Discussion of Dizziness
Dizziness is a symptom, which may be defined as
a sensation of unsteadiness or imbalance, a disorientation
in relation to an individual’s surroundings.
The symptom of dizziness may vary widely from person
to person and be caused by many different diseases.
It varies from a mild unsteadiness to a severe
whirling sensation known as vertigo. Because there
is little representation of the balance system
in the conscious mind, it is not unusual for it
to be difficult for patients to describe their
symptom of dizziness to the physician. In addition,
because the symptom of dizziness varies so widely
from patient to patient and may be caused by many
different diseases, the physician commonly requires
extensive testing to be able to provide the patient
with some knowledge about the cause of their dizziness.
This booklet is designed to provide the patient
with information regarding possible causes of dizziness
and their treatment.
Function of the Normal Ear
The ear is divided into three parts: external
ear, middle ear, and inner ear.
The external ear structures gather sound and direct
it toward the eardrum. The middle ear chamber consists
of an eardrum and three small bones. These structures
transmit sound vibrations to the inner ear fluid.
The inner ear chamber (labyrinth) is encased in
bone and filled with fluid (endolymph and perilymph).
This fluid bathers the delicate nerve endings of
the hearing and the balance mechanism. This fluid
bathes the delicate nerve endings of the hearing
and the balance mechanism. Fluid waves in the hearing
chamber (cochlea) stimulate the hearing nerve endings
which generate an electrical impulse. These impulses
are transmitted to the brain for interpretation
as sound. Movement of fluid in the balance chambers
(vestibule and three semicircular canals) also
stimulates nerve endings and sends impulses which
are interpreted in the brain as motion.
Maintenance of Balance
The balance mechanisms in the inner ear are one
of the main sources of input for the central nervous
system, although the eyes, the neck muscles, and
the muscles and joints in the limbs also play key
sensory roles in maintaining balance. The central
nervous system coordinates all of the input to
maintain balance for the patient. Disturbance in
any of these sensory areas may result in the subjective
sensation of dizziness or unsteadiness. True vertigo
most commonly results from disturbances in the
inner ear balance organs, but may result from central
nervous system problems as well. General disturbances
in the metabolism of the body may lead to dizziness
by interfering with coordination of impulses in
The brain, reacting to normal or abnormal impulses,
may respond in such a way that the individual has
a false feeling of movement resulting in staggering
or falling. The brain’s influence on the
body’s glands and muscles may result in the
individual breaking out in a cold sweat, having
nausea and vomiting, or feeling very faint.
Types of Dizziness
Sensations of unsteadiness, imbalance or disorientation
in relationship to one’s surroundings may
result from disturbances in the ear, neck muscles
and joints, the eyes, the nervous system connections
of these structures, or a combination of any of
Ear dizziness, one of the most common types of
dizziness, results from disturbances in the blood
circulation or fluid pressure in the inner ear
chambers, from direct pressure on the balance nerve,
or physiologic change involving the balance nerve.
Inflammation or infection of the inner ear or balance
nerve is also a major cause of ear dizziness.
The inner ear mechanism is about the size of a
pea, and is extremely sensitive. There are two
inner ear chambers: one for hearing (cochlea),
and one for balance (vestibule and semicircular
canals). These chambers contain a fluid which bathes
the delicate nerve endings. These nerve endings
are stimulated when there is movement of the fluid.
Nerve impulses are then transmitted to the brain
by the hearing and balance nerves. The nerves pass
through a small bony canal (internal auditory canal)
accompanied by the facial nerve.
Any disturbance in pressure, consistency, or circulation
of the inner ear fluids may result in acute, chronic,
or recurrent dizziness, with or without hearing
loss and head noise. Likewise, any disturbance
in the blood circulation in this area or infection
of the region may result in similar symptoms. Dizziness
may also be produced by over stimulation of the
inner ear fluids, such as one encounters when he
spins very fast and then suddenly stops.
Central dizziness is usually unsteadiness brought
about by failure of the brain to correctly coordinate
or interpret the nerve impulses which it receives.
An example of this is the "swimming feeling" or
unsteadiness that may accompany emotion stress,
tension states, and excessive alcohol intake. Circulatory
inefficiency, tumors, or injuries may produce this
type of unsteadiness, which or without hearing
impairment. A feeling of pressure or fullness in
the head is common. Occasionally true vertigo (spinning)
may be caused by central problems.
Neck dizziness (cervical vertigo) results from
abnormal or uncoordinated nerve impulses being
sent to the brain from the neck muscles.
The neck muscles are constantly sending nerve
impulses to the balance centers of the brain to
help maintain equilibrium. Spasm (tenseness) of
the muscles may result in an abnormal nerve discharge,
leading to unsteadiness or dizziness. This spasm
may result from injury, arthritis of the spine
or from pressure on nerves in the neck.
Muscle-joint dizziness is relatively uncommon.
Any disturbance of sensation arising from the muscles
and joints in the limbs (such as occurs in the
muscular dystrophies and other abnormalities) produces
this type of unsteadiness. Such as example is the
unsteadiness experienced when one tries to walk
on a leg that has "gone to sleep".
Eye muscle imbalance or errors of refraction may
produce unsteadiness. An example of this is the
unsteadiness which may result when on attempts
to walk while wearing glasses belonging to another
Another example of visual dizziness is that occasionally
produced if one is seated in a car looking out
the side window at passing objects. The eyes respond
by sending a rapid series of impulses to the brain
indicating that the body is rotating. On the other
hand, the ears and the muscle-joint systems send
impulses to the brain indicating that the body
is not rotating, only moving forward. The brain,
receiving these confused impulses (from the eyes
indicating rotation, from the ears and muscle-joint
systems indicating forward motion) sends out equally
confusing orders to various muscles and glands
that may result in sweating, nausea and vomiting.
When one sits in the front seat looking forward,
the eyes, ears, and muscle joint systems work more
uniformly and one is less likely to develop car
A visual disturbance may be caused by dizziness
from other sources. Intermittent inability to focus
the eyes, difficulty reading or intermittent blurring
of vision, although at time the result of anxiety
or tension, may result from small reflex movements
of the eyes call nystagmus. The nystagmus is common
during severe dizziness.
Persons subject to dizziness should exercise caution
when swimming. Buoyancy of the water results in
an essentially weightless condition, and visual
orientation is greatly impaired if one’s
head is under water. Therefore, orientation depends
almost entirely on the inner ear balance canals.
An attack of dizziness at this time could be very
dangerous. Similarly, individuals who have lost
both inner ear balance canals should avoid underwater
Ear Dizziness: Symptoms
Any disturbance affecting the function of the
inner ear or its central connections may result
in dizziness, hearing loss, or tinnitus (head noise).
These symptoms may occur singly or in combination,
depending upon which functions of the inner ear
Ear dizziness may appear as a whirling or spinning
sensation, unsteadiness, or giddiness and lightheadedness.
It may be constant, but is more often intermittent,
and is frequently aggravated by head motion or
a sudden change in position. Nausea and vomiting
may occur, but one does not lose consciousness
as a result of inner ear dizziness.
Diagnosing the cause of dizziness
Dizziness may be caused by any disturbance in
the inner ear, the balance nerve, or its central
connections. This can be due to a disturbance in
circulation, fluid pressure or metabolism, infections,
neuritis, drugs, injury or growths.
At times, an extensive evaluation is required
to determine the cause of dizziness. The tests
necessary are determined at the time of examination
and may include detailed hearing and balance tests,
x-rays, and blood tests. A general physical examination
and neurological tests may be advised.
The object of this evaluation is to be certain
that there is no serious or life-threatening disease,
and to pinpoint the location of the problem. This
lays the groundwork for effective medical or surgical
Imbalance related to aging
Some individuals develop imbalance as a result
of the aging process. In many cases this is due
to circulatory changes in the very small blood
vessels supply the inner ear and balance nerve
mechanism. Fortunately, these disturbances, although
they may persist, rarely become worse.
Postural or positional vertigo is the most common
balance disturbance of aging. This may develop
in younger individuals as a result of head injuries
or circulatory disturbances. Dizziness on change
of head position is a distressing symptom which
is often helped by vesitbular exercises.
Temporary unsteadiness upon arising from bed in
the morning is common in older individuals. At
times, this feeling of imbalance may persist for
an hour or two. Arising from bed slowly usually
minimized the disturbance. Again, vestibular exercises
may be useful to these individuals.
Unsteadiness when walking, particularly on stepping
up or down, or walking on uneven surfaces, develops
in some individuals as the progress in age. Using
a cane and learning to use the eyes to help the
balance is often helpful.
Neuritis is a physiological change, which occurs
in the nerve after injury by trauma, a virus, autoimmune
disease, or vascular compression. When this occurs,
the balance function is impaired, resulting in
a severe, and at times, prolonged episode of dizziness,
often followed by some unsteadiness or movement
sensation for weeks to years. Fortunately, this
balance disturbance usually subsides in time and
usually does not recur in the majority of cases.
It may be, however, very chronic at a moderate
to mild level.
Medical treatment is helpful in eliminating symptoms
until the central nervous system can compensate
for the injured nerve. This usually consists of
dizziness suppressing drugs. On occasion, the central
nervous system cannot compensate and surgery may
Occasionally metallic disturbances produce dizziness
with r without associated hearing loss by interfering
with the function of the inner ear or the central
nervous system. Occasionally hearing loss may occur
without the presence of dizziness. A change of
thyroid function or abnormalities in the blood
sugar is the most common metabolic disturbances
resulting in dizziness. Rarely, fat metabolism
abnormalities may also cause problems resulting
in hearing loss and/or dizziness. Thyroid dysfunction
is diagnosed by blood tests and treatment consists
of taking a thyroid hormone. Abnormalities in the
blood sugar are diagnosed, again by blood studies,
and treatment usually consists of diet control
and/or drug therapy. Fat metabolism problems are
diagnosed by studies of the fatty acids and cholesterol
in the blood. Treatment of these may consist of
diet control with or without drug therapy.
Rarely, allergies may cause dizziness and/or vertigo.
Allergies are usually diagnosed by obtaining a
careful history and occasionally performing a series
of skin tests with inhalants and food, and/or blood
tests. Treatment usually consists of elimination
of the offending agents when possible, or if this
is not possible, by allergy shots to stimulate
Injury to the head occasionally results in dizziness
of longstanding origin. If the trauma is severe,
it is usually due to the combined damage to the
inner ear, balance nerve, and central nervous system.
Lesser injury may damage any one, or a combination
of these components. The unsteadiness is at times
prolonged, and may or may not be associated with
hearing loss and head noise as well as other symptoms.
Treatment consist of anti-dizziness medications,
sedatives and occasionally medications to improve
blood circulation. Symptoms will usually clear
in a few months, but occasionally surgery is required
to stop the symptoms, and in a few instances, not
treatment will entirely eliminate the dizziness.
A noncancerous tumor occasionally develops on
the balance nerve between the ear and the brain.
When this occurs, unsteadiness, hearing loss and
head noise may develop. Extensive hearing tests,
balance tests, and x-rays are necessary to diagnose
If the diagnosis of a tumor is established, surgical
removal is imperative. Continued growth of the
tumor would lead to complications by producing
pressure on vital adjacent nerves and the brain.
An operation has been developed with allows the
removal of these tumors at an early stage. Best
results can be obtained if the tumor is diagnosed
early and removed while the only symptom are hearing
loss, dizziness, and tinnitus (head noise).
Meniere’s disease is a common cause of repeated
attacks of dizziness, and is thought to be due
(in most cases) to increased pressure of the inner
ear fluids due to impaired metabolism of the inner
ear. Fluids in the inner ear chamber are constantly
being produced and absorbed by the circulatory
system. Any disturbance of this delicate relationship
results in overproduction or underabsorption of
the fluid. This leads to an increase in the fluid
pressure (hydrops) that may, in turn, produce dizziness,
which may or may not be associated with fluctuating
hearing loss and tinnitus. Meniere’s disease
affects one ear about 60-70% of the time, but can
affect both ears in 30-40% of patients.
A thorough evaluation is necessary to determine
the cause of Meniere’s disease, if possible.
A definite cause may not be found about 40% of
the time. Circularity, metabolic, toxic, and allergic
factors may play a part in any individual. Emotional
stress, while making the disease worse, does not
Meniere’s disease is usually characterized
by classic attacks consisting of vertigo (spinning)
that varies in duration from a few minutes to several
hours. Hearing loss and head noise, usually accompanying
the attacks, may occur suddenly. Violent spinning,
whirling, and falling associated with nausea and
vomiting are common symptoms. Sensations of pressure
and fullness in the ear or head are usually present
during the attacks. The individual may be very
tired for several hors after the overt spinning
Attacks of dizziness may recur at irregular intervals
and the individual may be free of symptoms for
years at a time, only to have them recur. In between
major attacks, the individual may have minor attacks
occurring more frequently and consisting of unsteadiness
lasting for a few seconds to minutes.
Occasionally hearing impairment, head noise, and
ear pressure occur without dizziness. This type
of Meniere’s disease is called cochlear dydrops.
Similarly episodic dizziness and ear pressure may
occur without hearing loss or tinnitus, and this
is called vestibular hydrops.
Treatment of cochlear and vestibular hydrops is
the same as for classic Meniere’s disease.
The treatment of Meniere’s disease may be
medical or surgical, depending upon the patient’s
stage of the disease, life circumstances, and the
condition of the ears. The purpose of the treatment
is to improve the metabolism of the inner ear,
to prevent the hearing loss and stop the vertigo
Dizziness: Medical Treatment
The treatment of each individual patient varies
according to the cause, magnitude, and frequency
of symptoms. In addition, it depends upon the status
of the hearing in the ear and lifestyle of the
Medical treatment is aimed at improving the metabolic
status of the inner ear. Several types of drugs
are used depending upon the disease and the status
of the patient. Most often the patient will have
to take several drugs in combination, one of which
is usually an anti-dizziness medication (labyrinthine
suppressant). Sometimes drugs which dilute blood
vessels are used, as well as drugs (diuretics)
which decrease the amount of fluid in the inner
ear. Changes in diet, thyroid medication, medication
to control sugar metabolism, or other measures
may be needed. Vasconstricting substances should
be avoided to allow the inner ear to have maximum
circulation. Such substances are caffeine (coffee)
and nicotine (cigarettes). Very rarely allergic
treatments may be necessary to control dizziness.
Dizziness: Surgical Treatment
Surgery is indicated when medical treatment fails
to control the vertigo, or in special cases when
it is used to prevent further hearing loss. The
type of operation selected depends on the degree
of hearing impairment in the affected ear, the
life circumstances of the individual, and the status
of the individual’s disease. In some operations,
the hearing may be occasionally improved following
surgery, and in others, it may become worse. In
most cases it remains the same. Head noise may
or may not be relieved, and in some cases may become
even more marked. In most cases it is not relieved.
Surgery is most successful in relieving acute
attacks of dizziness in the majority of patients.
Some unsteadiness may persist over a period of
several months until the opposite ear and the central
nervous system are able to compensate and stabilize
the balance system. In the event that a conservative
operation does not relieve the attacks of dizziness,
a second operation may be necessary.