13 December 2010 | Dr Robin Yeoh | Consultant Audiovestibular Physician | The Portland Hospital
Dizziness is a very common complaint and it often provokes fear, anxiety and worry which often make the feeling worse. However, the majority of cases of dizziness and vertigo are not serious although a full assessment should always be undertaken. Furthermore, there are now well recognised methods for treating such cases with good results.
What is it?
Vertigo refers specifically to the condition where the patient feels that he or his surroundings are moving. This feeling is often one of spinning, similar to the experience on (or shortly after getting off) a playground roundabout. Dizziness is less specific, and is commonly used to describe any feeling of unsteadiness, faintness or light-headedness.
There are many causes of dizziness. Typically, light-headedness is the feeling that occurs before a simple faint and in other conditions where the blood pressure drops. Occasionally, consciousness may be impaired or lost. A brief drop in blood pressure, especially on standing up from a sitting or lying position, may commonly be caused by the drugs used to treat high blood pressure. A number of other drugs may cause a similar drop in blood pressure, enough to cause dizziness. Dizziness may also be a symptom of stress or anxiety, when it may be accompanied by over-breathing (hyperventilation) and/or by a tension headache. Very rarely, dizziness may be experienced before an epileptic seizure.
Vertigo may be of gradual or sudden onset. It is often associated (like seasickness) with nausea and vomiting and infrequently with diarrhoea. If it occurs whilst walking, the sufferer may stagger and have to steady himself, or may fall. The sufferer may feel safest lying perfectly still. Sudden movement, particularly turning over or sitting upright, may exacerbate or even provoke an attack of vertigo.
How does it occur?
Vertigo is caused by a disturbance in the balance organ of the inner ear or, less commonly, in the balance centres at the back of the brain.
The inner ear consists of a series of fluid filled channels within one of the bones in the base of the skull. It is linked to the eardrum by three tiny bones which cross an air filled space, the middle ear. Part of the inner ear is concerned with hearing (the cochlea) and part with balance.
Inner ear (in blue) with organs of hearing and balance
The balance organ consists of the three semicircular canals, sensitive to rotation, and the two otolith organs, sensitive to gravity, containing thousands of microscopic chalk crystals. The balance organ feeds the brain with information about the position and movement of the head.
If the inner ear is damaged, the wrong messages are sent and the result is vertigo. Vertigo is a symptom not a disease, and has many different causes. Often, although we can identify the ear as the source of the vertigo, we do not know the underlying cause.
Among the common causes of dizziness are:
- Infection of the middle ear
- Glue ear (catarrh behind the eardrum)
- Viral infection of the inner ear (labyrinthitis) or nerve of balance (vestibular neuronitis)
- Positional vertigo is common and the commonest form is a harmless inner ear disorder (Benign Paroxysmal Positional Vertigo, B.P.P.V)
- Meniere’s disease
- Many drugs can cause dizziness and, occasionally, actual vertigo.
- Arthritis of the neck
- Brain and nervous system diseases
- Psychological factors
What does treatment involve?
Patients with dizziness or imbalance should have a comprehensive clinical examination. This will be done by an experienced consultant audiovestibular physician with a special interest in imbalance.
Most attacks of vertigo may be diagnosed from an explanation of the patient’s experiences and an examination. A hearing test may be needed and, very occasionally, specialised balance tests or a scan of the ears or brain are helpful. Drug treatment may help to stop the vomiting and the worst of the vertigo. Dietary measures can help in both Meniere’s and migraine.
Persistent imbalance due to damage to one inner ear can be helped over a period by a programme of regular exercises (Cawthorne-Cooksey exercises) designed to induce mild dizziness on a regular basis. The purpose of the exercises is to retrain and recondition the balance mechanism in the brain. The brain learns to compensate and suppresses the dizziness.
Benign Paroxysmal Positional Vertigo can be completely cured by different manoeuvres aimed at repositioning the displaced chalk crystals, with 80% of patients cured by a single treatment. There are also self-administered procedures designed to reposition the displaced crystals. In the past a neck collar was sometimes advised: this should be avoided at all costs as it will delay or prevent recovery.
Precautions during treatment
Most drugs used to treat the symptom (rather than cause) of vertigo will cause drowsiness. They will make the sedative effect of alcohol worse and may impair the ability to drive. They may also delay the recovery process and should only be used for short periods of no more than a few weeks. Exercises are designed to induce vertigo and may actually make symptoms worse for a week or two before starting to help. It is vital to continue with the exercises through this period. Positioning manoeuvres used to cure positional vertigo can actually make a few patients slightly dizzy for up to two days. This is quite normal and is nothing to worry about.
What happens if the condition is not treated?
Most cases of vertigo improve on their own, even without treatment. However, this is likely to take a longer duration than with medical and therapeutic input. The main reason for seeking medical advice is to rule out the rarer but more serious causes, especially if there is hearing loss in one ear, and to start treatment in those conditions that may respond to specific treatment.
Vertigo is not generally inherited or infectious. It is unpleasant and worrying for the sufferer, and there may be a tendency to panic. However, as a rough rule of thumb, the more severe and unpleasant the vertigo, the more harmless the cause. Let the sufferer lie still and wait for the attack to subside. With a very severe attack, it may be worth asking the GP for anti-dizzy medication to relieve it.
For further information or to arrange an appointment please contact The Portland Hospital Audiology department on 020 7390 6573.
* With thanks to BAAP and Dr PDW West Consultant audiovestibular physician.What causes dizziness and do you need treatment? - The Portland Hospital Blog,