Myth: I'm so dizzy; I must have had a stroke
Truth: There are many causes of dizziness, and not all are life-threatening
Benign positional vertigo (BPV) is the most common cause of dizziness. It is caused when the tiny crystals in your inner ear - those responsible for balance - break free and float around in the inner ear fluids. When the head moves in certain positions, these floaters tickle the balance cells, causing transient vertigo.
There are other causes of dizziness as well. Labyrinthitis is an inflammation of the inner ear caused by viral infection or other causes. Its symptoms, which include dizziness, usually last for several hours and then diminish.
Meniere's disease is another cause of dizziness. Although the causes of this condition are varied, the symptoms include a build up of excessive inner ear fluid, causing pressure. This results in hearing loss,
stuffiness in the ear, and debilitating recurrent vertigo spells that can last hours.
So how can you tell what is causing your dizziness? If you have BPV you will likely experience room-spinning vertigo that occurs with looking up, down or rolling over in bed and lasts a few seconds.
Labyrinthitis is marked by violent vertigo with nausea and vomiting lasting for hours. There is usually no hearing loss or other ear symptoms, and an attack may be followed by weeks of unsteadiness or temporary vertigo when rolling over in bed.
Meniere's disease is accompanied by recurrent bouts of vertigo, possible nausea, and vomiting lasting 30 minutes to hours. Meniere's disease is usually accompanied by hearing loss, pressure in the ear, and roaring or ringing in the ear.
Luckily, all of these conditions can be successfully treated. BPV is treated in the office, where a vestibular therapist performs a maneuver called the Semont Maneuver that moves the crystals away from the balance cells. Ninety percent of patients with vertigo are cured with this treatment, which occasionally it needs to be repeated.
Labyrinthitis is treated with oral medication to reduce the dizziness sensation and replacement of fluids for any associated nausea and vomiting. In severe cases, hospitalization is required to provide medications intravenously until the symptoms subside.
Meniere's disease is treated with a variety of medications and surgical procedures, all designed to help reduce the frequency of vertigo attacks. Among the medications used to treat Meniere's disease are diuretics, circulatory medication, sedatives, and steroids
Despite these possible causes of dizziness, stroke cannot be ruled out, as it is also a cause. A stroke occurs when the blood flow to the brain is interrupted and the brain cells are deprived of oxygen. There are several symptoms of stroke, including
o sudden onset of dizziness or vertigo;
o difficulty walking or loss of coordination;
o numbness or weakness of the face, arm or leg;
o confusion;
o difficulty with speech; and
o severe headache.
If any of these symptoms suddenly occur, the person should be rushed to the emergency room for evaluation and treatment. Every minute that the brain is deprived of oxygen the potential for brain damage increases, so it is imperative that a suspected stroke be evaluated by emergency room physicians immediately.
Myth: My balance is bad because I am getting old, and I'll have to live with that
Truth: Age is not a factor in maintaining healthy balance function
Your balance mechanism works like a tripod. The three arms of the tripod are the balance canals in the inner ear, eyesight, and sensations from the joints and muscles in your legs and feet. Sensory messages from three sources are sent to the brain, where they are organized into meaningful information. Based on this information your brain then sends out new messages - instructions to your muscles to maintain your balance.
There are many causes of dizziness and imbalance. Confused messages, blocked message pathways, or weakness in the brain or the tripod limbs all can cause imbalance. Other possible reasons include:
o lack of circulation to the balance area of the brain,
o drop in blood pressure when you move from sitting to standing (orthostatic hypotension),
o inner ear disorders,
o vision problems,
o diseases of the bones and joints,
o side effects of medication, and
o drug interactions.
Additionally, an irregular heart beat or heart condition and neurological diseases may cause lightheadedness, dizziness, or imbalance.
But the majority of balance problems result from dysfunction in the inner ear balance canals. And dysfunction of two tripod limbs at the same time makes it even more difficult to maintain balance.
In order to correctly diagnose the cause of your dizziness you should be evaluated by an ENT physician. This evaluation includes specialized tests that measure inner ear and balance function. In some instances, a neurologist or other specialty physicians may need to be consulted.
You can note some basic symptoms yourself and share them with your doctor, aiding in the diagnosis process:
o If your imbalance occurs only for a short time when getting out of bed or when rising from a sitting position, it can be due to a transient drop in blood pressure.
o Unsteadiness or imbalance only when walking can be related to problems in the balance center of the brain or the balance canals in the inner ear.
o Vision problems can also be a cause of dizziness or imbalance.
Sometimes there are multiples causes of dizziness, which may require more specialized treatment. But in most instances, dizziness and imbalance can be treated by initiating Vestibular Rehabilitation (VR).
VR is an individualized program of home exercises and activities designed by a therapist with specialized training in balance disorders. Prior to starting VR, your musculoskeletal system will be assessed by testing the strength, coordination, and range of motion in your arms and legs. The therapist will also observe your balance when walking.
With this information your therapist can design a program to meet your specific needs. Then your progress is monitored at regular follow-up appointments.
The goal of VR is to decrease dizziness and increase balance function, improving general daily activity levels. Remember, age is not a factor in maintaining healthy balance function!
Herbert Silverstein, MD, FACS is president and founder of the Florida Ear & Sinus Center and the Ear Research Foundation, in Sarasota, FL. He has been consistently recognized since 1979 as one the "Best Physicians in the USA." He has been a leader in Meniere's Disease treatment for more than 25 years, developing surgical and diagnostic procedures; inventing instruments (such as the Microwick); teaching medical students, residents and fellows; and helping people from all walks of life.
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