Does it sometimes feel like the world is spinning around you? You’re not alone. Dizziness is a very common symptom, experienced by patients throughout the world. In fact, it is the third most common symptom reported to primary care physicians in the US, according to the National Institutes of Health. Due to a lack of understanding about symptoms and available treatment, dizziness is often incorrectly treated or ignored.
Is it vertigo, dizziness or imbalance?
Physicians and patients alike often do not understand the difference in these terms, which can prolong the work-up, and delay necessary treatment and relief for the patient. Stroke, heart problems, and hypoglycemia are very different conditions, yet may share similar symptoms of “dizziness.” It’s important that the terms “vertigo,” “light-headed,” and “imbalance” not be mistakenly used.
What’s the difference?
Vertigo: The whole-body sensation of uncontrollable spinning. Episodes of vertigo are usually disabling during their course.
Light-headedness: The feeling as if you are about to black-out or lose consciousness. There is no actual sensation of motion. This is common with blood pressure problems and hypoglycemia.
Imbalance: The inability to maintain balance; a feeling of disequilibrium. This is especially common among the elderly.
Of these descriptive terms, “vertigo” is usually the most disabling complaint. Vertigo is often caused by Benign Positional Paroxysmal Vertigo (BPPV). BPPV is due to loose calcium crystals in the balance canals of the inner ear. These tiny crystals are normally static (fixed), and are adherent to a gravity-detection organ in the ear. When they become loose, they move with gravity, causing a swirling motion of the fluid inside the inner ear.
Typically, a patient with BPPV will report that they have a violent spinning sensation that is provoked by head motion. It often occurs when rolling over in bed, looking up or down, or leaning back to have one’s hair washed at the beauty salon. The spinning sensation is violent, but brief, lasting no more than 15 seconds.
Fortunately BPPV is quite easy to treat if it is correctly identified by a physician or physical therapist. Get to the right physician first. An Otologist is a medical doctor (M.D.), with expertise in treatment of vertigo and disorders of the ear. Treatment is usually a series of gentle head and body movements that return the loose crystals to their proper place. Once this is done, the vertigo usually stops. Most patients with this condition are cured with only one treatment. BPPV is not treatable with any type of medication. BPPV is due to a mechanical dysfunction of the inner ear, and is treated by mechanical manipulation, not drugs.
Are there other types of “dizziness”?
Yes. Dizziness, light-headedness, vertigo and imbalance are all “symptoms” of underlying medical illness. It is extremely important that a qualified physician perform a complete medical evaluation. Not all physicians have expertise in treating “dizziness”, so be sure to ask if they specialize in treating disorders of the ear. An Otologist may recommend painless, non-invasive tests, including: hearing test, VAT and ENG, to assist in diagnosing the cause of the dizziness. These are tests that are used to check the function of the inner ears. Blood tests, CT or MRI scans or cardiology tests may also be ordered for certain dizzy symptoms.
In addition to BPPV, other common causes of “dizziness” include: Meniere’s disease, migraine variants, and presbystasis (age related dysfunction of the inner ear). As with any disease, curative treatment depends on making the proper diagnosis, and is different for each of these specific causes.
The good news is that most types of “dizziness” are treatable. Treatment may include dietary management, and occasionally medication or surgery. Many causes of “dizziness” are best treated with a specialized form of physical therapy called “Balance & Vestibular Therapy.”
Balance and vestibular therapy is rendered only by qualified physical therapist specialists who usually have many years of clinical experience and training. Therapy is one-on-one with a licensed physical therapist (not an aide) and usually 1-2x a week for several weeks. Exercises and techniques are dynamic and highly varied.
Advances in otology, as well as balance and vestibular therapy, enhance our ability to diagnose and treat all forms of dizziness. Working with the specialists in these fields will help eliminate dizziness, prevent falls, and restore one’s health and quality of life.
Dr. Kato is the founder of The Ear Institute in Palm Desert. Her top priority is improving the quality of life of her patients. Dr. Kato can be reached at: 760-565-3900.
Sources: Bhattacharyya N, Baugh RF, Orvidas L et al. (2008). “Clinical practice guideline: benign paroxysmal positional vertigo” (PDF). Otolaryngol Head Neck Surg 139 (5 Suppl 4): S47–81.; Korres, S. G., & Balatsouras, D. G. (2004). Diagnostic, pathophysiologic, and therapeutic aspects of benign paroxysmal positional vertigo. Otolaryngology – Head and Neck Surgery, 139(5), 438-444.; Epley JM. The canalith repositioning procedure: For treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992 Sep;107(3):399-404.;Vestibular Disorder Association www.vestibular.org