Dizziness, vertigo and balance disorders

About dizziness, vertigo and balance

Dizziness is one of the most common health problems for adults.

Dizziness can be a range of sensations including feeling light-headed, faint, woozy, giddy, unsteady, off-balance or weak.

Vertigo is a type of dizziness that feels as though you or your surroundings are spinning.

Dizziness is often caused by illnesses that affect the inner ear, such as benign paroxysmal positional vertigo (BPPV), migraine and inflammation of the inner ear balance apparatus (called vestibular neuritis).

While some people understandably find it difficult to describe their dizziness, a description of your dizziness and the circumstances in which it occurs may be very helpful in reaching a diagnosis.

Symptoms of dizziness

Descriptions of dizziness may include:

• a sensation of movement (including spinning), either of yourself or the external environment
• unsteadiness, including finding it difficult to walk in a straight line
• light-headedness
• feeling faint.

Other symptoms that may accompany dizziness include:

• headache
• nausea and vomiting
• fatigue
• ringing or other sounds in the ears (tinnitus)
• difficulty hearing
• staggering gait and loss of coordination (ataxia)
• unusual eye movements, such as flitting of the eyes (nystagmus)
• blurred vision
• finding it difficult to see clearly when moving, for example, when reading a sign while walking or driving
• difficulty concentrating.

Symptoms may be constant or come and go. Episodes can last from minutes to days.

Balance explained

Your sense of balance is controlled by signals to the brain about body movement and your position in relation to the environment. The brain integrates this information and sends signals back to the muscles on how to maintain balance.

Three sensory systems manage balance:

• vision
• proprioception – movement sensors in the skin, muscle and joints
• inner ears – the organ of balance in the inner ear is called the vestibular system. It includes 3 fluid-filled loops (semicircular canals) which respond to the rotation of the head. Near the semicircular canals are the utricle and saccule, which detect gravity and back-and-forth motion.

Good balance needs at least 2 of these 3 sensory systems working well. If one system is not working, the other 2 systems help keep you balanced.

If the brain can’t process signals from all of these systems, or if the messages are not functioning properly, you may experience a loss of balance.

Causes of dizziness

Dizziness rarely indicates a serious or life-threatening condition, even though it can be very disturbing and disabling. Symptoms can often disappear with no treatment.

Inner ear disorders cause about half of all dizziness cases including:

• Benign paroxysmal positional vertigo (BPPV) – involves intense, brief episodes of dizziness related to moving your head, often when turning over in bed or sitting up. It occurs when particles (otoconia) break loose and fall into the wrong part of the semicircular canals in the inner ear. This gives a sensation of spinning (vertigo). The cause of BPPV is not always known, but it may be a result of ageing or head trauma.
• Acute vestibular neuronitis or labyrinthitis – an inflammation of the inner ear causing sudden, intense vertigo that may persist for several days, with nausea and vomiting. This can be very disabling and may require bed rest initially. Fortunately, vestibular neuronitis generally subsides and clears up on its own. The cause of this condition is unknown but it may be a viral infection.
• Meniere’s disease – involves the build-up of fluid pressure in the inner ear. This leads to repeated sudden episodes of vertigo lasting 20 minutes or longer, with changing hearing loss, the feeling of fullness in the ear and buzzing or ringing in the ear (tinnitus). The cause of Meniere’s disease is unknown.
• Vestibular migraine – can cause vertigo lasting from minutes to days with or without headache. Attacks may be triggered by quick head turns, being in a crowded or confusing place, driving or riding in a vehicle, or watching movement on TV. Vestibular migraine may also cause unsteadiness, hearing loss, and ringing in the ears (tinnitus).
• Anxiety and stress – can intensify inner ear dizziness symptoms. Anxiety and stress are also the most common causes of dizziness that are not caused by the inner ear.
• Other causes – including brain related disorders and medical conditions such as low blood pressure.

Diagnosis of dizziness

In trying to work out the cause of a person’s dizziness, investigations may include:

• medical history, including careful questioning about the nature of the dizziness
• physical examination, which may include observing eye movements, positional testing and a blood pressure check
• specialised hearing or balance testing
• CT or MRI scans of the inner ear or brain
• other tests relating to specific conditions.

Treatment of dizziness

Treatment for dizziness and balance disorders varies depending on the diagnosis and severity. In mild cases, symptoms may go away on their own as the vestibular system heals or the body learns to adjust.

Treatments may include:

• medication
• changing your diet
• counselling
• simple home exercises
• physical therapy
• surgery, in rare cases.

Vestibular rehabilitation is a physiotherapy program that includes balance activities and eye movement exercises, easily practised at home. The activities restore the best use of your remaining vestibular function, vision, sensation in your feet and balance reactions to help maintain your balance.

Where to get help

• Your GP (doctor)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Neuro-otology Investigation Unit, The Royal Victorian Eye and Ear Hospital Audiology Service Tel. (03) 9929 8270