Capital Region Special Surgery medical office Albany, NY

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Dizziness and Vertigo

A large percentage of the adult population reports episodes of dizziness or vertigo to a physician during their lifetime. Many of these cases involve vestibular (inner ear) disorders. Other cases of dizziness are due to problems unrelated to the inner ear, such as cardiovascular, neurological, or psychological disorders..

Dizziness Caused by Vestibular Disorders
The vestibular organs of the inner ear provide the brain with information about changes in head movement. If the vestibular system is not functioning properly, dizziness, vertigo, imbalance, spatial disorientation, and other symptoms can result.

Vestibular-system distress can be caused by a variety of influences, including viral infections of the labyrinth (labyrinthitis) or the vestibular nerve (vestibular neuronitis). Bacterial infection of either the middle ear (otitis media) or the brain coverings (meningitis) may spread to the inner ear. Allergies can cause changes in the inner ear fluids or middle ear pressure because of swelling of the Eustachian tube and production of fluid in the middle ear.

Head trauma is a common cause of inner ear damage in people under age 50. A blow to the head or a “whiplash” injury can result in, for example, perilymph fistula or benign paroxysmal positional vertigo (BPPV). Vestibular-system dysfunction may appear immediately following head trauma or after a delay of days, weeks, or months.

Vestibular disorders can also occur from exposure to ototoxins (drugs or chemicals that are harmful to the inner ear or the vestibulo-cochlear nerve). Degeneration of the hair cells in the inner ear is also thought to occur with aging and can result in dizziness and vertigo as well as hearing loss. A benign tumor known as an acoustic neuroma can grow on the vestibulo-cochlear nerve. In many cases of vestibular disorders, including Meniere’s disease and other forms of endolymphatic hydrops, the underlying or original cause cannot be determined.

Other conditions that may affect vestibular function include migraine, mal de debarquement (a sensation of rocking that persists after a cruise or other travel), autoimmune inner ear disease, cervical (neck) problems, vascular compression of the vestibular nerve, superior canal dehiscence, cholesteatoma, enlarged vestibular aqueduct, and others.

The Capital Region Ear Institute vestibular disorders laboratory features the next generation of video electronystagmography to accurately diagnose and treat balance disorders.

Dizziness from Non-Vestibular Causes
Dizziness is the second most common complaint heard in doctors’ offices (after lower back pain). Dizziness has many causes other than inner ear dysfunction.

Visual disturbances can result in lightheadedness or dizziness. Some people feel dizzy while adjusting to bifocals or a new eyeglass prescription, or from reduced vision due to cataracts.

Hyperventilation can cause temporary dizziness. During rapid breathing, more carbon dioxide than normal is expelled and the level of carbon dioxide in the blood falls, which in turn affects the function of brain cells.

Decreased blood flow to the brain or brain stem can cause dizziness, because insufficient oxygen is reaching the cells. Conditions that can reduce blood flow to the brain include orthostatic hypotension (low blood pressure upon suddenly rising from a lying or sitting position), dehydration, vasovagal syndrome (a nervous-system response that causes sudden loss of muscle tone in peripheral blood vessels), arteriosclerosis (hardening or narrowing of blood vessels), and osteoarthritis (a joint disease that can narrow the openings in the neck vertebrae through which blood vessels flow).

Nervous-system disorders such as peripheral neuropathies (diminished nerve function in the legs or feet) can cause unsteadiness. A tumor may affect the brain stem, the cerebellum (the coordination center of the brain), or the part of the cerebral cortex that controls voluntary muscle movements.

Even stress, tension, or fatigue may cause dizziness. Under these conditions, the brain stem functions less efficiently, resulting in some loss of automatic reflex control of balance. This leads to elevated levels of activity for the cerebral cortex, as conscious energy is used to help maintain balance by controlling voluntary muscle movements. Lightheadedness and unsteadiness can result.

Diagnostic Tests for Vestibular Disorders
Doctors use the medical history and findings from a physical examination as a basis for ordering diagnostic tests to assess the function of the vestibular system and to rule out alternative causes of symptoms. These diagnostic tests are designed to evaluate the function and structure of the inner ear and/or brain, and they include hearing evaluations because the hearing and balance functions of the inner ear are closely related.

Tests of vestibular (balance) function include:

Other diagnostic tests include:

Helpful links

www.vestibular.org
The Vestibular Disorders Association (VEDA) is a non-profit organization that serves people with vestibular disorders and the health professionals who treat them. VEDA provides information, resources, support, and advocacy.

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