Causes of Dizziness and Imbalance

 

 

BPPV:  Benign Paroxysmal Positional Vertigo

BPPV is a condition where the otoconia (composed of calcium carbonate crystals, sometimes referred to as ear rocks) housed in the saccule (a membranous sac in the inner ear, which houses the otolith that senses movement and the direction of gravity) and the utricle (similar to the saccule) of the inner ear, become displace and end up floating in one of the three semi-circular canals, which leads to the follow symptoms:

  • Spinning vertigo and nausea lasting 5-30 seconds.

  • Mild sense of imbalance.

  • Vertigo is triggered by laying down, rolling over in bed, looking up or bending over.  There is often a slight delay (a few seconds) of the onset of vertigo when you initially assume these positions.

BPPV is the most common type of Vertigo and is easily treated in most cases, and usually requires just 1-3 sessions.  Due to the ease with which this is treated you should not hesitate to seek treatment for this.  There is no reason to continue to suffer.  You may even be taught how to treat this yourself.

Vestibular Neuritis

In most cases a definitive cause is never proven, but due to changes in the branches of the vestibular nerve there is evidence to support a viral cause.  Onset may follow and infection of the upper respiratory or gastrointestinal tracts.   The infection can happen simultaneously with the vestibular neuritis or the infection can have occurred as much as two weeks prior to the vestibular neuritis.

Symptoms:

  • Spinning vertigo and nausea lasting 24-72 hours.

  • Often preceded by an upper respiratory or gastrointestinal infection but can be spontaneous.

  • Visual clarity is poor with head movement but it is normal if standing still.

  • Vertigo is worsened by rapid movements of the head.

  • Imbalance.

Vestibular Neuritis is most common between the ages of 30 and 60.  Most symptoms will gradually resolve within 6 weeks.  Rehabilitation significantly speeds recovery and helps in reaching a full recovery.

Meniere's Disease

Symptoms:

  • Spinning vertigo lasting 30 minutes to 24 hours.

  • Fluctuation in hearing, tinnitus, pressure or fullness in the ear and the inability to tolerate loudness.

  • Gradual, permanent hearing loss.

  • Imbalance also occurs with attacks.

Meniere's Disease is treated with diet and medication.  If symptoms persist surgery is considered.

 

Perilymphatic Fistula

This is a leak between the inner ear and the middle ear.  These leaks are usually found after trauma due to severe pressure changes (such as diving), however there are occurrences of spontaneous leaks.  There are no preoperative diagnostic tests to confirm perlymphatic fistula, and often time the results of surgical exploration are inconclusive.

Symptoms:

  • Episodes of vertigo which is improved with rest and worsens with activity, sneezing, straining and nose blowing.

  • Disturbance of vision while walking, hearing loss, imbalance, and loud tinnitus.

Perilymphatic Fistulas usually heal and a full recovery is common.  If symptoms persist surgery is considered.

 

Vestibular Paroxysmia

Symptoms:

  1. Attacks of spinning vertigo lasting 20 seconds to several minutes.

  2. Attacks are triggered by specific head positions and can be reduced with changing head position.

  3. Tinnitus can be permanent or just during the attack.

Vestibular Paroxysmia is treated with medication and if needed, surgery.

 

Bilateral Vestibular Disorders

May occur as a result of meningitis, labyrinthine infection, otosclerosis, Paget's disease, polyneuropathy, bilateral tumors, endolymphatic hydrops, Meniere's Disease, ototoxic drugs, inner ear autoimmune disease, or congenital malformations.

Symptoms:

  • Vertigo, hearing loss, imbalance and inability to maintain balance in darkness.

**Bilateral Vestibular disorders have many causes but can be managed with balance retraining.**

Causes of Imbalance Without Dizziness

  • Stroke

  • Deconditioning (lack of use/weak muscles)

  • Cervical (neck) restrictions

  • Fear of falling

  • Or any combination of the above

For any reason if we become less active and become more sedentary, our bodies lose the ability to keep our balance because we simply don't ask it to use it balance often enough.  Treatment for imbalance requires training in situations that ask you to use your balance.  Treatment can be intimidating at first, but it can also be very rewarding to regain independence through balance training.