by anxiety, blurry vision, nausea, vomiting, trembling, rapid pulse, and diarrhea.

Afterwards, exhaustion often sets in, leading to an increased need for sleep. Attacks may be brief, lasting for as little as 20 minutes, or may persist for as long as 24 hours. Their frequency is unpredictable and sporadic; they may occur several times a week, or as little as once every few years. Due to the unpredictable nature of this disease, it’s impossible to tell just how much it will affect your life.

How Is Ménière’s Disease Treated?

Because the symptoms of Ménière’s disease resemble those associated with other conditions, we will need to perform hearing and balance tests in order to make a diagnosis. An audiogram will show hearing loss in the low tones, a key indicator of Ménière’s disease. In some cases, imaging scans or blood tests are ordered.

Medical options for treating Ménière’s include motion sickness and anti-nausea medications, diuretics, an antibiotic called Gentamycin, and oral or injectable steroids. These, coupled with a low-sodium diet, can help prevent dizziness or reduce the severity of attacks. Other lifestyle remedies include limiting caffeine, alcohol, chocolate and monosodium glutamate from your diet; drinking six to eight glasses of water per day; quitting smoking; avoiding allergens; and reducing stress and anxiety.

When medications don’t work, you may benefit from vestibular rehabilitation exercises to improve balance. Hearing aids will help treat hearing loss associated with Ménière’s.

Individuals who experience severe attacks and are unable to find relief from other treatments may have success with surgery. Procedures that have proven effective include an endolymphatic sac procedure to drain fluid from the inner ear, a vestibular nerve section to cut the nerve that connects the ear and brain to eliminate dizziness and preserve hearing, and a labyrinthectomy to control dizziness.

Call Willamette ENT & Facial Plastic Surgery at (503) 581-1567 for more information or to schedule an appointment.