Dizziness Calls for Fact-Based Treatment

Dizziness can be more than a literally dis-orienting experience. It can get downright frightening when the room starts spinning, you lose any sense of balance, and a powerful wave of nausea grips you.

Dizziness is a widespread problem, at some point affecting 40% of Americans at a level requiring a visit to the doctor.

"Complaints of dizziness are very common, but the causes vary greatly," notes David R. Friedland, MD, PhD, Medical College of Wisconsin Assistant Professor of Otolaryngology and Communication Sciences. Dr. Friedland practices at the Froedtert & The Medical College of Wisconsin Otolaryngology and Communication Sciences Clinic.

"In the case of vertigo (typically experienced as a spinning sensation), most likely it's vestibular - a problem that begins in the inner ear," says Dr. Friedland. "Sometimes the sense of dizziness or light-headedness is more likely to be a metabolic or physiological problem.

"Heart problems, the level of blood sugar associated with diabetes, blood pressure medications, allergies, or stress and anxiety can all cause dizziness," says Dr. Friedland.

"Ironically, I find that stress and anxiety often occur as a cause of dizziness among people who say, 'I'm handling it well,' observes Dr. Friedland. "It turns out that their brains need some kind of release."

Diagnosing the source of the problem begins with a thorough history, says Dr. Friedland. "We look closely at the type of dizziness the patient is experiencing," he explains. "For example, is it an imbalance or more of a fogginess? Is it continuous or sporadic?

"We also look at the intensity of the sensation, and its associated symptoms. Is there a sense of aural fullness, that is, the ears feeling full? Are there headaches? Heart palpitations? We consider all these things.

"From there, we move to specific testing," explains Dr. Friedland. Much of the testing focuses on the inner ear. "The inner ear receives information on how you move, telling the brain and eyes how you move your head."

The Inner Ear as a Gyroscope
The inner ear is a complex area that acts as a kind of gyroscope, carefully maintaining proper balance and keep the eyes moving appropriately to a changing environment.

Testing may include a video "nystagmogram" to record and measure eye movements, the application of air or water to the inner ear to see if dizziness results, hearing examinations aimed at determining the patient's overall inner ear function, and "posturography," which measures the body's response to a swaying platform.

The two most common inner-ear disturbances cause forms of vertigo. The first type - called vestibular neuronitis or labyrynthitis - produces sudden, intense vertigo sometimes associated with nausea and vomiting or hearing loss that can last hours, days, or in a milder form, even several months. Usually, vestibular neuronitis is believed to be the result of a virus that follows a mild upper respiratory infection. "When a patient is hit with this, we may sometimes direct them to an emergency room to rule out a stroke," says Dr. Friedland.

Treatment for this form of vertigo is relatively simple. "We give them medication for the dizziness, with low-dose valium being the best in my experience," Dr. Friedland says. The medication most typically used to treat nausea is phenergan, a drug that is also used to prevent motion sickness.

"Then we put them on a program of physical therapy with specific activities to get the sense of balance working again. Some physicians may prescribe meclizine, which is an anti-histamine." This drug is also used against the symptoms of nausea, vomiting, and dizziness from motion sickness and vertigo.

Crystals in Ear
The second main type of inner-ear problem is known as BPPV: benign paroxysmal positional vertigo. "With this form, we see 10- to 30-second instances of vertigo, presented by tilting of the head and other head movements. BPPV results when the small calcium carbonate crystals in the inner ear get dislodged and balance is affected.

"The treatment for this is mechanical," says Dr. Friedland. "We simply rotate the head to restore the crystals to their proper places. This kind of treatment has proven about 90% effective."

Another inner-ear disorder is Meniere's Disease, which involves episodes of vertigo lasting from minutes to hours and fluctuations in the ability to hear. It is often associated with tinnitus, a condition in which people hear ringing, roaring, buzzing or clicking in their ears.

Preventive Steps: The 'FACTS'
While people who experience dizziness sometimes feel there is nothing they can do to gain control over their symptoms, there are a set of preventive concepts to keep in mind. Dr. Friedland and his colleagues call these points of awareness the FACTS:

• Fatigue: don't push yourself past the point of exhaustion.
• Alcohol: avoid overusing alcoholic beverages.
• Caffeine: use with restraint.
• Tobacco: avoid entirely if possible, but minimize use if you can't kick your habit.
• Salt: use in very low amounts.

Sticking to the FACTS, along with proper diagnosis and medications, can go a long way toward relieving the distress and anxiety of dizziness.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.