Finding balance: Is it dizziness or vertigo?


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Patients experiencing dizziness can find diagnosis and treatment options

Many of us take our good balance for granted, but when it is impaired and the world seems to be spinning, the effects can be disabling.

It is estimated that at least half of people in the United States are affected by a balance disorder in their lifetimes. Dizziness is not a disease, but a symptom. As we age, incidents of dizziness tend to increase due to changes in blood pressure, side effects of medications, or more serious events such as head injury or stroke. Some episodes occur out of the blue, with no discernible cause. 

Some cases of dizziness are caused by vertigo, a medical condition that causes people to feel as if they’re swaying or spinning when they’re not moving. Vertigo can be debilitating to daily life activities and can even be dangerous when dizzy spells lead to falls. There are different types of vertigo, and confirming a diagnosis can lead to effective treatment. 

What causes vertigo and how it’s diagnosed

The inner ear is imperative to balance. Within the inner ear is the cochleovestibular system – the primary system of balance. This system includes the snail-shaped cochlea. Attached to the cochlea are three semicircular canals, the saccule, and the utricle that form a system that carries sensory messages to the central nervous system through tiny hairs suspended within fluid in the ear. When the vestibular system is working normally, this information describes where you are physically and spatially in relation to the rest of the world. When it’s impaired, your balance will be affected.

Because vertigo can be serious, we encourage patients to request an appointment at the first sign of dizziness or impaired balance. During the exam, we’ll ask a few questions about your symptoms, such as:

  • What triggers the dizziness?
  • How often does it occur?
  • How long does it last?
  • Is it associated with movements of your head?
  • Did an injury precede the symptoms?
  • Are you nauseous?
  • Do you have a headache?
  • Did you start a new medication or adjust doses to a drug you’ve been taking?

These questions help us determine if you are experiencing vertigo or if your dizziness is related to something else. If we suspect you have vertigo, we must determine what type it is to get you the proper treatment. Two of the most common forms of vertigo are benign paroxysmal positional vertigo (BPPV) and Meniere's disease.

Types of vertigo

Benign paroxysmal positional vertigo (BPPV)

We all have fluid within in our semicircular canals. If you have BPPV, tiny crystals can form in this fluid. If these stones settle, they can push on the hairs in the wrong way. This causes the sensation of movement when there is none, which can be debilitating.

We explain BPPV to patients like this:

  • Benign – meaning it is not life-threatening, even though the symptoms can be intense and disruptive.
  • Paroxysmal – often occurring in sudden, short spells.
  • Positional – head positions and/or movements can trigger a spell.
  • Vertigo – the feeling that you or the world around you is spinning. 

BPPV causes common and distinctive symptoms. Some of these include nausea or vomiting, severe disorientation, instability, or a spinning sensation triggered by head movements. BPPV episodes can be intense but often last only a few minutes. Treatment often includes therapy exercises to alleviate symptoms. 

In our office, we will safely trigger an episode of vertigo to determine what causes your symptoms and whether you have BPPV. Once we have a diagnosis, we can use controlled exercises to move the floating stones back to where they belong so your symptoms will subside. 

Meniere's disease 

Another form of vertigo is Meniere's disease. This disorder is much less common than BPPV, and its symptoms are different:

  • Severe spinning sensations lasting much longer – 20 minutes to several hours
  • Ringing in the ear(s), tinnitus, hearing loss
  • Pressure, fullness in the ear(s)

In the U.S., Meniere's disease is most likely to occur in adults between ages 40 and 60, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). Each year 45,500 new cases are diagnosed.

There is no test to confirm Meniere's disease, so we measure on a gradient of possible to probable based on a compilation of symptoms. There also is no agreement on the exact cause of Meniere's disease, but a prevalent theory is that swelling in the inner ear interferes with the normal hearing and balance signals between the inner ear and the brain.

Treatments for Meniere's disease begin with diet changes, such as lowering salt intake, as well as medications based on symptoms, such as diuretics or antihistamines. We commonly treat Meniere's disease with injections of steroids or antibiotics into the middle ear. The need for surgery is rare, but when it’s required, our surgeons can place a shunt in the ear or surgically alter the vestibular nerve to manage dizziness and related symptoms.

The inner ear is a delicate balance of tiny nerves, fibers, and tissue. Don’t risk falling or struggling with dizziness that interferes with your quality of life.