Dizziness

Definition

Dizziness is a general term for a feeling of light-headedness, unsteadiness, or that the world is moving or spinning.

Description

Feeling dizzy is a sensation familiar to almost everyone. Although rarely dangerous itself, dizziness can be a warning of a medical problem or drug side effect. Medically, dizziness is divided into four categories of sensation: vertigo, imbalance, lightheadedness, and near-fainting.

• Vertigo is the false sensation or hallucination that the world is spinning. This is one of the most common feelings people describe as dizziness.
• Imbalance, also called disequilibrium, is the feeling of being unsteady and off center when walking.
• Lightheadedness is the feeling of being “spacy” or “out of it.” Some people describe it as a feeling as if their head is revolving.
• Near fainting is the feeling that one is going to lose consciousness.

Demographics

Dizziness, vertigo, imbalance, and near fainting are common complaints in about one-quarter of people over age 65 without respect to gender, race, or ethnicity. This number increases with increasing age.

About 8% of elderly patients have diagnosed benign positional vertigo (BPV), a type of vertigo that occurs when the individual moves in certain ways. Meniere's disease, a more severe type of vertigo, occurs in about one of every 10,000 people and is age independent. The incidence of other causes of dizziness is difficult to determine because episodes are often brief and improve without treatment. Some studies estimate that more than 2 million people visit the doctor each year because of symptoms of dizziness.

Causes and symptoms

The eyes, the vestibular system within the inner ear, and motion sensors, pressure sensors, and nerves that help the body recognize how it is oriented in space all work together to maintain balance. Of these, problems within the inner ear are most likely to cause vertigo.

Vertigo has several causes, most related to disruption the balance mechanisms within the inner ear. These include:

• Benign positional vertigo (BPV). This is the most common type of vertigo. With BPV, a spinning sensation occurs whenever the person changes position. Episodes of vertigo are often brief, lasting only 5–15 seconds, but can be quite disturbing. People with BPV do not have hearing loss or ringing of the ears (tinnitus). The condition usually improves on its own, but can reoccur.
• Meniere's disease. Vertigo in Meniere's disease is caused by excess fluid in the inner ear. The periods or vertigo can last for several hours. People with Meniere's disease often have ringing in the ears and intermittent hearing loss. The cause of this disease is unknown.
• Inner ear infections. When the inner ear becomes inflamed, severe vertigo accompanied by nausea and vomiting can result. The condition is usually incapacitating; all the individual can do is try to lie motionless in bed. The cause is unclear, although a virus is suspected. There is no treatment. The condition eventually clears up on its own.
• Vestibular migraine. People who have migraines are often sensitive to motion. Conditions that trigger migraines may trigger vertigo instead of a headache.
• Acoustic neuroma. This non-cancerous growth on the acoustic nerve that transmits signals from the ear to the brain can cause vertigo, loss of balance, hearing loss and ringing in the ears.

QUESTIONS TO ASK YOUR DOCTOR

• What is causing my dizzy spells?
• Is the medication I am taking contributing to my dizziness?
• When I have vertigo, I also feel nauseated and sometimes vomit. Is there anything I can do to treat this nausea?
• Do I need to be referred to a specialist?
• What kind of precautions can I take in the home to prevent falling during a dizzy spell?

Imbalance, also called disequilibrium, is the feeling of being unsteady and off center when walking. This can be caused by some inner ear abnormalities such as acoustic neuroma, but also by impaired vision, muscle and joint weakness, and certain medications. Imbalance greatly increases the risk of falling, a major problem for the elderly.

Lightheadedness is the feeling of being “spacy” or “out of it”. Some people describe it as a feeling as if their head is spinning or disconnected from their body. Lightheadedness can be caused by inner ear problems, mood disorders such as depression and panic attacks, or as a side effect of medications. It can even be caused by extreme sleep deprivation. Often no specific cause can be found.

Near fainting is the feeling that one is going to lose consciousness. It is caused by a temporary period of inadequate blood flow to the brain. Orthostatic hypotension, for example, is a drop in blood pressure that occurs when a person stands up. It causes a momentary feeling that the individual is going to faint. Near fainting can also occur in individuals with atherosclerosis or heart arrhythmias .

Diagnosis

More than with many disorders, the patient's description of the sensation of dizziness and the patient's impression of what triggers a dizzy spell are important clues in arriving at a diagnosis. In addition to a health history , the physician will do a complete medication history, as dizziness is a side effect of many medications. The patient will also be questioned about whether any other symptoms such as nausea or ringing of the ears accompany the dizzy spells.

During a physical examination, the doctor will take blood pressure readings with the patient standing, sitting, and lying down. The patient may be asked to move the head and body in certain ways to try to reproduce dizziness symptoms. If heart disease is suspected, the patient may be referred to a cardiologist for additional cardiac tests. If the cause is unclear, the physician may refer the patient to an ear, nose, and throat specialist for tests on the inner ear.

Treatment

If an underlying problem is found, such as heart disease, infection, or vision problems, that condition is treated. Medication changes also can reduce or eliminate dizzy spells. Often, however, the problem simply goes away without treatment, although it may reoccur.

Therapy

Some people find relief in vestibular rehabilitation exercises. These involve moving the eyes, head, and body in certain sequences. They are usually taught by a physical therapist .

Prognosis

The outcome depends on the cause of the dizziness. If a treatable underlying disease causes the condition, the dizziness may be permanently eliminated when the underlying condition is treated. Some disorders such as Meniere's disease are life long. Often dizziness clears up on its own for a while and then reappears in an irregular pattern.

Prevention

There are no specific ways to prevent dizziness. However a regular review with a pharmacist or physician of medications being taken can reduce the chance of dizziness being caused by medication side effects.

Caregiver concerns

Dizziness in the elderly can contribute to falls that lead to broken bones and disability. Care givers can make accommodations in the home such as grab bars in the shower to minimize the possibility of falls. Use of a well-fitted cane or walker also can help prevent falls and give confidence to people with disequilibrium. Care givers also need to monitor medication usage.

KEY TERMS

Arrhythmia —An abnormal heart rhythm

Atherosclerosis —In this disease, deposits of fatty materials build up on the walls of arterial blood vessels, causing them to narrow or become obstructed. Blood pressure increases, leading to heart disease.

Inflammation —The body's response to tissue damage. Includes warmth, swelling, redness, and pain in the affected part.

Resources

BOOKS

Bronstein, Adolfo M., and Thomas Lempert. Dizziness: A Practical Approach to Diagnosis and Management. New York: Cambridge University Press, 2006.

Poe, Dennis. The Consumer Handbook on Dizziness and Vertigo. Sedona, AZ: Auricle Ink Publishers, 2005.

OTHER

“Dizziness.” Aging in the Know. undated [cited April 6, 2008]. http://www.healthinaging.org/agingintheknow/chapters_print_ch_trial.asp?ch=23.

“Dizziness.” Mayo Clinic. July 12, 2006 [cited April 6, 2008]. http://www.mayoclinic.com/health/dizziness/DS00435.

“Dizziness.” MedlinePlus. April 3, 2007 [cited April 6, 2008]. http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm.

Friedman, Marc and Mohamed A. Hamid. “Dizziness, Vertigo, and Imbalance.” eMedcinie.com. February 21, 2007 [cited April 8, 2008]. http://www.emedicine.com/neuro/TOPIC693.HTM.

Haith, William L. “Dizziness.” eMedicineHealth.com. August 10, 2005 [cited April 6, 2008]. http://www.emedicinehealth.com/dizziness/article_em.htm.

ORGANIZATIONS

American Geriatric Society Aging Foundation for Health, 350 Fifth Avenue, Suite 801, New York, NY, 10118, (212) 755-6810, (800) 563-4916, (212) 832-8646, http://www.healthinaging.org.

American Heart Association, 7272 Greenville Avenue, Dallas, TX, 75231, (800) 242-8721, http://www.americanheart.org.

Helen Davidson