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When The World Starts Spinning
Thomas M. Jung, M.D. Ph.D.
Neurotologist for Tri-State Otoloaryngology
It is estimated that almost 2 million people a year visit their doctors with complaints of dizziness or vertigo. The difference between dizziness and vertigo is quite important.
When a patient describes dizziness, he oftens means a light-headedness or woozinesss. Light-headedness can be caused by a number of things, including low blood pressure, low blood suger or changes in blood flow to the brain. Vertigo, on the other hand, describes a sensation of spinning. Patients will either describe the room as spinning or themselves as spinning. True vertigo is usually caused by an inner ear problem.
The maintenance of balance is rather complex and requires the interaction of three different systems: the visual system - one can see how they are oriented to the horizon; the balance system of the inner ear, and motion receptors in the spinal cord and muscles that can sense when the body is tilting. A problem with any one of these systems can result in a balance problem.
The treatment of vertigo or dizziness requires an accurate diagnosis.
The most important part of the medical evaluation for arriving at an accurate diagnosis is a complete and thorough history. The most important questions to be asked are: When did you symptoms begin? How long do they last? How often are you having the spells? Does any movement bring them on or make them worse? And, are there any other symptoms that occur with your spells, like hearing loss or ringing of the ears? The physical examination and laboratory tests are used to rule out any obvious and treatable conditions. Hearing tests are usually always performed when evaluating a patient with balance complaints because the inner ear serves as both a balance and a hearing function. Therefore, a problem with one component may lead to an unrecognized problem with another system.
Dizziness can be caused by alterations in blood flow to the brain as in conditions like atherosclerosis - where cholesterol clogs the arteries to the brain or osteoarthritis - where the spinal cord narrows and pinches off the blood vessels that go to the brain.
Another simple cause may be low blood pressure due to certain blood pressure medicines which may require a change in those medications.
True vertigo is usually caused by an inner ear problem. An infection of the inner ear by bacteria or a virus is called labyrinthitis or vestibular neuritis, which may require antibiotics or antiviral medications. Meniere's disease is a condition that affects hearing and balance and results in intermittent spontaneous vertigo. Benign positional vertigo is a brief (10 seconds) spell of vertigo that occurs with head movements which is treated with specific exercises. More rare causes of vertigo include sclerosis and certain brain tumors.
The good news is that with an accurate diagnosis most patients with balance problems or vertigo can be helped.
Those patients with vertigo associated with movement can usually be helped by designing a specific exercise program (called vestibular rehabilitation) that forces the brain to reinterpret the signals it receives from the inner ear balance center. Patients who have symptoms that fluctuate or occur spontaneously usually can decrease or eliminate the episodes with changes in diet, such as beginning a low-salt diet, or with medications that help promote the removal of salt in the urine. For patients with severe symptoms, there are a number of surgical procedures available, the choice of which depends on the severity of symptoms and whether the patient has residual hearing.
In most cases, the diagnosis of a balance disorder can be made with a complete medical examination, including a thorough history, physical examination and diagnostic tests where indicated. An accurate diagnosis usually results in a directed treatment plan that eliminates or decreases the severity of vertigo spells. It is important to maintain a positive outlook. This may be a chronic condition and patients may have periods of depression, frustation and fear. This is perfectly normal and patients need time to adjust. They should avoid giving in to self-pity and therefore require the support of family and friends. With proper encouragement and treatment plans, patients can continue to lead active fulfilling lives.
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