What causes dizziness? An overview of common balance disorders

By Ayesha Nazeer Zarook

Dizziness is a common symptom that affects many people in our country; it has been reported to be the one of the most common complaints in patients 75 years of age or older. Dizziness, however, is a common term used to describe multiple sensations (sense of spinning known as vertigo, lightheadedness, imbalance), each having numerous causes and can be seen in people of all ages (15 years and above). 

It is often difficult to explain the quality of dizziness a person is experiencing and decide how to proceed with medical management. Therefore, the focus of this article is going to be on function of the balance system – the peripheral and central vestibular system. We will also review the more common disorders specific to this system, describe how patients with these disorders present, and discuss management protocols.

Vertigo can have a wide range of causes, the most common being a viral infection or tiny calcium crystal free floating in the inner ear, which is pretty much our body’s accelerometer. Any disruption in there sends the brain confusing signals about the body’s position, which causes really heavy vomiting sensation, dizziness, and headaches. If you’ve ever felt seasick, it’s quite a similar vibe. If not, think about that feeling when you just get off a rollercoaster…it’s like that, only ‘all day long’! 

So how does this all work? The vestibular system is broadly categorised into both peripheral and central components. The peripheral system is made up of three fluid filled tubes in our inner ear called the semicircular canals (posterior, superior, lateral) and the otolithic organs (saccule and utricle). The semicircular canals detect rotational head movement while the otolith organs (saccule and utricle) respond to linear acceleration (forward and backward movement) and gravity, respectively. 

These vestibular organs are in a state of symmetrically tonic activity (meaning the vestibular organs from each ear coordinate symmetrically with each other), and that when excited stimulates the central vestibular system (located in the brain). This information, along with proprioceptive (stimuli for position and movement) and visual input, is processed by the brain and hence maintains our sense of balance and position.

If a disease or injury damages this system, you can have a vestibular disorder. Dizziness and trouble with your balance are the most common symptoms, but you also can have problems with your hearing and vision.

Common vestibular disorders

80% of people complaining of dizziness or pure vertigo is due to a disease or injury to the peripheral vestibular organ. The rest of the time it could be a central involvement or something medical related. This is why, we will focus on understanding the disorders mainly related to the Peripheral vestibular system. 

Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of positional vertigo, a sudden feeling that you’re spinning or swaying when turning towards a particular side. It happens when tiny calcium crystals in one part of the ear move into an area where they shouldn’t be. This causes the inner ear to tell your brain you’re moving when you’re really not.

BPPV can be treated through a series of head movements your doctor guides you through. These put the crystals back where they’re originally supposed to be.

Labyrinthitis

You might know this as an inner ear infection. It happens when a fragile structure deep inside your ear known as a labyrinth (where the vestibular organ and hearing organ is situated) gets inflamed. This affects not just your balance and hearing, but you also may have ear pain, pressure, pus or fluid coming from your ear, nausea, and a high fever.

If your labyrinthitis is caused by a bacterial infection, you may need to take antibiotics. Your doctor also might recommend steroids to help bring down inflammation and/or another kind of drug known to help with vomiting and dizziness.

Vestibular neuritis

A viral infection somewhere else in your body, such as chickenpox or measles, can bring on this disorder that affects the nerve that sends sound and balance information from your inner ear to your brain. The most common symptoms are sudden dizziness with nausea, vomiting, and trouble walking.

To treat vestibular neuritis, your doctor may give you medicine to wipe out the virus that’s causing it.

Meniere’s Disease

People with this disorder have sudden attacks of vertigo, tinnitus (a ringing, buzzing, or roaring sound in their ears), hearing loss, and a feeling of fullness in the affected ear. This may be caused by too much fluid in the inner ear, thanks to a virus, allergy, or autoimmune reaction. The hearing loss gets worse over time and can be permanent in some cases.

Some lifestyle changes can help – like cutting down on salt, caffeine, and alcohol – and medication can ease attacks when they happen. In rare cases, people need surgery to relieve their symptoms. Parts of the affected inner ear are cut or removed so they stop sending the wrong balance signals to your brain.

Vestibular migraine: If your brain sends the wrong signals to your balance system, that can lead to a severe headache, dizziness, sensitivity to light or sound, hearing loss, and ringing in your ears. Some people also say they get blurred vision.

If you have vestibular migraines often, your doctor may give you a drug to prevent them. Many medications, including some antidepressants, and calcium channel blockers (which relax your blood vessels), can help.

The above discussed disorders are all due to the peripheral vestibular system (except for vestibular migraine). However, not all vertigo results from a peripheral vestibulopathy and may actually be secondary to central pathology. Patients with central pathology more often present with complaints of disequilibrium and ataxia rather than true vertigo, but this is not always the case. There are however, sophisticated state of the art equipment for vestibular assessments that can help differentiate between central and peripheral pathologies and hence, further assessments if required and specific treatment can be decided based on these findings.

Wickramarchchi Hearing Care has a fully equipped balance practice with the latest advancement in Vestibular testing and qualified professionals to perform the assessments and Vestibular Rehabilitation if needed. For further information on balance testing, please contact 011-2680175. 

(The writer is a Senior Consultant Audiologist and Speech Language Pathologist.)