Dizziness is a term used to describe everything from feeling faint or lightheaded to feeling unsteady or off-balanced. Dizziness that creates the sense that you or your surroundings are moving or spinning is called vertigo.

Dizziness is one of the most common reasons adults see a doctor. Although frequent or constant dizziness can keep you from doing much of anything, it is rarely a serious or life-threatening condition.

One important part of the history is the description of the dizziness, as this helps localize the problem. The feeling of motion or spinning (vertigo) often represents a problem with the inner ear. A lightheaded or faint description is a characteristic of a vascular abnormality, whereas a feeling of off-balance may represent a neurological problem.

Common causes of vertigo may include:

  • Benign paroxysmal positional vertigo (BPPV). BPPV causes intense, brief episodes (usually 5-20 seconds) of vertigo immediately following a change in the position of your head, often when you turn over in bed or sit up in the morning. BPPV is the most common cause of vertigo and is successfully treated by positional maneuvers (Epley).
  • Inflammation in the inner ear. Signs and symptoms of inflammation of your inner ear (acute vestibular neuritis) include the spontaneous onset of intense, constant vertigo that may persist for several days, along with nausea, vomiting and imbalance. It can be incapacitating, requiring bed rest. Many patients require some treatment with anti-nausea medications for a short time. Fortunately, vestibular neuritis generally subsides and clears up on its own. However, some patients may have some permanent balance problems.
  • Meniere’s disease. This disease is uncommon and involves the excessive buildup of fluid in your inner ear. It is characterized by sudden episodes of vertigo lasting 30 minutes to several hours, and often associated with hearing loss and loud tinnitus and pressure in the affected ear. Patients typically are treated with low-salt diets and a diuretic (fluid pill), but may need more invasive treatments including surgery.
  • Migrainous vertigo. Migraine is more than a headache disorder. Just as some people experience a visual “aura” (seeing stars prior to experiencing a headache) with their migraines, others can get vertigo episodes and have other types of dizziness between migraines.
  • Acoustic neuroma. An acoustic neuroma (vestibular schwannoma) is a noncancerous (benign) growth on the vestibular nerve, which connects the inner ear to your brain. Symptoms of an acoustic neuroma generally include progressive hearing loss and tinnitus on one side accompanied by dizziness or imbalance. A MRI scan is needed for diagnosis and treatments include radiation or surgery.
  • Other causes. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke, brain tumors or multiple sclerosis. In such cases, other neurological symptoms are usually present, such as double vision, slurred speech, facial weakness or numbness, limb coordination, or severe balance problems.

Presyncope is the medical term for feeling faint and lightheaded without losing consciousness. The most common reason for this is problems with control of blood pressure. Many older patients may experience this condition when rising from a seated position quickly, and need to get-up slower than in the past. Other, less common causes include heart conditions such as an irregular heart beat.

Disequilibrium is the loss of balance or the feeling of unsteadiness when you walk. Causes may include an inner ear problem, including permanent damage caused by vestibular neuronitis. More often the dysequilibrium is noted to be multifactorial, caused by diffuse neurological sensory weakness (peripheral neuropathy in diabetics, for example) and joint problems such as arthritis. One of the most common factors in contributing to balance problems is taking medications. Many medications can cause dizziness, and the more medications one takes the higher probability they will experience balance problems. The family physician often can evaluate the medications to see if any changes can be made if this is felt to be exacerbating the symptoms.

Depending on your symptoms, there are many studies that your physician might think is needed to help make a diagnosis and treat the condition appropriately. However, many times testing is not needed.

If you or a family member is experiencing balance problems or dizziness, then an evaluation by an ENT physician may be warranted.

Robert Wilson, MD.

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