What is dizziness?

Dizziness is a sensation that many people experience in their daily life. It is a term used to describe feeling weak, unsteady, light-headed or even faint. In our latest article, leading consultant ENT surgeon Mr S James Quinn discusses the causes, signs and treatments. The surgeon, who practices in Hitchin, Harpenden and Hatfield, explains when dizziness becomes a serious medical condition, and answers more of the most frequently asked questions related to the topic.

What is dizziness? Are there different types? 

In order to understand the different types of dizziness, it’s important to have an understanding of the balance system and how it works. Our brains constantly take in inputs from the sensation of pressure in our feet when we stand, or from our bottoms and legs when we are sitting. In addition, the brain receives inputs from our muscles and joints. These inputs travel along nerves up to the brain, along with sensory inputs from the eyes and the ears. The brain coordinates these sensory inputs, and then sends out messages to the muscles to tell them how to contract to maintain our balance. This, in essence, is how the balance system works.  

Dizziness or imbalance can occur if something goes wrong in any part of this system. Balance experts commonly split dizziness into several different types which helps us to differentiate the possible causes of the dizziness. These types include light-headedness, poor balance, vertigo, and motion-induced disequilibrium. 

If you are diabetic or have a B12 deficiency, for example, you may have reduced nerve sensations coming up from your feet. This could mean that when you stand up, you feel off balance.  Knee, hip, and spine problems can also lead to a general feeling of imbalance as can muscle weakness. Dysfunction of the brain, which can be due to a variety of things, can leave you with a similar off-balance feeling.  

Having issues with your ears can also result in balance problems. This might be an acute situation, where the room suddenly starts to spin around, called acute vertigo, or a chronic situation, where the balance mechanisms in the inner ears are sending altered messages to the brain which the brain has difficulty interpreting. This typically manifests as a feeling of imbalance or vertigo which is precipitated or worsened by moving the head. 

What happens when a patient comes to the clinic with symptoms of dizziness?  

When a patient presents with symptoms of dizziness, the most important factor to consider is the history. The exact symptoms the patient experiences and an accurate timeline are essential in diagnosing the cause. Once the history has been established, the ears will be examined, followed by a hearing test and a clinical balance assessment. At this stage it is usually possible to make a diagnosis, or at least narrow the cause down to a few possibilities. Depending on the findings, other investigations may be needed. 

Some further balance-related tests may be organised, such as an MRI scan of the brain and the ears, to look for signs of a tumour or stroke, caloric, and head impulse testing, which assesses the function of the inner ears from a balance perspective and Videonystagmography (VNG), which checks the central brain pathways.  

What might dizziness be a warning sign of? 

Dizziness means that the balance system isn’t functioning as it should.  This may be caused by a dysfunction of the nerves going to the brain, of the brain itself, of the ears, of the eyesight, or of the muscles and joints. 

When is dizziness considered as a serious medical condition? 

If there is a progressive loss of balance, continually deteriorating over a period of two weeks or longer, that would be quite concerning. An instance of acute imbalance or vertigo that hasn’t improved within two weeks would be similarly worrying. Imbalance associated with other symptoms such as hearing loss in one ear or headache should also be investigated. In these cases, early investigation, usually by an ENT surgeon or neurologist, would be advisable.  

When should someone seek immediate medical attention in relation to dizziness? 

If someone has acute vertigo, and they are incapacitated or vomiting, it would be reasonable to seek medical attention straight away. A doctor can intervene and give an anti-sickness tablet or anti-sickness injection which can help. If someone is worried about their balance and feels they are, for example, at risk of falling they should also contact their GP and discuss their concerns. Finally, if anyone is experiencing a sudden deterioration of balance, which is otherwise unexplained, they should seek early medical attention.  

What are the different treatment options available to patients who suffer from dizziness? 

If you are experiencing an acute form of dizziness, where the room is spinning around and you’re feeling nauseous, vestibular sedative tablets (e.g., sea-sickness tablets) can ease the symptoms. For chronic imbalance, balance exercises are usually the most helpful treatment. For positional vertigo, where the room spins for up to 30 seconds in certain head positions, The Epley manoeuvre is usually very effective. If someone suffers recurrent episodes of acute vertigo which are disabling, they may be given tablets to try to prevent the episodes, and sometimes medication is injected directly into the ear.