It has been estimated that there are between 5 and 8 million physician visits for dizziness in the United States each year, and dizziness is the leading reason for a physician visit for patients over age 75 years.
Dizziness is a term that is used to describe two different conditions – light headedness and vertigo. Lightheadedness, or “feeling faint” can happen for a number of reasons including low blood pressure (often in response to rising from a seated position), medication side effects, generalized ill health and psychological responses. Vertigo is a sensation of motion where there is in fact none. This can be a sense that your environment is spinning or moving, or that your head and/or body is spinning or falling while the world is still.
In addition, falls are the leading cause of injury in older adults and are the leading cause of death in those over age 85. Five percent of falls lead to bone fracture, resulting in approximately 300,000 hip fractures annually. Every year, one-third to one-half of the population age 65 and over experience falls; and half of the seniors who fall do so more than once. Of all falls suffered by seniors, 50 percent are the result of vestibular problems.
Balance and gait dysfunction
Sometimes problems with balance and gait can be attributed to dizziness. Balance and gait abnormalities may be due to vertigo, sensory neuropathy (nerve injuries resulting in difficulty sensing the position of the limbs in space as well as numbness and tingling) and musculoskeletal issues such as arthritis.
Vertigo, a sensation of movement of the environment or self where there is none, is often associated with nausea and has many causes. Most of them do not reflect serious underlying disease. These include:
- Medication side-effects
- Benign paroxysmal positional vertigo (BPPV) – a condition caused by the abnormal presence of tiny “stones” of calcium in the fluid filled tubes of the inner ear. People typically feel a sudden sensation of spinning that is triggered by movement of the head. It is often accompanied by severe nausea, vomiting and difficulty with balance. The symptoms last seconds to minutes and then gradually abate.
- Vestibular neuritis – inflammation of the nerve that connects the apparatus of the inner ear to the brain and labyrinthitis – inflammation of the inner ear itself, are thought to be caused by viral infections in most cases. Symptoms of vertigo, nausea, vomiting and balance difficulties will last days to weeks but can sometimes persist for months.
- Meniere’s Disease is characterized by bouts of vertigo associated with a sense of fullness in the ear, “tinnitus”, a sensation of ringing in the ear, and hearing loss. Symptoms last hours but usually recur. Hearing typically recovers in between episodes, but may deteriorate after multiple attacks. The condition is thought to be related to abnormal fluid pressures in the inner ear.
- Migraine-associated vertigo is vertigo or imbalance resulting from migraines. It may precede or occur with a migraine headache, or occur independently of the headache.
Serious, but fortunately rarer, causes of vertigo include stroke, brain tumors and brain infection
The evaluation of vertigo will include a detailed history, physical and neurological exam. Frequently, this is enough to make a diagnosis; however, sometimes additional studies are necessary such as lab work and/or imaging of the brain. Further testing, such as an audiogram to evaluate hearing, may need to be performed.
Treatment depends on the cause of the vertigo and most commonly includes medications for symptom management and/or treatment of the underlying condition. Physical therapy and special exercises to reduce symptoms of vertigo and abnormal balance are highly effective in many cases.
The Vestibular and Balance Clinic
at the Martha Jefferson Outpatient Center uses cutting edge technology and highly trained, experienced rehabilitation therapists to evaluate and treat vertigo, balance and gait dysfunction.
When is vertigo an emergency?
Vertigo can sometimes represent a medical emergency such as a stroke. Call 911 if the vertigo has a sudden onset and is accompanied by any of the following:
- Inability to walk or stand (not to be confused with difficulty walking)
- Inability to coordinate limb movement, or weakness and/or numbness of an arm and/or leg
- Difficulty with speech and/or comprehension, confusion or difficulty staying awake
- Vision changes
- Following a head injury