Dizziness or vertigo

Dizziness (or vertigo) is a term to describe various sensations:

• Numbness
• Insecurity
• Weakness
• Instability.

Dizziness can be caused by disorders in the inner ear (peripheral dizziness).

It’s the same feeling you get from a considerable height when you look down at Earth.

Dizziness is more common in women than in men.

According to Marcelo B Antunes, MD (Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System), equilibrium is the result of an integration of information originating from sensory receptors located at the level of:

• vestibular apparatus (in the inner ear),
• Eyes
• Proprioceptive nerve endings (which signal the position of the body in space).

This information is processed:

• In the cerebellum,
• In the brainstem.

The correct integration of nerve signals allows:

• Walking upright,
• A correct posture,
• Focusing images with your eyes.

Central dizziness may be caused by:

• A disorder of the cerebral vestibular organs (brainstem and cerebellum),
• Lack of stimulus information (in the area of the cerebral cortex).

The vestibular nerve is the vestibular nerve.

Injuries to the vestibular nerve lead to an imbalance that can affect the sensory vestibular information.

However, it can be compensated by the nerve of the other side and by the vestibular risks. Therefore, patients never have severe dizziness, but may feel a sense of insecurity.

Indications of the anatomy of the ear or the mechanism of balance

The vestibular organs of the ear are:

• Utriculus,
• Sacculus,
• Three arcades.

The archways register rotational movements of the head.

They are arranged at right angles to each other and contain a liquid called endolymph.

Each channel has a special function and registers the movement of the head: up and down, from side to side and rotations.

These channels contain sensory hair cells that are activated by the movement of the endolymph.

When the head is rotated (for example, when the head is tilted to one side), the sensory hair cells receive a nervous impulse from the brain via the acoustic nerve.

The endolymph (in the semicircular canal) moves the otoliths.

These crystals glide over the sensory hair cells:

• of the Utriculus,
• Des Sacculus.

The impulses reach the brainstem and cerebellar areas.

When the otoliths detach from the sensory hair cells, they swim around inside the vestibular labyrinth and can cause severe dizziness and balance disorders (benign positional vertigo).

Classification of dizziness

• In the case of subjective dizziness, the person feels that his body is turning.
• With objective dizziness, the person feels that his body is fixed while the environment revolves around him.

Types of dizziness according to its origin

1) Peripheral dizziness is caused by a disturbance of the labyrinth. Its duration is short-term, but it occurs suddenly.

Peripheral vestibular dizziness is limited to the eighth cranial nerve and inner ear.

Patients may also report a loss of balance.

Often other symptoms occur, such as:

• Nausea
• Vomit
• Sweating and bradycardia (slow heartbeat).

In this case, the dizziness is recurrent or recurrent over a period of time, after which it passes on its own. (Timothy L. Thompson, MD – Department of Otolaryngology – Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA).

Diseases that can cause peripheral dizziness include:

1. Meniere’s disease
2. Benign paroxysmal positional vertigo
3. Vestibular neuritis
4. Labyrinthitis
5. Acoustic neuroma (brain tumor)
6. Perilymph fistula (abnormal connecting channel between the inner ear and perilymphatic space)
7. Dehiscent upper semicircular (missing bone above the upper semicircular canal)
8. Trauma

2) Dizziness is said to be central when the cause is a disease or damage to the central nervous system. The disorder begins gradually, but lasts for a long time.

Patients with central dizziness, first of all, have constant balance and coordination problems, no real dizziness.

However, this is not always the case.

Often, patients cannot stand or walk, while patients with peripheral vertigo can walk without problems.

Depending on the underlying disorder, it can be observed:

• Hearing
• Other neurological symptoms.

Diseases that can cause these symptoms include:

• Stroke in vertebrobasilar ischemia
• Vertebrobasilar insufficiency
• Multiple sclerosis

Causes of dizziness

Many causes are not serious. Symptoms can be improved by simple changes in everyday lifestyle.

Many symptoms disappear without the need for treatment.

The most common causes of dizziness are explained below:

Hypotension

With orthostatic hypotension, blood pressure decreases:

• When getting up suddenly,
• When you lie down from sitting.

The body should quickly adapt to this change in position.

Some people need a few minutes to return to normal pressure.

As long as the blood pressure does not stabilize, the person may suffer from dizziness.

Dehydration

Another cause of sudden dizziness is dehydration.

If the body does not have enough fluid, one feels:

• Numbness
• Insecurity
• Blurred vision or blurred vision.

During physical training, lack of water can lead to an imbalance in the body.

Drinking alcohol leads to dehydration.

If vomiting, diarrhea or fever occurs, dizziness may occur.

Migraine

Symptoms of migraine include:

• Headache
• Vertigo
• pseudo-dizziness,

Light and noise also cause dizziness.

Experts believe that changes in the blood vessels in the brain are responsible for migraines. The dizziness often passes when the migraine is treated.

To treat dizziness caused by vestibular migraine, the doctor can give valuable advice on:

• Nutrition
• Stress
• How to sleep at night,
• Sports exercises.

Some medications can prevent vestibular migraines, reducing nausea and vomiting.

Hypoglycemia

Low blood sugar can cause dizziness and other symptoms in people who take insulin to treat diabetes, such as:

• Confusion
• Cold welding.

Drug

Blood pressure-lowering drugs can work too hard and lower the pressure below the desired level, causing dizziness.

Tranquilizers can also cause dizziness.

Pregnancy

Women may experience lightheadedness and dizziness during pregnancy.

These are caused by changes that take place in the woman’s body.

According to Webmd, the pregnancy hormone progesterone causes vasodilations (dilation of blood vessels) and thus a larger amount of blood flows to the uterus.

The consequences are:

• A drop in blood pressure,
• Swelling of legs and feet, because the blood accumulates in this area.

The position can also make a big difference.

For example, when a pregnant woman lies on her back, the uterus presses on the inferior vena cava (it carries blood from the lower part of the body to the heart).

In this way, the return flow of blood to the heart is hindered and blood pressure drops further.

Arrhythmia and other heart problems

The heart is an organ that pumps blood throughout the body.

Decreased blood flow to the heart leads to heart muscle pain.

An arrhythmia (irregular heartbeat) can also cause dizziness.

Depression and anxiety

Often depression and anxiety cause dizziness.

Experts associate panic attacks, anxiety, depression, etc. with dizziness.

Depressed or anxious people often have dizziness.

Other symptoms of depression include:

• Anxiety attacks
• Panic attack
• Pseudo-dizziness

Anxiety affects a person’s respiratory system and causes hyperventilation.

It should be noted that dizziness is caused by some tablets taken to treat depression.

Dizziness due to cervical causes

Causes of cervical dizziness include:

• neck tension (worsens towards evening),
• cervical arthrosis,
• posture (for example, during breastfeeding).

Problems on the ear

Many dizziness conditions are caused by disorders of the ear.

Some inner ear problems lead to:

• balance problems,
• Vertigo.

The acoustic neuroma is a benign tumor of the auditory nerve.

This nerve connects the brain to the inner ear. The disease causes dizziness.

Meniere’s syndrome also causes similar symptoms.

If fluid accumulates in the inner ear, this pathology can occur.

Acute vestibular neuritis is an inflammation of the inner ear and can cause dizziness for many days.

The symptoms of this pathology are:

• Nausea
• Vomit
• Balance problems

Labyrinthitis is a disorder of the ear in which the labyrinth is inflamed. Labyrinthitis causes severe dizziness and other symptoms such as:

1. Deafness
2. Vomit
3. Tinnitus (buzzing or whistling in the ears).

Dysfunction of the temporomandibular joint

The jawbone is connected to the temporal (contains the organs of the ear).

If a bone is misaligned or not well aligned, it can cause various symptoms, including:

• Jaw stiffness
• Headache or migraine
• Jaw pain
• Rubbing noise or crackling when opening the mouth
• Earache
• Neck
• Nocturnal teeth grinding
• Feeling of stuffy ears

Benign paroxysmal positional vertigo (BPLS)

It is a disorder caused by displacement of the otoliths (small calcium carbonate crystals) from the organelles of the otoliths (utriculus and sacculus) into the semicircular ducts of the inner ear.

Symptoms appear during some movements, especially in the morning.

During the night, the head is raised at an angle of about 30° above the bed level when the person sleeps on a pillow.

In this position, the macula of the utriculum is located just above the dome of the posterior portico.

If the ear stones come loose, they can sink into the ampoule (the part of the posterior semicircular canal where the positional receptors with the stereocilia are located).

Upon awakening and when the person rises from bed, the displacement of the endolymph and the ear stones (which should not be present here) causes excessive irritation of the dome of the arcade.

The result is dizziness.

Also, the absence of otoliths at the macular level of the utriculus can favor the appearance of dizziness.

Cholesteatoma

This is a benign structure in the middle ear that extends to the inner ear and can interfere with:

• the equilibrium apparatus,
• The hearing aid and the cochlea.

If the cholesteatoma affects the latter, it causes irreversible neurosensory deafness (even with a prosthesis).

Penetrating into the vestibular apparatus, it causes objective dizziness with:

• Nausea
• Vomit.

There is a special sign that facilitates diagnosis.

The lateral semicircular canal, located on the middle wall of the middle ear, is most affected.

Is this channel violated:

• Changes in the bony labyrinth occur.
• The result is the exposure of the membranous labyrinth (which is no longer protected by the bone).

A labyrinth fistula is formed, which connects the labyrinth to the middle ear.

A (even small) pressure on the canal causes the appearance of a very violent dizziness.

This is a sign of the presence of a fistula.

Cardiovascular problems

The main cardiovascular problems that cause dizziness are:

• Arrhythmia
• Heart attack (may also cause pain in the shoulder blade, arm, and left hand)
• Cardiac arrest (early symptoms)
• Vascular damage to the spinal cord or brainstem (e.g. Wallenberg syndrome)
• Narrowing of the carotid arteries (this leads to reduced oxygen transport to the brain, especially in circulatory disorders of the vertebral arteries)
• Hypotension

Other causes of dizziness

• Smoking a cigarette, after which slight dizziness may occur for a few seconds
• Drugs
• Allergy – can lead to blockage of the Eustachian tube and thus to inflammatory fluid accumulation in the ear. The result is a loss of balance, since the vestibular organs are located in the ear.
• Cold
• There are antihistamines to treat the allergy that can cause dizziness, for example, diphenhydramine (Benadryl)
• tumor or metastases in the brain,
• Internal bleeding or heavy menstrual bleeding (for anaemia or low blood pressure)
• Premenstrual syndrome (before the menstrual cycle or during ovulation due to hormonal changes)
• After eating or when someone is under stress and more blood flows to the muscles and stomach, the brain receives less and mild dizziness occurs.

Dizziness in the elderly

Often a patient feels good when getting up, but dizziness occurs after a short time.

A patient has no complaints at home, but he cannot go shopping or go for a walk outside.

In this case, we are talking about instability.

In the elderly, there are many reasons for this, for example:

1) skeletal muscle stiffness, a rigid body with high-frequency tremors can only be perceived as unstable by the vestibular system (for example, Parkinson’s disease);

2) The elderly often suffers from presbycusis (progressive hearing loss related to age) and presbyastasia (progressive degeneration of the vestibular system with reduction of labyrinth reflexes);

3) Often the patient suffers from disorders that cause poor vision (catarect, maculopathy, etc.). The consequence is that vision cannot compensate for the decline in labyrinth function;

4) These include possible peripheral neuropathic disorders, such as sensorimotor neuropathy of the lower extremities, which lead to loss of sensitivity in the soles of the feet. In this case, first of all, the patient perceives instability:

• When he closes his eyes,
• At night
• If he walks on uneven ground.

5) Psychogenic dizziness is suspected if the patient:

• cannot accurately describe the feeling of instability or dizziness,
• Constantly changing his statement,
• General terms.

Dizziness in children

Children may feel unstable, weak, or dizzy.

Often other symptoms occur with dizziness:

• Nausea
• Vomit
• excessive sweating,
• Abnormal eye movements (nystagmus).

According to a study by A.P. CASANI et al. (Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Italy), the most common causes of dizziness in children are:

1. Vestibular migraine (38%),
2. Acute labyrinthitis/vestibular neuritis (16%),
3. somatization (16%),
4. Benign paroxysmal positional vertigo (11%),
5. Paroxysmal torticollis (2%),
6. Post-traumatic: canalolithiasis of the posterior semicircular canal (8%),
7. Meniere’s syndrome (5%),
8. Chronic idiopathic dizziness (2%).

Hypoglycemia is another cause of dizziness.

Hypoglycemia leads to the following consequences:

• Energy
• Fatigue
• Confusion

In this case, therapy is simple: a little sugar water improves the symptomatology.

Heat stroke or dehydration can also cause dizziness.

Children who suffer from anemia, cardiac arrhythmias and diabetes are more prone to dizziness.

Dizziness and blurred vision

Causes:

• Brain tumor
• Diabetes
• Dehydration
• High/low blood pressure
• Multiple sclerosis
• Migraine
• Panic attack.

Sudden dizziness

The main causes of sudden dizziness are:

• Dehydration
• pseudodizziness (psychogenic),
• Hypotension
• Stroke
• Medication (antibiotics, cancer medicines, painkillers, COX-2 inhibitors, cardiac drugs, etc.)

Causes of morning dizziness

• infections of the inner ear,
• vestibular problems,
• sensory disturbances,
• Migraine
• Multiple sclerosis
• Hypotension
• Psychogenic or functional dizziness caused by anxiety (symptoms are also tachycardia, increased sweating and tremors),
• Fast movements,
• Stroke.

Dizziness when standing up is caused by:

• Circulatory
• adverse drug reactions,
• head trauma,
• internal bleeding,
• hormonal changes,
• Anxiety
• Panic attack
• Depression
• Migraine
• Anaemia
• Dehydration.

• Dizziness and nausea: causes and symptoms, pregnancy
• Dizziness and cervical spine
• Dizziness: diagnosis, medications and natural remedies