Dizziness – An Overview

Dizziness is a non-specific term that can mean many different things to different people. It can encompass a variety of sensations including (but not limited to):

1. Feeling like you are spinning or moving when you are not.
2. Feeling off balance
3. Feeling lightheaded/faint
4. Feeling sick to your stomach

A problem with the balance organs in the inner ear can cause dizziness, and so many patients are referred to ENT specialists for this problem. Problems with many other parts of the body can also cause dizziness, and so other specialists such as neurologists, physical therapists, and rehabilitation doctors can be the best option to treat a particular patient’s dizziness.

Your sense of balance is complicated and comes from several different areas of the body:

1. Your inner ears tell you if you are spinning or moving. An example of this would be getting into an elevator. The only way you can tell that you are moving up or down is through the sensors in your inner ear.
2. Your eyes tell you if you are moving as well. You can see things moving around you as you turn your head, walk, or make any other movements.
3. The rest of your body, especially your arms and legs, tell you if you are moving and where you are in space. If you close your eyes and move your arm around, you can tell that it is moving.

Information from all 3 areas (inner ears, eyes, and the rest of the body) is collected by the brain and spinal cord and organized as your sense of balance. A problem in any of these areas or in the brain itself can contribute to a sense of dizziness or feeling off balance.

The first and most important thing that I do when seeing dizzy patients is to have them describe exactly what they are feeling. Is it a spinning sensation (vertigo), feeling off balance, feeling lightheaded/faint, or something else? Vertigo is a very specific term which means feeling like you are spinning when you are not actually moving. Many patients are told that they “have vertigo.” It is not a disease, it is a symptom, the same as pain or nausea.

Problems with the inner ears tend to cause vertigo, typically with associated nausea. Depending on the problem there can also be hearing loss, pressure in the ear, and ringing/noise in the ear (tinnitus). Brain problems can also cause vertigo, but it tends to be less severe and there is less nausea. Sometimes viral illnesses such as colds or stomach flus can cause temporary vertigo as well.

Problems with the eyes and with sensation in the extremities (especially the legs) tend to cause an off-balance sensation without much vertigo. Common problems in these categories are an outdated glasses prescription and peripheral neuropathy (frequently caused by diabetes).

Lightheadedness is usually caused by low blood pressure, especially lightheadedness on standing or sitting up too quickly. Many times, patients are on medications for high blood pressure and the dose of the medications needs to be lowered to fix the lightheadedness.

Many medications can cause dizziness, especially when patients are on lots of different medicines. Patients who are elderly, chronically ill, obese, or deconditioned from an injury or hospitalization are all prone to feeling dizzy as well because of their underlying physical weakness.

The last few paragraphs highlight some of the common reasons for dizziness. There are many more possible diseases and diagnoses that should be considered as well. At your appointment, the doctor will take a careful history and perform a detailed ear, neurologic, and balance exam to help determine the problem. Sometimes a hearing test, other balance testing, blood tests, and imaging studies can be helpful as well.

The good news is that most dizziness improves with time alone. Our brains are very good at adapting and lessening the dizzy sensation over time.

Many patients are given medications for dizziness, most commonly meclizine but also other medications such as robinul, valium, klonopin, ativan, phenergan, and others. These medications are excellent at controlling severe vertigo but actually inhibit the brain from adapting and getting rid of the dizziness in the long run. I usually recommend medications like meclizine be used on an as-needed basis only and for no more than 1 week straight.

Better options for long-term control of dizziness are vestibular exercises and vestibular rehabilitation, typically performed under the care of a physical therapist.

Please see the separate page with more specific information for vertigo and call (512)550-0321 if you have any questions! We serve the South Austin Metro Area, including Kyle, San Marcos, and Lockhart.