Dizziness is the most common medical complaint in patients over 50 years of age. The average age of patients evaluated in the emergency room for dizziness is 70 years. It is also the most common cause of falls in this age group. Vestibular disorders are responsible for 85% of patients complaining of dizziness.
Dizziness is one area where doctors and patients fail to see eye to eye. People are seen by multiple specialists and end up with different opinions which often lead to extreme frustration on the patients’ part. Accurate diagnosis is crucial for increasing safety and minimizing direct health-related issues.
The evaluation of the dizzy patient is further complicated by the patient’s inability to accurately describe his or her complaints, the number of intricate neurological systems involved in balance, and the poor availability of specific diagnostic tests for vestibular disease. A systematic assessment combining a problem-focused approach with appropriate testing can be a very cost-effective way of arriving at a specific diagnosis.
The vestibular system is an equally paired system on each side of the head comprised of three physiologically distinct semicircular canals perpendicularly oriented to one another’s plane in space (horizontal, anterior, posterior) and the otolith organs (named the utricle and saccule) in the inner ear, each of which perform a specific function including the detection of head motion, the detection of head position and relative eye movement at any given point for compensatory binocular vision. The pairing of these vestibular organs on either side of the head makes this system functionally unique. Neither works alone, and the brain is always comparing one side with the other. When there is a significant side-side asymmetry, the brain interprets the imbalance as movement. When there is a bilateral decrease in function simultaneously, there is an inability to detect motion, which in turn is interpreted as a visual illusion or oscillopsia.
Symptoms described as dizziness include vertigo, light-headedness, imbalance, and visual disorientation. Vertigo is the illusionary sensation of motion, described by the patient as subjectively moving or their surroundings moving about them. A lesion anywhere in the vestibular system from the inner ear to its connections in the brain may be responsible. Acute vertigo is sometimes a warning sign of an impending stroke and requires urgent attention.
Visual disorientation typically accompanies head trauma following vestibular loss, though anxiety and patients affected with migraines also have reported this symptom (though migraine patients typically have motion sickness or intolerance of visual motion).
Light-headedness should be distinguished from vertigo and visual disorientation. It usually precedes a fainting spell and is commonly associated with dimming of vision, excessive sweating, feeling cold, and having loss of color. The subsequent loss of consciousness is a result of decreased blood pressure and is usually a sign of non-vestibular disease.
Imbalance is the inability to maintain the center of gravity and could be a sign of serious brain disease but is usually a result of decreased sensory input into the balance centers in the brain.
Once your doctor has examined you and determined the probable causes of your dizziness, you may require pertinent diagnostic tests most of which are performed in our office for your convenience. These may include:
- Audiometry or hearing test
- Electronystagmography (ENG), which evaluates your balance, equilibrium and posture with relation to your visual reflexes
- Auditory Evoked Potential (AEPs), which tests the integrity of the inner ear and the brain by means of electrical conduction and their interplay
- MRA brain scan to evaluate the brain circulation may be a useful adjunctive test which could add useful information to determine the cause of your symptoms. Testing the cardiovascular system for patients complaining primarily of light-headedness, and specific blood tests like thyroid functions may also need to be performed to arrive at an accurate diagnosis.
Note: please bring pertinent testing done outside to your doctor’s appointment to help us assist in your diagnosis.
The mainstay of treatment for acute vertigo involving the inner ear is vestibular therapy performed by skilled therapists. Please ask your doctor about these specialized treatments. A comprehensive vestibular rehabilitation program, including the use of the Epley maneuvers are available to you at MNA.
Remember that migraine headaches could cause dizziness and preventative intervention can save considerable frustration and the cost of unnecessary testing. Ask your treating physician about the various treatments available for migraines.
Primary ENT disorders like Meniere’s disease and Endolymphatic leaks need specialist referral and treatment.
Psychological problems like anxiety and panic attacks can sometimes cause intense dizziness and often respond to appropriate psychiatric counseling and medical management.
Common medical illnesses like diabetes, high blood pressure and thyroid disease can be associated with dizziness and respond to medical treatment.
Finally, medication like sedative-hypnotic drugs and Meclizine (Antivert) should not serve as long-term treatment for dizziness as they impair vestibular compensation. Please bring a list of all your medications, including over-the-counter medications to your doctor, as over 1,000 rugs listed in the PDR have dizziness, vertigo, or light-headedness as possible side effects.
For more information, please contact the American Neurotology Society, the official organization for balance and vestibular disorders in the United States.