Preface

"Dizziness" is a general term, and in usage can mean either vertigo or faintness (incomplete passing out).

Vertigo has been defined as an illusion of movement. This illusion can be a sensation of rotation, linear movement or tilt. Faintness, on the other hand, involves at least a partial loss of consciousness.

True vertigo is frequently accompanied by symptoms of "imbalance" and/or "nausea" (giddiness), the sensation we get on carnival rides.

Vertigo is due to a recent insult to the balance system, usually occurring in the inner ear. Faintness is usually of central vascular origin (inadequate blood supply to the brain), as occurs to the person standing for a prolonged time on a hot day.

Thus, most dizziness is vertigo, and most vertigo originates in the inner ear. At least 90% of vertigo is caused by one of the following four common dizziness syndromes (combinations of signs and symptoms) caused by malfunction of the inner ear.

Benign paroxysmal positional vertigo (BPPV)

Symptoms: Brief (seconds), violent attacks of vertigo after moving the head into certain positions. Typically occurs after lying down, turning to a particular side, or after leaning the head forward.

Mechanism: Abnormal loose heavy particles in a semicircular canal that affect the sensors for rotation.

Cause: Trauma, prolonged inactivity, other ear disease. Mostly unknown.

Diagnosis: When the head is placed into positions that provoke vertigo, a characteristic nystagmus (involuntary eye movement) is observed.

Treatment: The Epley repositioning maneuvers are the treatment of choice worldwide. (Also called canalith repositioning, or particle repositioning.)

This treatment is designed to move the particles to an area where they no longer produce symptoms. In the few cases that are resistant to the Epley Maneuvers, treatment with a positioning apparatus under IR video observation (e.g. the OMNIAX) can be effective.

Meniere’s Disease (Endolymphatic hydrops)

Symptoms: Acute, spontaneous (no apparent reason) attacks of spinning vertigo (minutes to hours) accompanied by ringing and pressure in a particular ear, with temporary decrease in hearing. Symptoms clear between attacks, but in the late stages (months to years of attacks) the hearing loss becomes permanent. Also, the other ear may become involved later.

Mechanism: Swelling of the inner compartment (endolymphatic) of the inner ear.

Cause: Unknown, but there are probably many causes (trauma, viral infection, immune-mediated).

Treatment: Diet: avoid salt and caffeine. Medication: diuretics. Surgery: endolymphatic shunt (valve). New: transtympanic medication (Corticosteroid, Gentamicin, Streptomycin) shows great promise.

Post-traumatic vertigo (Inner ear concussion)

Symptoms: Onset sometime after minor head trauma (or severe shaking such as whiplash), of constant lightheadedness, imbalance and short-term memory loss. May take weeks or months to develop.

Mechanism: Probably a derangement of an otolith organ (gravity sensor), causing it to be receptive to pressure changes and sound within the body or in the environment. This uncontrollable and constant abnormal input into the brain causes a disruption of balance function, and in many cases, a secondary cognitive dysfunction. The delayed onset and response to corticosteroids suggests an autoimmune factor.

Cause: Concussion (severe shaking) of the inner ear, probably followed later by an inflammatory response. A leak from the inner ear (perilymph fistula) may interfere with recovery.

Differential: Often confused with brain concussion, which generally is at its worst immediately after the traumatic incident and then gradually recovers. The symptoms of inner ear concussion may not even be apparent immediately post trauma, but gradually develop or increase over the ensuing weeks to months.

Treatment: Surgical closure of fistula, if present. New: Transtympanic medication, to correct the inflammation and/or decrease the abnormal sensitivity, has proven very effective.

Vestibular Neuronitis ("Acute labyrinthitis")

Symptoms: Acute onset, often following a flu-like illness, of severe spinning vertigo. No hearing loss or tinnitus. Recovery occurs gradually over a period of days to weeks.

Mechanism: Usually an inflammation of a vestibular nerve, the nerve that serves the balance mechanism in the inner ear.

Diagnosis: Spontaneous nystagmus (a jerking movement of the eyes), no loss of hearing (usually), no other signs of neurological disease.

Differential: Often confused with the first attack of Meniere’s Disease or BPPV. Must rule out impending neurologic disease.

Treatment: Anti-nausea medications (Meclizine, Valium, etc.) for control of symptoms in the acute phase only. After that, they may interfere with compensation and recovery. A short course of corticosteroid and anti-viral medication often promotes recovery.

Home  |  Balance System 101  |  Common Syndromes  |  Dizziness from A to Z
Dizziness Q & A  |  EarInfo Column  |  New Advances  |  Other Vertigo Resources
Hearing Loss Q & A  |  Tinnitus  |  Other Hearing Resources
Related Books  |  The Portland Otologic Clinic
About Dr. Epley  |  The "Epley Maneuvers"

Please report any bugs or comments
about this site to webmaster