Finding your footing on dizziness

Dizziness is a feeling of lightheadedness and off-balance. It is typically a symptom of an underlying condition or disorder. In this article, a consultant neurologist describes dizziness and its associated pathologies. 

What is dizziness?

Dizziness can affect everyone and it is not necessarily indicative of a more serious problem. People can become dizzy after spinning around rapidly, standing up quickly and bending over, or after going a long time without eating. However, consistent or repetitive dizziness could point to a more serious issue, as well as impact your quality of life.

Dizziness may feel like:

• Feeling faint
• Feeling nauseous
• Loss of balance
• Disorientation
• Warped vision

What causes dizziness?

Reoccurring dizziness may occur due to a disruption of the flow of information that is transmitted from the ears and eyes along the nervous system, and this can be caused by many different conditions. Many times, an issue with the inner ear, which is the centre of balance, is the main culprit, such as labyrinthitis, where the inner ear system called the labyrinth becomes inflamed, vestibular neuritis infection, or benign paroxysmal positional vertigo (BPPV).

Dizziness as a symptom is not restricted to inner ear issues. Dizziness can also occur due to:

• Anaemia, where there are low levels of red blood cells, leading to a lack of oxygen to the body’s organs including the brain.
• Migraines, which are severe headaches caused by abnormal brain activity.
• Anxiety and stress, where feelings of panic can result in irregular breathing, disrupting the levels of oxygen and carbon dioxide in the blood leading to dizziness.
• Parkinson’s disease and multiple sclerosis, which are neurological disorders that affect the sense of balance.
• Head trauma (concussion), where the brain has been physically damaged.
• Dehydration and low blood sugar.
• Reaction to medications.
• Poor blood circulation.

How is dizziness treated?

To treat dizziness, it is important to know the context in which the dizziness is occurring.

Bloodwork, imaging tests like MRI and CT scans, a physical exam, and a thorough review of your medical history may be necessary to find the root cause of dizziness.

To further see how the dizziness is impacting your bodily function, a doctor may conduct testing on:

• Eye movement, to see how the eyes fix on a moving object
• Head movement, such as the Dix-Hallpike manoeuvre which can confirm BPPV
• Your sense of balance (posturography)

Treatment for dizziness will depend on the base condition and symptoms. Treating the base condition will typically alleviate dizziness or manage it at the very least.

Patients may be prescribed medications to relieve dizziness and nausea or be recommended alternative medication if the ones they are taking are causing them to be dizzy. Anti-anxiety medications can be used for anxiety-related dizziness, and iron tablets to address anaemia.

Therapies to cope with dizziness caused by inner ear conditions include balance training (vestibular rehabilitation) and special head position movements (canalith repositioning) to recalibrate the inner ear fluids. Injections of antibiotics called gentamicin may be used in order to stop the inner ear function of the disordered ear.

In very extreme cases, patients may be recommended to undergo a labyrinthectomy to remove the labyrinth of the inner ear. However, this will cause total hearing loss in that ear.

For relief during a dizzy spell, it is advised to lie down until the dizziness passes, so that you are not in danger of falling over. Make slow, measured movements, and drink some water to stay hydrated.