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The ABC of Common Medical Conditions Causing Dizziness, Vertigo and Imbalance

COMMON BALANCE DISORDERS

Migraine Woman
Autoimmune Disease

Autoimmune disease happens when the body’s natural defense system can’t tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells. There are more than 80 types of autoimmune diseases that affect a wide range of body parts. It is most often seen in females and individuals who may have a history of rheumatoid arthritis (RA). The inner ear is very vulnerable to this condition. It may cause gradual hearing loss in one ear and in some cases dizziness or vertigo. Because the symptoms may also mimic several other inner ear conditions, it may require consultation both with a rheumatologist and otolaryngologist/ENT physician working together. 

Symptoms may include

  • Gradual or sudden hearing loss in one ear. Second ear may become symptomatic years later 
  • May be accompanied by dizziness or vertigo 

What can be done

  • Consultation with your physician or specialists to understand how to treat and manage the underlying autoimmune condition with medications or other medical strategies 
  • Non-medical treatment with hearing aids and VRT as needed to help with any residual hearing loss or dizziness 
Benign Paroxysmal Positional Vertigo (BPPV) 

Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear condition that causes dizziness or vertigo when you change your head position. The dizziness is usually brief, lasting only a few seconds, but it can be severe and make you feel like you’re spinning or moving. Although BPPV is not a serious condition, but it may be very bothersome and could reduce your daily activities. It can cause a serious fall if you have vertigo while in the shower, on a ladder or step stool, so it should not be ignored. 

The cause of BPPV are the  tiny crystals (otoliths) within the inner ear that have loosened from a fluid-filled sac. Changes in head position, like laying down, cause the crystals to move into one of six canals in the inner ear that are responsible for helping our balance. This sends a false signal of movement to the brain about your body’s position. Crystals will naturally loosen and move into canals, but they usually will dissolve on their own within a few days. When they accumulate and don’t dissolve, changes in head movement may cause dizziness and vertigo. 

BPPV is common, due to the natural aging process. There is also a link with vitamin D deficiency, migraine, diabetes, and hypertension. By age 70 it is estimated at 50% of all people will have it at least once in their life. A common cause, even in children and younger individuals is  mild head trauma. The symptoms of BPPV may vary from person to person. Symptoms are usually  triggered by a change in body or head position, like laying down in bed or looking up at a top shelf.   

Symptoms may include

  • Dizziness or vertigo only with change of head or body position 
  • Nausea and vomiting associated with the vertigo 
  • Lightheadedness following the vertigo 
  • Unsteadiness when walking 

Good News!
BBPV is successfully treated  95%+ of the time with just a few 5–10-minute treatments called Canalith Repositioning. No pins, needles, or medication. Just a simple physical positioning while laying on a comfortable treatment table by a skilled practitioner. The AIB has successfully performed over 16,000 treatment since 1994 and has published many scientific articles on best treatment methods. 

Concussion, Post-Concussion Syndrome or mild Traumatic Brain Injury (mTBI) 

Head injuries are most often caused by falls, motor vehicle accidents or sports. They are not uncommon for children to older adults. A diagnosis of concussion may be made by a physician based on the symptoms that the person is reporting rather than based on a specific test. If not serious causing a fracture of the skull or bleeding of the brain, most individuals recover within 7-10 days following their physician’s orders. However, symptoms may last beyond this time period. 

Common symptoms may include 

  • Dizziness or foggy headedness 
  • Confusion 
  • Fatigue 
  • Trouble concentrating 
  • Nausea or vomiting 
  • Blurred vision made worse with head movement 
  • Difficulty reading or focusing 
  • Poor balance 
  • Headache

The part of the inner ear called the Labyrinth may also have some trauma in individuals who have had a concussion or mTBI. When this occurs the symptoms of blurred vision while reading or walking, imbalance and dizziness may be more noticeable. 

What can be done to recover

  • Follow your physician’s orders 
  • Have the proper diagnosis and testing as needed 
  • Vestibular and Concussion therapies by a properly trained rehabilitation specialist as recommended 
  • Be patient, as it may take time for the brain to heal 
Meniere’s Disease 

Meniere’s disease is often referred to as “glaucoma” of the ear. It is caused by an over production of inner ear fluids with poor absorption. Most Meniere’s disease is idiopathic, meaning the cause is unknown, however it is more common in individuals with a history of migraine, which also means more females than males. Sometimes it is difficult to distinguish Meniere’s from Vestibular Migraine. The big difference is that Meniere’s has a fluctuating low frequency hearing loss, almost always just in one ear and Migraine rarely has any loss of hearing. 

Symptoms may include

Meniere’s disease is classified by four (4) major symptoms which typically occur together and can have varying frequency: 

  • Fluctuating hearing loss 
  • Tinnitus 
  • Vertigo 
  • Aural fullness 

Neurodiagnostic vestibular testing typically shows certain patterns of findings which, along with a clinical examination can help your doctor make a diagnosis of Meniere’s disease. An otolaryngologist often referred to as an Ear, Nose & Throat (ENT) physician, is the best specialist to see for this condition.  

What can be done 

  • Medications ranging from diuretics, anti-motion, and anti-nausea medications 
  •  Dietary restrictions, usually limiting salt intake 
  •  Otolaryngologist/ENT physician may place medication inside the inner ear 
  • Vestibular Rehabilitation Therapy (VRT) to deal with any lingering dizziness or balance issues  
Persistent Postural Perceptual Dizziness (3PD) 

Persistent Postural Perceptual dizziness (3PD) is a chronic condition that may cause dizziness, unsteadiness, or an internalized sensation of movement. It is often triggered by prior episodes or attacks of vertigo. It may then linger as a sensation of movement, but may also be triggered by complex visual stimuli, such as crowds or busy environments. The symptoms of 3PD may vary in severity sometimes making it  difficult to carry out everyday activities often causing anxiety. 

While the exact cause of 3PD is not fully understood, but it is thought to be caused by a combination of factors, including: 

  • A prior vestibular event, such as vestibular neuritis or other causes of vertigo 
  • History of anxiety, panic attacks or depression 
  • A traumatic event, such as a car accident 
  • A medical condition, such as migraine

The symptoms of 3PD can vary from person to person, but they may include

  • Dizziness 
  • Unsteadiness 
  • Lightheadedness 
  • Nausea 
  • Vomiting
  • Visual disturbances, such as blurred vision or double vision 
  • Anxiety 
  • Depression 

If you are experiencing symptoms of 3PD, it is important to speak with your physician and referral to specialists for testing and proper diagnosis. 3PD is a treatable condition with proper diagnosis and care. 

What can be done 

  • Medication, such as anti-anxiety medication or vestibular suppressants 
  • Vestibular Rehabilitation Therapy (VRT), which helps the brain to recognize triggers and correct and reduce movement created symptoms and improve balance 
  • Cognitive Behavioral Therapy (CBT), which helps people to manage their anxiety and depression 

Here are some tips for managing 3PD 

  • Avoid triggers. If you know what triggers your symptoms, try to avoid them. 
  • Get regular exercise. Exercise can help to improve your balance and reduce anxiety. 
  • Eat a healthy diet. A healthy diet can help to improve your overall health and well-being. 
  • Get enough sleep. Sleep is important for your physical and mental health. 
  • Manage stress. Stress can worsen symptoms of 3PD. Find healthy ways to manage stress, such as exercise, meditation, or yoga. 
  • Talk to a therapist. A therapist can help you to understand your symptoms and develop coping strategies. 
Multifactorial Disequilibrium  (general imbalance and unsteadiness) 

A loss of balance and difficulty walking comfortably and safely on challenging surfaces like grass or sand. This condition may increase likelihood of falls or fear of falling. This condition is most common when there have been changes in one or more of the sensory system that help keep balance; inner ear, vision, and touch. This may be worsened by conditions of the musculoskeletal or nervous system like arthritis or stroke.  

Causes may include

  • Reduced or loss of inner ear balance function 
  • Age related deconditioning or sedentary lifestyle 
  • Prescriptions, singular or interactions of several medications 
  • Medical conditions; cardiovascular, diabetes, arthritis, or Parkinson’s disease etc. 
  • Vision conditions; low vision, macular degeneration, glaucoma, cataracts etc. 
  • Orthopedic problems 

If you are experiencing imbalance or have already had a fall, it is important to tell your physician in order  to determine the cause. Falls are serious and are the #1 cause of accidental death in persons aged 65 years and older. Fractures of the wrist, leg, and hip, as well as head trauma following a fall are not only painful but may require surgeries, long-periods of recovery and therapy. 

What can be done

  • Discuss your concerns with your physician
  • Receive a complete Fall Risk evaluation which should include testing of the inner-ear balance system
  • Physical therapy, as indicated to improve balance and coordination
  • Management and adjustment of any prescription medications or other medical conditions by your physician
  • Exercise to improve overall health and fitness as deemed safe by your medical providers
Perilymphatic Fistula

The inner ear is a fluid filled system encased in bone. When there is trauma such as a blow to the head, it is possible for this system to rupture and the fluid to leak. This may also be caused by increased intracranial pressure, which may happen when lifting heavy objects. When this occurs,  vertigo and hearing loss will happen almost immediately. It usually occurs on one side, and typically opposite the side of the head trauma if that is the cause. It may seem to get better when laying on one side, but worse when the injured side is pointing towards the ground or when trying to lift anything heavy. This is an acute medical condition which requires immediate medical attention as soon as possible.

Symptoms may include

  • Vertigo or severe dizziness, worse with body position
  • Hearing loss
  • Changes in reduction or worsening of symptoms with rest, change in head position or lifting heavy objects
  • Sense of imbalance or unsteadiness

What can be done

  • Seek expert medical care immediately
  • An otolaryngologist/ENT physician will usually perform a procedure to repair the leak
  • The hearing loss may or may not recover fully
  • Vestibular Rehabilitation Therapy (VRT) may be recommended and help recover any lingering dizziness or balance problems
Semicircular Dehiscence (SCCD)

The inner ear is a fluid filled sac encased in bone. This bony covering protects the fluids from becoming exposed. If there is an opening or thinning of the bony shell, the fluid filled sac can become hypersensitive to sound, even one’s own voice. Rather than having a hearing loss, it feels like your ear has become super sensitive to sounds. It is believed that this thinning has been there for years, but at some point just on its own, or following even a mild head trauma. There is no pain or physical discomfort.

Symptoms may include

  • Increased hearing sensitivity
  • Sense of imbalance
  • Dizziness caused by loud sounds

What can be done

  • Seek expert medical advice from an otolaryngologist/ ENT Physician
  • CT scan and testing will confirm the diagnosis
  • Surgical repair may be indicated if symptoms are severe
  • If surgery is not recommended other options include using ear plugs or avoidance of loud sounds
Sudden Idiopathic Sensorineural Hearing Loss

This condition may occur because of vascular (blood flow to inner ear) or viral changes effecting the inner ear.  It is usually just in one ear not both. It is sudden and may feel like a partial or total hearing loss. In some people it may also be accompanied by severe vertigo lasting 30 minutes or more. Generally, the hearing will recover, but studies show that if the condition includes vertigo, hearing may not return completely. This condition requires immediate medical attention, the sooner the better.

Symptoms include

  • Sudden hearing loss, partial or total usually in one ear
  • Vertigo may occur in some people

What can be done

  • Seek expert medical advice from an otolaryngologist/ ENT Physician
  • He/she will likely prescribe medications and have you take some tests
  • If hearing and/or balance function does not fully recover than non-medical intervention such as hearing aid for hearing loss and Vestibular Rehabilitation Therapy (VRT) may be recommended
Vestibular Labyrinthitis

Vestibular labyrinthitis is an infection of the fluids of the inner ear that affects balance. It is caused by a virus or bacteria and can also be caused by an autoimmune reaction. The symptoms of vestibular labyrinthitis include vertigo, nausea, vomiting, and dizziness and hearing loss. The vertigo can be so severe that it makes it difficult to walk or stand. The symptoms usually last for a few weeks but can sometimes last for months. It usually only affects one ear.

What can be done

  • It is important to see a doctor to rule out other conditions, such as a stroke or brain tumor. An otolaryngologist often referred to as an otolaryngologist/Ear, Nose & Throat (ENT) physician, is the best specialist to see for this condition.
  • There are medications that can help to relieve the symptoms of vestibular labyrinthitis. These medications include anti-nausea medications, anti-vertigo medications, and steroids.
  • In some cases, vestibular rehabilitation therapy may be helpful. This therapy helps to retrain the brain to compensate for the loss of balance.  Although vestibular labyrinthitis is a serious condition, it is  not life-threatening. Most people make a full recovery within a few weeks. Some people, however, may have longer-term problems with balance.
Vestibular Migraine

A vestibular migraine is a type of migraine that is associated with vertigo, which is a sensation of dizziness or spinning. People with vestibular migraines may also experience nausea, vomiting, and sensitivity to light and sound. The symptoms of a vestibular migraine can last for hours or even days. There are 23 different categories of migraine, and a vestibular migraine may or may not be accompanied by a headache or other symptoms of migraine. Migraine is very common, affecting one in four females and one in six males.

The exact cause of vestibular migraines is unknown, but they are thought to be caused by a combination of genetic and environmental factors. Families often see this in several generations from grandparents to parents to grandchildren. Some of the environmental factors that can trigger vestibular migraines include stress, lack of sleep, changes in weather, and certain foods and drinks.

Since much of migraine is genetic there is not a “cure” for vestibular migraines, but there are treatments that can help to relieve the symptoms.  Neurology is the medical specialist best suited to help patients diagnose and manage their migraine. A common treatment for vestibular migraines is medication. There are a variety of medications that can be used to treat vestibular migraines, including triptans, anti-nausea medications, and vestibular suppressants. In addition to medication, there are several lifestyle changes that can help to prevent or reduce the severity of vestibular migraines. These changes include getting enough sleep, avoiding triggers, managing stress and a food diary, notating foods that trigger the symptoms.

If you believe you may be experiencing vestibular migraines, it is important to see your physician and possible consultation with a neurologist to get a diagnosis and treatment.

Here are common symptoms

  • Vertigo
  • Nausea and vomiting
  • Sensitivity to light and sound
  • Headache
  • Fatigue
  • Dizziness
  • Blurred vision
  • Difficulty concentrating
  • Trouble walking
Vestibular Neuritis

Vestibular neuritis is a condition that affects the vestibular nerve, which is responsible for sending information about balance and head position from the inner ear to the brain. When this nerve becomes inflamed or swollen, it interrupts the way the brain reads information, which can lead to dizziness, vertigo, and other balance-related symptoms. Usually only one ear will be affected.

The exact cause of vestibular neuritis is caused by a viral or bacterial infection, such as the flu or a cold.  It is in the family of the same viruses that causes chicken pox.  It often occurs in people who have had a shingles outbreak weeks or months earlier. In severe cases it may also effect the hearing or facial nerves causing hearing loss and some facial issues.

The symptoms of vestibular neuritis can vary from person to person, but they typically include

  • Sudden, severe vertigo lasting 30 minutes or longer up to hours
  • Nausea and vomiting
  • Unsteadiness and dizziness for days or weeks after the severe vertigo stops
  • In complicated cases may cause hearing loss and some facial paralysis

The symptoms of vestibular neuritis usually last for a few days to a few weeks, but they can sometimes last for several months. In most cases, the symptoms will eventually go away on their own. However, there are some things that you can do to help relieve the symptoms and speed up the recovery process.

What can be done

  • It is important to speak with your physician and likely to see an otolaryngologist also known as an Ear-Nose & Throat (ENT)specialist.
  • Treatment may include medications like steroids and to reduce the inflammation and anti-motion and anti-nausea medication.
  • If minor symptoms persist like dizziness lasting seconds with head movements, a specialized physical therapy protocols called vestibular rehabilitation therapy can help the recovery. The results are highly successful, and outcomes are typically very good. The therapy is easy and comfortable and can be performed both in the physical therapy center and at home.
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