Introduction

Dizziness is a symptom, not a disease. It may be defined as a subjective sensation of unsteadiness or imbalance, or a disorientation in relation to one’s surroundings. Dizziness can be caused by many different diseases and varies from a mild unsteadiness to a severe whirling sensation known as “vertigo.”

Metabolic Disturbances and Allergies

Metabolic disturbances and allergies can produce dizziness, with or without associated hearing loss, by interfering with the function of the inner ear or in central connections. Occasionally hearing loss may occur without the presence of dizziness.

The most common metabolic disturbances are a result of decreased thyroid function, abnormal sugar tolerance, and inhalant or food allergies.

Thyroid dysfunction is diagnosed by blood tests. Treatment consists of thyroid hormone. Abnormal sugar tolerance is diagnosed by blood sugar studies (glucose tolerance test). Treatment consists of diet control, with or without drug therapy.

Allergies may be diagnosed by blood tests or skin tests for inhalants and foods. Treatment consists of elimination of the offending agents when possible. If avoidance of these agents is not possible, then extracts of the different substances may be administered by injection to stimulate immunity.

Injury

Injury to head occasionally results in dizziness due to damage to the inner ear and its blood vessels. The unsteadiness is at times prolonged, and may or may not be associated with hearing loss and head noises. Treatment consists of vasodilators, sedatives and anti-dizzy medication. The symptoms usually disappear but occasionally surgery (vestibular nerve section) may be necessary.

Perilymphatic Fistula

Dizziness, with or without hearing impairment, may result from a perilymphatic fistula – a leak of inner ear fluid into the middle ear through one of the two inner ear windows. The fistula may appear spontaneously or may follow a head injury, a sudden change in atmospheric pressure (barotrauma) or ear surgery. A perilymphatic fistula may close spontaneously. If symptoms persist, exploratory surgery may be advised to repair of the fistula with ear tissue. This usually eliminates the dizziness, but often does not help the hearing. At times, the hearing is worse following fistula repair.

Autoimmune Inner Ear Disease

Disease of the immune system may cause sensorineural (nerve) hearing impairment or dizziness or both. The diagnosis is based on the symptoms and results of blood tests. Treatment with cortisone, and at times anti-immune drugs, may prevent further hearing loss and relieve dizziness. Frequently the hearing is improved. Long-term therapy is often necessary.

Tumors

A non-cancerous tumor occasionally develops on the balance nerve deep in the ear bone. When this occurs, unsteadiness, hearing loss and head noise may develop. Extensive hearing tests, balance tests and x-rays or magnetic resonance scans (MRI) are necessary to diagnose such tumors.

If the diagnosis of a tumor is established, surgical removal is imperative. Continued growth of the tumor would lead to complications by producing pressure on vital adjacent nerves and the brainstem. An operation has been developed which allows the removal of these tumors at an early stage. Best results can be obtained if the tumor is diagnosed early and removed while the only symptoms are hearing loss, dizziness and tinnitus.

Dandy’s Syndrome

A total loss of the inner ear balance function in both ears is rare. It results in a condition called Dandy’s Syndrome. This may result from infections, injuries or tumor removal.

There may be serious dizziness at the time the individual first loses the balance mechanism. Other portions of the balance mechanism (eyes, muscles and joints) help the individual to compensate for loss of inner ear function. Most do quite well except in the dark or when swimming. Many notice oscillopsia, a tendency for observed objects to appear to move up and down while the person is in motion.

There is no treatment for Dandy’s Syndrome. Most patients compensate well and lead normal lives. One should avoid movement in total darkness and avoid underwater swimming.

Vascular Compression Syndrome

The vestibular (balance) nerve is located in a very complex part of the skull called the posterior fossa. A number of blood vessels are in close proximity to the nerve. If a blood vessel happens to compress or pulsate against the vestibular nerve, dizziness may result. The diagnosis of this syndrome is difficult. A careful history and the results of specialized auditory and balance tests provide a physician with the suspicion of a vascular compression syndrome. The treatment is a surgical procedure, microvascular vestibular nerve decompression.

Meniere’s Disease

Meniere’s Disease is a common cause of repeated attack of dizziness and vertigo. It is due to increased pressure of the inner ear fluids.

Fluids in the inner ear chambers are constantly being produced and absorbed by the circulatory system. Any disturbance in this delicate relationship results in over-production or under-absorption of the fluids. This leads to increased fluid pressure (hydrops) that in turn produces dizziness, which may or may not be associated with fluctuating hearing loss and tinnitus. Fortunately this usually affects only one ear.

A thorough evaluation is necessary in most cases of Meniere’s Disease to determine the cause of the increased fluid pressure. Circulatory, metabolic, toxic, allergic or emotional factors may play a part in many cases.

Symptoms
Meniere’s Disease is characterized by attacks of dizziness that vary in duration from a few minutes to several hours. Hearing loss and head noise usually accompanying the attacks. The attacks of dizziness may occur suddenly and without warning. Violent spinning, whirling and falling, nausea and vomiting, are common symptoms. A sensation of pressure and fullness in the ear is usually present.

Attacks of dizziness may recur at irregular intervals. The individual may be free of symptoms for years at a time. If the attacks do recur, they are usually less severe and of shorter duration than in the initial attack. In between attacks, the individual tends to remain free of symptoms.

Occasionally hearing impairment, head noise and ear pressure occur without dizziness. This type of Meniere’s Disease is called cochlear hydrops. Similarly, episodic dizziness and ear pressure may occur without hearing loss and tinnitus; this is called vestibular hydrops. Treatment of both of these is the same as for Meniere’s Disease.

Treatment of Meniere’s Disease

Treatment of Meniere’s Disease may be medical or surgical. It is aimed at improving the inner ear circulation and controlling the fluid pressure changes of the inner ear chambers. At times, it is necessary to cut the balance nerve or remove the inner ear structures.

Medical treatment of Meniere’s Disease varies with the individual patient according to suspected cause as well as magnitude and frequency of symptoms. It is effective in decreasing the frequency and severity of attacks in 80% of patients. Treatment may consist of medication to stimulate the inner ear circulation, decrease the inner ear fluid pressure, or prevent inner ear allergic reactions.

Various vasodilating drugs are used to stimulate the inner ear circulation and are prescribed together with anti-dizziness medication. Vasoconstricting substances have an opposite effect and, therefore, should be avoided. Such substances are caffeine (coffee) and nicotine (cigarettes). Diuretics (“water pills”) may be prescribed to decrease the inner ear fluid pressure.

Meniere’s Disease may be caused or aggravated by metabolic or allergic disorders. Special diets, drug therapy, or allergy shots are indicated at times to control these problems.

On rare occasions streptomycin injections, which selectively destroy balance function may be used. This treatment is reserved for patients with Meniere’s Disease in their only hearing ear or with Meniere’s Disease in both ears.