Dizziness is the third most common complaint among patients seen in outpatient clinics.  Patients may present to emergency departments, family practitioners, or specialty clinics.  Patients with chronic dizziness average four to six physician visits without resolution.  For some people, dizziness/vertigo is a feeling of unsteadiness, while others can experience the whole room spinning around them.  Many times patients can't quite explain what they are feeling, but they know there is something different.  Dizziness/vertigo can affect an individual's independence, ability to work, and their quality of life.  Often, people report that they feel dizzy, but what they are really feeling is unsteadiness on their feet.  Generally, if someone has feelings of nausea, wooziness, and a sensation of spinning, this is usually referred to as vertigo.   

                                                                

There are many different causes of dizziness.  Below is a list of some of the more common causes of dizziness.

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) IS one of the most commonly encountered causes of vertigo.  Fortunately, this is both easy to identify and treat.  BPPV does not respond to pharmacologic  intervention but is managed using appropriate repositioning techniques which are both noninvasive and basically fast to perform.  The typical symptoms of patients with BPPV is vertigo (spinning) with looking up or lying down in bed.  The vertigo typically lasts less than a minute. 

PRESYNCOPE is the uncomfortable, lightheaded sensation preceding fainting.  This feeling typically happens when you stand up too quickly.  A common cause of presyncope is orthostatic hypotension which happens when there is a slight drop in blood pressure as one stands after being in a sitting or a supine position.  As people age, orthostatic hypotension occurs more frequently.

DYSEQUILIBRIUM is a slight dizziness or imbalance not related to head position or activity.

                                                                     

PSYCHOLOGICAL DYSEQUILIBRIUM are typically temporary sensations which can be seen with increased anxiety or stress.  Hyperventilation syndrome accounts for the most common cause of dizziness among younger patients.

MOTION SICKNESS

ATAXIA is clumsy motion and unsteadiness due to lack of coordinated muscle movement.  Symptoms are typically present constantly and individuals often report that they feel like "they are drunk while walking."

SOUND-INDUCED VERTIGO-the inner ear is susceptible to loud sounds or rapid changes in pressure due to a lack of normal bony cover of the inner ear.  This can be seen in superior canal dehiscence and perilymphatic fistulas.

MENIERE'S DISEASE occurs in just under 1% of the population and is a disorder of the inner ear that affects both hearing and balance.  Symptoms are thought to occur due to an abnormal accumulation of the fluids of the inner ear.  Classic Meniere's disease is thought to comprise the following:  episodic vertigo with nystagmus, fluctuating low frequency hearing loss, unilateral tinnitus and aural fullness. 

MIGRAINE HEADACHES

VESTIBULAR NEURONITIS often presents after a recent cold or upper respiratory infection and the etiology is thought to be related to a viral infection of the vestibular nerve.  Vertigo typically lasts between 1 and 3 days.

LABYRINTHITIS is an infection of the entire inner ear which is similar to vestibular neuronitis with the addition of hearing loss and tinnitus. 

HEAD TRAUMA

CEREBROVASCULAR DISEASE

MEDICATIONS

METABOLIC DISORDERS such as uncontrolled diabetes, renal failure, hepatic failure, and altered ion homeostasis can induce a constant feeling of dizziness.

NEUROLOGICAL SYMPTOMS  Multiple cranial nerve deficits may be seen in patients suffering from strokes, tumors, vertebrobasilar insufficiency, and TIA's.   Patients with seizures and multiple sclerosis are also at increased risk for developing vertigo due to interactions with neural pathways. 

OTOTOXIC MEDICATIONS

NEUROLOGIC MEDICATIONS

ANTIHYPERTENSIVE MEDICINES include diuretics, beta-blockers, calcium channel blockers, and ACE inhibitors and can lead to orthostatic hypotension in patients.

ACOUSTIC NEUROMA is a noncancerous (benign) growth on the acoustic nerve, which connects the inner ear to the brain.