Ear, Nose & Throat

Dizziness and Vertigo

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Dizziness and Vertigo

There are a multitude of causes of dizziness which may have nothing to do with the balance organ in the inner ear.

Fainting attacks, heart problems, thyroid problems and brain problems can all give rise to feelings of light-headedness, giddiness and general imbalance.

One form of dizziness is vertigo which is the specific complaint of either the environment moving in relation to the patient or the patient moving in relation to the environment. It is usually a spinning or rotatory sensation. Vertigo is specifically linked to problems with the inner ear. Of the people who suffer from vertigo due to inner ear problems, 99% will recover with time and without any treatment.

Normal Balance

  • Balance and the ability to remain upright is dependent upon three systems
  • Eyes
  • Feet, legs and neck,
  • Inner ear.

All three of these systems give information to the brain about the position of the body in space. Generally people can keep their balance if two of the three systems are working, but they cannot cope with only one system working. This is why most people tend to become more unsteady as they get older, because they may have arthritis in their legs and their neck or poor eyesight.

The balance organ (or labyrinth) is made up of three semi-circular canals and the vestibule, which are all filled with liquid. The semi-circular canals sense rotational movement and the vestibule senses acceleration and deceleration.

Many different factors can affect the inner ear and cause vertigo. One way to distinguish them is by the duration of the dizziness.

Short-lived episodes of dizziness (few seconds to minutes)
An extremely common type of vertigo is benign positional vertigo. This is typically a very sudden onset of dizziness, which settles rapidly after a few seconds or at most a couple of minutes.

It is often started off by the person suddenly looking upwards or sideways, and some people get it when they turn over in bed. In between attacks, the sufferer feels entirely normal. It is probably caused by a little piece of lining coming loose in the inner ear and floating into the balance receptor, causing a sudden increase in nerve stimulus to the brain.

Sometimes the attacks start following a whiplash injury or other head injury, but often there appears to be no reason that they should have started. The attacks usually disappear with time.

Medicines do not help, but a manoeuvre known as Epley's Manoeuvre can be extremely effective in some patients. This can be carried out either by the ear nose and throat surgeon or physiotherapy department, depending on the hospital.

Medium length episodes of dizziness (half-hour to several hours)
These types of vertigo are rarer and are thought to be due to an increase in pressure of the fluid in the inner ear, although nobody really knows for sure.

When dizzy episodes are linked with vomiting, and the sufferer can often tell an episode is about to start because he or she notices a drop in their hearing, a feeling of fullness in the ear and some tinnitus, your Ear Nose and Throat surgeon should be contacted immediately.

Longer episodes of dizziness: (days to weeks)
An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks under the care of your Ear nose and throat surgeon.

Investigations
The majority of patients who experience episodes of vertigo will recover without any long-term ill effects and usually within a few weeks or month of the onset of the symptoms.

In the majority, specialist investigations do not help with the diagnosis but they can be helpful in certain circumstances. If they are thought necessary, investigations of vertigo will generally be carried out in a hospital by a neurologist, general physician or ear nose and throat surgeon or a audiological physician. Types of test that may be requested include: audiological (hearing) tests, tests of balance, blood tests (rarely), and radiological examinations such as an MRI scan or CT scan.

Treatment
In general, treatment is given to control the symptoms without regard to the specific cause of the vertigo. The body is very good at overcoming the imbalance experienced during inner ear disease, and so symptomatic treatment should be short because it can delay this natural compensation.

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