Dizziness, Vertigo, and Imbalance

Dizziness, vertigo and balance disorders

We rarely think about balance even though it guides our every waking moment. So when the ground suddenly feels unstable, the body seems wobbly or the world starts spinning, it can be a frightening experience.

                                   

About 40 percent of Americans will deal with some form of dizziness or balance difficulties over the course of a lifetime, according to the National Institute on Deafness and Other Communication Disorders.

Vertigo

                                            

What Is It?

Vertigo is the sensation that either your body or your environment is moving (usually spinning). Vertigo can be a symptom of many different illnesses and disorders. The most common causes of vertigo are illnesses that affect the inner ear, including:

• Benign paroxysmal positional vertigo — In this condition, a change in head position causes a sudden sensation of spinning. The most likely cause is small crystals that break loose in the canals of the inner ear and touch the sensitive nerve endings inside.
• Acute labyrinthitis, also called vestibular neuritis — This is an inflammation of the balance apparatus of the inner ear, probably caused by a viral infection.

• Symptoms

  Vertigo can feel like the room is spinning or like you are spinning in the room, or it can be just a sense of imbalance. It may be associated with nausea, vomiting and ringing in one or both ears (tinnitus).

                                     

• Diagnosis

  Your doctor will diagnose vertigo based on your description of what you are feeling. Vertigo can be divided into two major categories, peripheral vertigo and central vertigo.
  Peripheral vertigo, which is much more common, includes benign positional vertigo, labyrinthitis and Ménière's disease. Positional vertigo is diagnosed when moving the head causes the vertigo and returning the head to a neutral position relieves symptoms. Labyrinthitis and Ménière's attacks usually come on abruptly and last from a few hours to a couple of days. There may be intense nausea and vomiting and variable hearing loss.
  Central vertigo is a more serious problem in the cerebellum (back part of the brain) or brain stem.
  Your doctor will evaluate your eye to look for abnormal jerking movements (nystagmus). The pattern of your eye movements may help to determine if the problem is peripheral or central. Usually, no further testing is needed unless your doctor suspects you have central vertigo. If central vertigo is suspected, your doctor will order a computed tomography (CT) scan or magnetic resonance imaging (MRI) of your brain.

• Expected Duration

  Depending on its cause, vertigo may last only a few seconds or last for weeks or months.

  Prevention

  Vertigo can happen to anyone, and there is no way to prevent the first episode. Because vertigo can be associated with an intense sense of imbalance, it is important to avoid situations in which a fall could cause significant harm, like climbing a ladder or working on a slanted roof.

  Treatment

  Your doctor may begin treatment by recommending bed rest or prescribing medications that suppress the activity of the inner ear, such as meclizine (Antivert, Bonine and other brand names), dimenhydrinate (Dramamine) or promethazine (Phenergan); anticholinergic medications such as scopolamine (Transderm-Sco); or a tranquilizer, such as diazepam (Valium). Depending on the cause and duration of the vertigo, additional advice may be offered.
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