Dizziness is a common description of a variety of different feelings referred as being imbalanced, giddy, feeling of floating, lightheaded, feeling faint, weak, unsteady or woozy. It’s a symptom not a disease which can have a variety of underlying reasons.

In contrast vertigo means a spinning sensation often triggered by head movement or positioning mostly associated with nausea and vomiting and usually related to diseases of the balance organs of the inner ear.

Dizziness and vertigo may occur in frequent spells for seconds or lasting constant for several days. Dizziness and vertigo rarely signals a life-threatening condition!

The sense of balance depends on the combined input from different parts of the sensory system including:

• Eyes, which helps to determine where the body is in space and how it's moving
• Sensory nerves, which send messages to the brain about body movements and positions
• Inner ear, which houses sensors that help detect gravity and back-and-forth motion

These “inputs” are registered and evaluated by the brain. If the brain receives signals from the inner ear that aren’t consistent with the signals from eyes and sensory nerves, it gives the feedback code: failure, which causes dizziness or vertigo as the brain works to sort out the confusion.

Causes

The most common inner ear problem is a Benign paroxysmal positional vertigo (BPPV). This condition causes an intense and brief but false sense that you're spinning or moving. These episodes are triggered by a rapid change in head movement. Followed by a Vestibular Neuritis, a viral infection of the vestibular nerve.

The most common metabolic reasons are dehydration, low blood sugar, anaemia and infections. Circulation problems as to low or to high blood pressure, cardiomyopathy and heart arrhythmia. Motion sickness when travelling by boat, car, train or plane.

Neurological conditions as neuropathy, vertebra basilar circulatory disorders as transient ischemic attacks or Parkinson’s disease. Anxiety disorders. Medications such as anti-seizure drugs, antidepressants, sedatives, tranquilizers and blood pressure lowering medications.

Diagnosis

Dr. Doerthe Schiess Neurology Clinic starts diagnosis by taking an extensive medical history addressing your symptoms, the trigger factors, the duration and the frequency, work environment, social habits, toxic exposure, risk of infectious diseases and family history of neurological disease. Checking the vital signs such as blood pressure and pulse, followed by a proper physical examination focusing on gait and maintaining of balance, eye movement testing by watching the path of the eyes when tracking a moving object and head movement testing called the Dix-Hallpike manoeuvre should give a first differential diagnosis. Additional tests such as laboratory tests, check of heart and blood vessels, imaging of brain or a specific Ear-Nose-Throat (ENT-) related consultation are sometimes necessary.

Treatment includes medications (diuretics, antihistamines, anticholinergics, scopolamine skin patches, anti-nausea medication, anti-anxiety medication), diets (e.g. low salt in Meniere’s disease, high salt in low blood pressure), balance exercises, head position manoeuvres (canalith repositioning or Epley manoeuvre) or behavioural therapy.