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Dizziness is one of the most common medical disorders that we experience. Dizziness is not a disease itself. Rather, it is a symptom of another disorder within the body. Most everyone has experienced dizziness at some point in his or her life. There are many different types of dizziness. It is often hard to describe dizziness. Someone once described dizziness as comparing colors. It is easy to say that something is blue. However, a light powder or baby blue has very little resemblance to a dark navy blue. Dizziness is the same way.

Many causes of dizziness are associated with ear problems; hearing problems are also associated with dizziness in many cases.

The Balance System

The balance system is composed of four basic entities. Both inner ears send messages from the semicircular canals, the utricle, and the saccule to the brain stem or computer part of the brain. The brain stem also receives information from the eyes and special sense organs in the muscles and joints of the neck, arms, legs, and feet, which tell the brain when weight is shifted or when there is a strain on one particular part of the body; this is known as the proprioceptive system. The brain stem, or computer part of the brain, takes information from the inner ears, eyes, and proproception.

Types of Dizziness

Dizziness can be caused from any abnormality in any of the systems of the body related to balance. An unusual cause of dizziness is due to eye problems. Many of us have experienced temporary dizziness due to tricks with our vision. Examples of this include the sensation one gets when sitting in the car at a stoplight and the car next to you rolls back as you are looking at it. You might slam on the brakes thinking that you are creeping forward when, in fact, you are still. Your eyes were telling your body that you were moving even though you weren’t. Another type of dizziness due to eye problems is evident when one wears another person’s glasses and tries to walk. It is also more difficult to walk in the dark due to the lack of information from our eyes.

It is rare to be dizzy from proprioceptive irregularity. However, many people will have balance trouble from proprioceptive problems. Diabetics are particularly prone to peripheral neuropathy. This causes a deficit of information from the feet in detecting weight shifts. The condition affects a feeling similar to what one would feel when walking on a large sponge or in a “moonwalk” playhouse. Occasionally, neuropathy is reversible from vitamin B12 deficits or other rare conditions. Usually it is not reversible but can be overcome by using a cane to get proprioceptive information via the arm. Sometimes physical therapy can be helpful in conditioning the body to rely more on the inner ear and visual systems to help with balance.
Ear dizziness is a common cause of dizziness, and there are many types of ear disturbances that can cause dizziness.

Central dizziness is related to dysfunction of the central nervous system or brain stem, the computer part of the brain that coordinates information from other body systems. This is also a relatively common cause of dizziness. A certain amount of compromise in this part of the brain occurs with aging.

Diagnosing The Cause of Dizziness

The information that you give regarding the characteristics of your dizziness is the most important tool in determining what type of problem you are having. Many of the questions you see on the dizziness questionnaire you will fill out are difficult to answer. However, they are helpful in sorting out various problems that can cause dizziness.

Because the balance portion of the inner ear is intimately related to the hearing part, a hearing test is necessary in evaluating most types of dizziness.
Often, blood tests are needed to evaluate causes of dizziness and these are ordered through the laboratory.

Sometimes a balance test is needed to determine what is causing the dizziness. This is called a videonystagmogram or VNG. It is very important in the test to avoid any strong pain medicines, alcohol, medicines for dizziness, sleeping pills or antihistamines 48 hours before this test. The test consists of placing a recording device around the eyes also involves stimulating the inner ear by placing cool water and warm water in the ear canal. This test takes from one to two hours and is not painful.
Sometimes a scan of the head, such as a magnetic resonance scan (MRI) is needed to examine the structures inside the head.

Occasionally, tests are needed to measure the blood flow through the small vessels in the brain.

Cause of Dizziness

Orthostatic Hypotension
This is the most common type of dizziness and is our reaction to transient low blood pressure to the brain. Most of us have experienced this light headed feeling when arising quickly, especially after we are dehydrated or tired. Upon arising the blood pools in large veins of the pelvis and legs. In a young person, the blood vessels squeeze, the heart beats faster and no change in blood pressure occurs. However, in older persons and especially those on heart or blood pressure medicines, these compensatory responses are prevented. This condition, if it occurs frequently, can be helped with adjustments to medicines, postural precautions, and use of compression stockings.
Benign Peroxismal Positional Vertigo
This is a condition of the inner ear that causes momentary dizziness in the form of vertigo. Vertigo is a sensation of spinning. BPPV is caused by some loose calcium particles in the inner ear. With BPPV spontaneous dizziness does not occur; it is always caused by some change of head position. A more detailed discussion of this condition is available in another pamphlet.
Labyrinthitis or Vestibular Neuritis
On occasion, either due to a viral infection of the inner ear or balance nerve or a decrease in the blood supply to the inner ear or balance nerve due to system blockage, one can have a very sudden spell of spinning sensation (vertigo) with accompanying nausea and sometimes vomiting. This can be very violent at times and leave one prostrate. It may require bed rest for several days. The first line of treatment is to try and restore the balance organs to good health through the use of various medications. Also, in the early phase, it is necessary to use medicines that tranquilize the inner ear. After the early phase is over, it is helpful to begin an exercise program that allows the computer part of the brain to compensate for the irregular information it is receiving from the crippled ear. Most of the time over a period of weeks, with tapering off of the inner ear tranquilizers and increasing exercise for the inner ear, one restores the normal balance mechanism. Sometimes, however, the inner ear is very crippled and it is very difficult for the brain stem to make compensation. This is especially true in older people.

A helpful illustration of this condition would be seen in imagining an airplane with two engines. As long as both engines are going at a steady rate of speed, the plane goes forward. If one engine is cut back or cut off, the plane begins to spin. However, if the rudder is set properly, the plane can go straight on just one engine or on an irregular supply from each engine. Think of each inner ear as an engine, and think of the brain stem as the rudder. The brain stem is able to make adjustments for most inner ear abnormalities.
Meniere’s Disease
Meniere’s syndrome is a disorder of the inner ear characterized by the triad of hearing loss, tinnitus, and episodic vertigo. It is caused by a fluid imbalance in the inner ear. A more detailed discussion of this disorder is available in another pamphlet.
Perilymphatic Fistula
Occasionally with increased pressure in your head with severe straining or, as occurs with scuba diving or some airplane flights, pressure changes can rupture one of the membranes in the inner ear. Occasionally, it is necessary to surgically repair this leak.
Sometimes disturbances in the hormones and fluids in the body can result in dizziness. Some people get dizzy when their blood sugar gets too high or too low, as is seen in diabetes and hypoglycemia. Also, irregularities of the thyroid gland can cause dizziness. Frequently, the hormonal changes that women experience in the menstrual cycle and at menopause can cause dizziness. Usually there are other symptoms accompanying metabolic disorders than just the dizziness.
Central Dizziness
There are many disorders that affect the central nervous system. One of the most common is motion sickness. Motion sickness is thought to be due to an irregular sensitivity to movement in the computer part of the brain. There is quite a wide variation among people in their ability to withstand motion without getting dizzy. Some people are affected by just watching waves on the water. Fortunately, there are medicines that are very effective in relieving this condition.

Occasionally, the balance computer in the brain stem develops a glitch. It can be due to poor circulation or rarer conditions such as multiple sclerosis. Usually, we don’t know why it stops working smoothly. However, we can usually improve the condition with medicines that are active in brain stem function.
Because this irregular brain stem activity is similar to seizures, mild anti-epileptic drugs are often used to help smooth out the irregular brain activity.
Mal de Debarkment
This is a French word meaning sickness after disembarking as one might get from coming off a boat. This is just the opposite of motion sickness. When a person first gets off a lengthy boat cruise, he or she feels as if the ground is swaying. Within a day or so, this resolves. They get their “land legs” back. This is due to the brainstem resetting itself. In rare cases, the brainstem does not reset and the result is Mal de Debarkment. A person feels stable when he or she is in a car, on a boat or a plane moving along, but the moment they step on firm ground, they feel imbalance. This condition usually lasts for a short time but can persist for a few months. Fortunately, there are medicines that usually help this condition quite effectively.
Panic Attacks
Anxiety or panic attacks are generally characterized by feeling that the heart is racing with sweaty palms and tingling of the lips and fingers, and an overwhelming feeling of anxiety. There can also be chest pains and a smothering feeling associated with this. Sometimes one feels a sense of de-personalization or de-realization. Dizziness also accompanies this. Sometimes, it is difficult to sort out whether the dizziness causes the anxiety or whether the anxiety causes the dizziness. Often, it is helpful to try a course of medicines for panic disorder to see if that will help relieve the problem.
Vascular Compression Syndrome
Sometimes small blood vessels that are adjacent to the brain will press on the balance nerve and cause dizziness. This condition is difficult to diagnose. In cases in which it is present, it is very helpful to remove these blood vessels from the balance nerve and insert a small piece of felt between the vessel and the nerve to stop this dizziness.
Head Injury or Brain Stem Concussion
Occasionally with a very severe blow to the head, the computer part of the brain can be bruised and can cause persistent imbalance. Initially, it is often helped with the use of medications to smooth out any irregularities in the brain stem. Later on, it is useful to stimulate repair of this system through exercise. The patient wit this type of problem can expect to see slow improvement up to eighteen months after the injury.
Sometimes depression can make one feel dizzy. This is usually described as a vague light headedness related to a general sense of lethargy.
Many medicines cause dizziness. Be sure to tell the doctor about all prescription and non-prescription medicines you take. Did your dizziness start when you began a new prescription?
Have you ever had a time in your life when you drank heavily? This can cause chronic dizziness and balance problems later on.
The content of this site is intended for information purposes only; it is not meant to take the place of seeing a healthcare professional. If you have any concerns regarding your own or someone else's health, we strongly encourage you to consult a physician.

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