The term dizziness is referred to the feeling of being weak, faint, off-balance or unsteady. Vertigo is the false sensation of spinning or the world moving around you. Vertigo is a symptom, not an actual diagnosis. Individuals diagnosed with vertigo complain of either feeling their body swaying or their environment rotating around them. While this is the primary symptom of vertigo, some individuals may also complain of accompanying symptoms like headache. Studies show vertigo, dizziness, and headaches are the most common reasons an individual may visit an ENT specialist. Data shows that an individual is likely to experience these symptoms in 20 to 30% of the cases during their lifetime. (1) However, due to a lack of awareness regarding vertigo, its causes, and its treatment, a majority of the individuals have to go through an odyssey of visits to their general physician, before they finally visit a specialized ENT and get a diagnosis.
Common Causes of Dizziness and Balance Issues
The most common cause of dizziness is BPPV. Other abnormalities of the inner ear can also cause vertigo, including Meniere’s disease, SSCD (superior semi-circular canal dehiscence), and viruses that attack the vestibular system (such as labyrinthitis, neuronitis or Ramsay Hunt Syndrome).
Benign Paroxysmal Positional Vertigo
Benign Paroxysmal Positional Vertigo, also called BPPV, is caused by the deposition of calcium or other forms of debris in the semicircular canals of the inner ear. This leads to frequent temporary episodes of spinning dizziness. These usually last for seconds to minutes, especially when the individual is lying down or getting up from bed. (3)
Meniere’s disease is another common cause of dizziness and balance issues in many individuals. Certain factors may increase an individual’s risk for Meniere’s disease. These include poor drainage of fluid in the ear or an immune condition. Individuals diagnosed with Meniere’s disease complain of symptoms like hearing loss, ringing of the ears, ear fullness in one ear and severe attacks of vertigo.
Ramsay Hunt Syndrome
Ramsay Hunt Syndrome is caused by the virus known as Herpes Zoster. Hence this condition can also be referred to as Herpes Zoster Oticus. It is caused by the inflammation of the nerve responsible for balance, known as the Vesticbulocochlear nerve. Sometimes it also involves the facial nerve, which results in paralysis of the face. (5)
Treatment of Dizziness and Balance Issues
The treatment for dizziness and balance issues mainly depends on their primary cause, the individual’s health status, and the severity of the symptoms.
Certain medications may be recommended to improve the symptoms of dizziness and balance issues. These are ideal for acute episodes of vertigo and provide immediate as well as long-term relief to the individual. The most commonly recommended medicines for symptomatic relief of dizziness and balance issues caused by various reasons include antihistamines, antiemetics, and benzodiazepines. The type of antihistamine frequently recommended is Meclizine, which is also considered safe during pregnancy. However, since benzodiazepines, antihistamines, and antiemetics can also cause mild sedation, they are often not given to elderly patients. Certain forms of vertigo, like benign paroxysmal positional vertigo, may require the use of corticosteroids in order to provide relief from acute symptoms. Individuals with Meniere disease are most commonly recommended a combination of medication and physiotherapy. (7)
Physical therapy is amongst the most commonly recommended non-pharmacologic treatment for dizziness and balance issues. This may prove to be beneficial for both unilateral and bilateral vestibular problems. The vestibular rehabilitation exercises in physical therapy involve using visual and proprioceptive tools to train the brain and allow the individual to maintain balance. The effectiveness of vestibular rehabilitation for symptoms of vertigo is also proven in a number of studies. The results of the studies have shown vestibular rehabilitation to achieve a reduction in dizziness on movement. (8)
Head Rotation Exercises
Head rotation exercises are most commonly recommended to individuals with BPPV. These exercises and movements allow the calcium deposits to get displaced to the ear vestibules. This is also referred to as Epley Maneuver.
The Bottom Line
Dizziness and loss of balance is a common complaint that is brought to ENT clinics all over the world. This may be experienced by individuals of all ages but is most commonly seen to affect the older population. There are many reasons for these symptoms, which include forms of Vertigo like Benign Paroxysmal, Positional Vertigo, and Meniere’s disease. While the most common treatment for short-term relief of symptoms is pharmacological, physical therapy and the Epley maneuver may provide long-term results. Quick and accurate diagnosis of dizziness and imbalance is crucial for resolution of symptoms and prevention of falls with injury.
If you are experiencing dizziness or balance issues, we recommend that you make an appointment right away. Our experienced team of ENT Physicians, Audiologists, and Advanced Practice Providers are able to give unique care to each patient. You can learn more or schedule an appointment here.
- Neuhauser H. K. (2007). Epidemiology of vertigo. Current opinion in neurology, 20(1), 40–46. https://doi.org/10.1097/WCO.0b013e328013f432
- Post, R. E., & Dickerson, L. M. (2010). Dizziness: a diagnostic approach. American family physician, 82(4), 361–369.
- Labuguen R. H. (2006). Initial evaluation of vertigo. American family physician, 73(2), 244–251.
- Paparella, M. M., & Djalilian, H. R. (2002). Etiology, the pathophysiology of symptoms, and pathogenesis of Meniere’s disease. Otolaryngologic clinics of North America, 35(3), 529–vi. https://doi.org/10.1016/s0030-6665(02)00019-1
- Yokose, M., & Shimizu, T. (2021). A Case of Ramsay Hunt Syndrome That Began with Vestibular Symptoms: A Great Mimicker. The American journal of medicine, 134(4), e271–e272. https://doi.org/10.1016/j.amjmed.2020.09.049
- Semaan, M. T., & Megerian, C. A. (2006). The pathophysiology of cholesteatoma. Otolaryngologic clinics of North America, 39(6), 1143–1159. https://doi.org/10.1016/j.otc.2006.08.003
- Shih, R. D., Walsh, B., Eskin, B., Allegra, J., Fiesseler, F. W., Salo, D., & Silverman, M. (2017). Diazepam and Meclizine Are Equally Effective in the Treatment of Vertigo: An Emergency Department Randomized Double-Blind Placebo-Controlled Trial. The journal of emergency medicine, 52(1), 23–27. https://doi.org/10.1016/j.jemermed.2016.09.016
- Cohen, H. S., & Kimball, K. T. (2003). Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngology–head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery, 128(1), 60–70. https://doi.org/10.1067/mhn.2003.23
- Cetin, Y. S., Ozmen, O. A., Demir, U. L., Kasapoglu, F., Basut, O., & Coskun, H. (2018). Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial. Pakistan journal of medical sciences, 34(3), 558–563. https://doi.org/10.12669/pjms.343.14786
- Berisavac, I. I., Pavlović, A. M., Trajković, J. J., Šternić, N. M., & Bumbaširević, L. G. (2015). Drug treatment of vertigo in neurological disorders. Neurology India, 63(6), 933–939. https://doi.org/10.4103/0028-3886.1700