Dizziness

Symptoms of Dizziness

A person may be suspected to have dizziness if they suffer from the following:

• Giddiness, lightheadedness, or feeling faint.

• A sensation of abnormal swaying such as feeling of moving from side to side.

• A sensation where the person feels he/she is spinning or the world around him/her is spinning.

• A feeling of imbalance or loss of balance.

• A sensation of nausea (may or may not be accompanied by vomiting).

Types of Dizziness

Dizziness can be classified into four subtypes:

• Vertigo: The patient may feel as if he/she is spinning or the surroundings are spinning.

• Lightheadedness: This is a vague sensation in the head where the patient may feel that his head is floating or feels giddy.

• Disequilibrium: This is a disturbance in the balance or  coordination. It may affect the patient’s normal way of walking.

• Pre-syncope: This occurs when the patient feels like he/she will lose consciousness.
  
  

Causes Of Dizziness

Dizziness is a symptom that occurs in many diseases and may be caused due to many underlying disorders. It is important to correctly differentiate and determine the cause for dizziness as treatment varies with each cause.

I. Problems with the ear and vestibular system

The ear is the organ responsible for maintaining normal balance and equilibrium of the body. Problems in the ear and vestibular system can lead to vertigo, a type of dizziness. Multiple conditions can be associated with vertigo such as:

1. Benign paroxysmal positional vertigo (BPPV)

• Benign: not dangerous to health

• Paroxysmal: presents as a sudden, brief episode

• Positional: set off by particular head or bodily movements

• Vertigo: an internal sense of irregular or spinning movement either of oneself or of the surroundings
  
  

BPPV is the most common cause of vertigo. It is a harmless condition that presents as mild to intense dizziness lasting for a few seconds or minutes. It is often associated with a sudden change in the position of the head or body, like bending over, turning in bed, or sitting up. BPPV usually resolves on its own and is not serious.

The inner ear is a system of canals filled with fluid that lets the brain know about movements of the head. In BPPV, small calcium crystals in the inner ear move out of place. Hence, the system is not able to send the correct signals to the brain.

BPPV can happen because of a head injury or aging as well. The natural breakdown of cells that happens with age or during injury is thought to be responsible for this.

2. Meniere’s disease
This is a rare condition that causes severe vertigo, nausea, ringing in the ears, muffled or distorted hearing, hearing loss, and feeling of a plugged ear. This condition is characterized by excess fluid buildup in the inner ear. Meniere’s attacks usually happen suddenly and can last from 20 minutes to 24 hours. Patients also feel worn out after the attack passes.

3. Ear infections
Viral and less commonly bacterial infections can cause inflammation of the nerves in the ears. The vestibulocochlear nerve, a nerve in the inner ear, has two branches:

• The vestibular nerve sends signals to the brain about balance. Its inflammation leads to vestibular neuritis.

• The cochlear nerve sends signals about hearing. Its inflammation causes labyrinthitis.
  
  

This inflammation hinders the messages the nerves of the ear take to the brain. Hence, the symptoms of vertigo are experienced.

4. Acoustic neuroma (vestibular schwannoma)
It is a benign tumor that develops on the vestibular or cochlear nerves leading from the inner ear to the brain. The pressure on the nerve from the tumor may cause vertigo.

5. Vestibular migraine
Migraines are often characterized by painful headaches, however vestibular migraine may or may not involve headaches along with vestibular symptoms such as vertigo and imbalance. People with vestibular migraine do report common migraine symptoms such as sensitivity to light & sound. 

II. Problems with blood circulation

1. Hypotension or low blood pressure
Dizziness is commonly seen in people who have low blood pressure. Due to low blood pressure, enough oxygen-rich blood is not delivered to the brain, thereby affecting its function. This can lead to dizziness. Some of the common causes for low blood pressure are:

• Dehydration or loss of water during extreme summers, heat cramps, heat exhaustion, or heat stroke. Dehydration often occurs along with vomiting and diarrhea as well. Fever can also cause a remarkable loss of water due to elevated metabolic rate and profuse sweating when the body tries to cool itself.

• Anemia due to decreased production or increased destruction of red blood cells.

• Bleeding may cause loss of red blood cells and lead to anemia.

• Alcohol use

• Pregnancy
  
  

2. Postural hypotension (orthostatic hypotension)
If someone is dehydrated or anemic, blood pressure readings may be normal when they are lying down. However, when they sit up or stand up too quickly they may experience a brief feeling of lightheadedness. This feeling may go away in a few seconds as the body adapts. If dehydration or medications like beta blockers prevent the body from reacting, the dizziness may continue to the point at which the patient faints.

3. Heart diseases
Conditions such as cardiomyopathy, heart attack, heart arrhythmia, and transient ischemic attack could cause dizziness. 

III. Endocrine diseases

1. Diabetes
Uncontrolled diabetes is one of the main diseases that may cause dizziness.

• Hypoglycemia or low blood sugar can occur because of reduced food intake, or from overmedicating with diabetes medication. In this situation, the person experiences dizziness because the brain doesn't get enough glucose to function properly. 

• Hyperglycemia or high blood sugar levels may also cause dizziness due to dehydration. This happens due to lack of sufficient insulin to allow cells to use glucose for energy metabolism.
  
  

2. Thyroid diseases

 Abnormalities of the thyroid may also cause dizziness as a symptom.

• Hyperthyroidism or high levels of thyroid hormone may cause palpitations and lightheadedness.

• Hypothyroidism or low levels of thyroid hormone may lower blood pressure and heart rate leading to dizziness and weakness.
  
  

3. Addison's disease
 Addison's disease is a condition in which the adrenal glands do not produce enough cortisol to meet the demands of the body. If cortisol levels are low, a patient may experience weakness, low blood sugar, low blood pressure, and dizziness.

IV. Other causes

1. Neurological conditions
Rarely, the cause of vertigo may arise from the brain. Stroke, tumors, seizures, peripheral neuropathy, Parkinson’s disease, and multiple sclerosis may be associated with vertigo.

2. Trauma
Concussions and minor head trauma can also cause vertigo.

3. Certain medicines
Dizziness can be a side effect of certain medications such as antibiotics like gentamicin and streptomycin, anti-seizure drugs, antidepressants, sedatives, tranquilizers, antihypertensive drugs like beta-blockers, diuretics, ACE inhibitors & medications for erectile dysfunction.

4. Psychological disorders
Stress, anxiety, panic attacks, and depression can also cause dizziness when you hyperventilate or breathe too quickly.

5. Carbon monoxide poisoning
Symptoms of carbon monoxide poisoning may include nausea, vomiting, shortness of breath, dizziness, weakness, and confusion.

Risk Factors For Dizziness

Dizziness can happen to anyone at any point in time in their life. It may occur as a one-time, brief episode, or it may be long lasting with intermittent periods of symptoms. It is estimated that most people over the age of 40 might have experienced dizziness at least once in their lifetime.

Certain factors can increase the chance of dizziness such as:

1. Old age especially people over 65 

2. Being a woman

3. A medical history of past episodes of dizziness

4. Having a family member who has vertigo

5. Hyperlipidemia

6. Vitamin D deficiency 

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Diagnosis Of Dizziness

If a patient presents with symptoms of dizziness, a thorough history and detailed physical examination are key to diagnosis. Aggravating and relieving factors of dizziness along with other associated symptoms are assessed. Review of the past medical history and current medications the patient is taking is also done.

I. Blood tests

The requirement for blood tests depends on the cause of the dizziness. Common tests that are done are:

• Complete blood count (CBC) 

• Blood sugar tests 

• Electrolyte levels

• Thyroid tests

• Kidney function tests

II. Cardiac tests

Sometimes cardiac health needs to be assessed using the following tests to rule out any heart diseases that can cause dizziness:

• Electrocardiography (ECG)

• Echocardiography (Echo)

III. Imaging studies

Radio imaging tests may be performed to determine the cause of dizziness. The cause of such dizziness could be inner ear disturbances or other head and neck conditions, like cervical spondylosis, brain tumor, an insufficient blood supply to the brain. Some of the common tests that are recommended include:

• CT scan (head)

• CT neck plain

• MRI brain

• MRI brain with contrast

• MRI cervical spine

IV. Balance tests

These tests check for balance disorders by evaluating how the body responds to changes in posture. Vestibular system which is located in the inner ear along with the central nervous system is responsible for maintaining body balance. The following tests can be done to evaluate the functioning of these systems:

1. Rotary chair test

This test records eye movements while the patient is sitting on a rotational computerized chair. The test evaluates the vestibular system which regulates balance, posture, and the body's orientation in space. 

2. Computerized dynamic posturography (CDP)

This test is also called test of balance (TOB). It evaluates the ability to remain standing in either stationary or moving conditions.

3. Vestibular-evoked myogenic potentials (VEMP) test

This test assesses vestibular function by measuring the reaction of muscles to a repetitive sound stimulus.

4. Video head impulse test (vHIT)
The doctor will gently move the patient’s head to each side. Eye movements are recorded while the patient focuses on a stationary object like a spot on the wall. 

5. Vestibular test battery

A vestibular test battery includes several tests that will assess if vertigo is due to problems in the inner ear or due to some neurological cause. This helps in making an appropriate treatment plan.

6. Electronystagmography (ENG) and videonystagmography (VNG) tests

These tests record and measure the eye movements. In ENG, electrodes or small sensors are placed over the skin around the eyes. In VNG, special goggles are placed on the eyes. Patient is asked to look at and follow patterns of light on a screen. Patient is asked to move into different positions while watching the light pattern. Then warm and cool water or air will be put in each ear. This should cause the eyes to move in specific ways. If the eyes don't respond, it indicates damage to the nerves of the inner ear.

Prevention Of Dizziness

Dizziness may be caused due to a disturbance in the equilibrium mechanism regulated by the inner ear. It may also occur due to other head and neck conditions that affect balance or due to problems with nutrition and blood circulation. It is possible to prevent these spells of dizziness by avoiding certain activities like:

1. Avoid sudden movements of your head from one position to another, or stand up suddenly after lying down for a prolonged period.

2. Do not insert sharp objects or foreign matter deep into your ears for cleaning purposes, as it may damage the inner ear.

3. Always monitor your blood sugar levels closely if you are a diabetic on insulin therapy.

4. Drink plenty of water to avoid dehydration, especially in the summer season.

5. Closely monitor your blood pressure levels.

6. Certain medications may trigger spells of dizziness. In such cases, consult your doctor to make the necessary adjustments.

Specialist To Visit

Most cases of dizziness are mild and occur as a one-off episode. Such patients do not need to visit any doctor as the dizziness may often resolve on its own. However, if dizziness continues for a longer period of time and interferes with the ability to live a normal life, consult the doctor. Also, it is important to seek medical care if your dizziness is accompanied by nausea, vomiting, headaches, weakness in the hands or legs, difficulty in speech, or hearing loss. 

The specialist doctors who can diagnose and treat dizziness depending on the cause are:

• ENT surgeon

• Neurologist

• Endocrinologist

• Cardiologist
  
  

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Treatment Of Dizziness

Often, episodes of dizziness are mild and do not require any treatment as they resolve on their own. The treatment for dizziness is necessary when the episodes do not go away or are so severe that they interfere with a patient’s day-to-day activities. The treatment for dizziness depends on the cause and severity of symptoms. Here are some medicines which are generally suggested:

I. Dizziness due to vertigo

1. Betahistine
Betahistine is used to treat vertigo caused due to Meniere’s disease (a disorder of the inner ear that can lead to dizzy spells and hearing loss). It works by improving the blood flow in the inner ear and reduces the pressure of the excess fluid that causes the symptoms of vertigo

2. Antiemetics
This is a class of medicine that helps ease the symptoms of nausea and vomiting, frequently associated with vertigo. Medicines that are effective against nausea and vomiting associated with vertigo are:

• Promethazine

• Ondansteron
  
  

3. Antibiotics 
If the cause for vertigo is a middle or inner ear infection, then it must be treated with antibiotics to resolve the infection. Oral antibiotics and ear drops help fight bacterial infections of the ear, reducing the inflammation that causes vertigo.

4. Vestibular suppressants
These are medications that reduce the intensity of vertigo that occurs due to vestibular imbalance. There are three main categories of drugs:  

• Antihistamines are the most commonly prescribed medicines which help relief symptoms such as dizziness & prevent motion sickness
• Benzodiazepines like clonazepam and lorazepam are anti-anxiety medications that can also act as vestibular suppressants in low doses and help reduce the symptoms of an acute vertigo episode. These medicines are not routinely prescribed and their use is restricted to acute severe episodes of vertigo or to manage anxiety associated with vertigo.
• Anticholinergic drugs like scopolamine help with dizziness and motion sickness.
  
  

II. Dizziness due to problems with nutrition 

1. Electrolytes/glucose drinks
When the person starts feeling dizzy, in addition to the symptoms of cold extremities and profuse sweating, it may be due to reduced blood glucose levels or dehydration. In such situations, it is important to immediately offer the patient a rapid source of glucose and electrolytes.

2. Iron supplements
Correcting iron deficiency with iron supplements helps improve dizziness caused by anemia.

3. Medications as per diseases
Dizziness due to various conditions can be corrected by getting appropriate treatment for them.

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Home-care For Dizziness

A one-off episode of dizziness does not require any special care. However, if these episodes are severe and frequent, the patient needs to take utmost care. Some tips to circumvent dizziness are:

1. Avoid sudden, jerky movements of the head and neck.

2. When you feel dizzy, stop what you are doing immediately and sit down until it passes.

3. Lie down flat immediately when symptoms occur. This will allow blood to reach your brain quickly.

4. Rest as much as possible.

5. Change positions slowly, especially when you are standing up after lying down. Try to sit for a couple of minutes before standing up.

6. Drink plenty of water. Make sure you drink enough fluid, at least 8 glasses of water every day, unless advised otherwise by your doctor.

7. Take a healthy balanced diet comprising all the essential nutrients.

8. Closely monitor blood sugar levels in case of diabetes and if on insulin therapy.

9. Monitor blood pressure levels regularly.

10. Do not engage in activities that involve speedy movements such as driving or joy rides.

11. Avoid standing at high places or climbing a ladder. Avoid wearing high-heeled shoes as well.

12. Use walking aids such as a cane or walking stick, in case of severe dizziness and increased risk of falling.

13. Hold onto the railing when going up and down stairs.

14. Avoid driving or operating equipment or machinery while you feel dizzy as this could be dangerous to yourself and others.

15. Install hand grips in bathrooms and showers.

16. Remove clutter from the floor like rugs, loose electrical wires, etc.

Complications Of Dizziness

If dizziness is left untreated, the underlying cause may worsen and lead to several complications such as:

1. Increased falls due to loss of balance.

2. Accidents may occur, if the patient feels dizzy while driving or operating heavy machinery.

3. Loss of consciousness or fainting.

4. Hypotensive shock, if dizziness is due to extremely low blood pressure.

5. Ischemic stroke, if dizziness is due to poor blood supply to the brain.

Alternative Therapies For Dizziness

Some forms of dizziness such as vertigo, can benefit from alternative therapies such as:

1. Physiotherapy

Vestibular rehabilitation and balance training exercises, such as standing on a bosu ball or a tilt board, walking in S shape, standing with eyes closed, etc. are a specific set of exercises that can help improve balance. These can help decrease the chances of falls and dizziness.

2. Homeopathy

Homeopathic preparations such as byronia, cocculus indicus, etc., have shown that homeopathy is as effective as conventional medications in controlling the symptoms of vertigo.

3. Canalith repositioning maneuver

The canalith repositioning procedure can help relieve benign paroxysmal positional vertigo (BPPV). The doctor may guide you to perform simple head exercises called the Epley maneuver or canalith repositioning procedure (CRP). These help to get the dislodged calcium crystals back to their proper position. They are highly effective and most people feel better after one or three treatment sessions.

Living With Dizziness

Dizziness can affect the quality of life as it often imposes certain restrictions on an individual's lifestyle. As dizziness may be aggravated by sudden rapid movements of the head, a person with dizziness may not be able to enjoy adventure activities like joyrides. One may face aggravated motion sickness that may hinder traveling as well. 

Patients with other underlying health conditions such as low blood sugar, low blood pressure, anemia & neurological disorders, often face a lack of productivity due to the symptoms of dizziness and fatigue. 

Severe forms of dizziness that impair balance may lead to increased chances of falls and the complications arising out of falls. Patients with dizziness should not drive a car or operate heavy machinery to avoid any mishap.