Guest post by:
Habib G. Rizk, M.D., MSc
Specialist in Vestibular Balance and Ear Disorders
MUSC Health ENT

 

Dizziness is one of the most common complaints that someone may have during a lifetime. It is most frequently found in the elderly population, but can also be present, to a lesser degree, in younger age groups. The word “dizzy” derives from the old English word dysig meaning “foolish or stupid” as well as from the word dheu meaning “dust, vapor, smoke, or to rise in a cloud”. It is not surprising, then, that “dizzy,” much like the symptom it describes, later became synonymous with the concept of “having a whirling sensation”— a vague and difficult to categorize description. The problem with dizziness is a problem of defining the actual symptom the patient has. In fact, many different symptoms that are difficult to describe are often categorized as dizziness.

Depending on the description of symptoms a patient has, a specialized physician can begin to decipher the exact source of the problem. For example, an illusion of movement of oneself relative to one’s surroundings is described as vertigo. This feeling is commonly experienced after riding a merry-go-round and then immediately stopping. Other examples of dizziness include a lightheadedness feeling, as is frequently felt by people who are about to faint or lose consciousness.

The body’s balance system has many inputs, including the eyes, ears, and joints of the legs and feet. If any one of these systems is not functioning properly for any reason, the body’s balance system may begin to misinterpret one’s surroundings which results in the feeling of dizziness. For example, patients with diabetes may have a condition known as “peripheral neuropathy.” The condition causes a misfiring of the nerves of the lower extremity — most frequently the feet. Without functioning nerves of the foot, the body’s balance system starts to misinterpret the presence of gravity and causes one to feel unbalanced and unsteady. Similarly, if one or both of our inner ears are not functioning properly, such as can occur from benign paroxysmal positional vertigo, Meniere’s disease, migraine headaches or strokes, our sense of left and right will be unbalanced and we will be unable to move forward easily. Finally, medications that are frequently taken for dizziness, such as Meclizine and Valium, if used long-term can blur one’s sensorium and actually exacerbate the problem.

Altogether, the purpose of the body’s complex balance system is to keep us upright and moving in an intended direction. What makes dizziness so distressing to most patients is that the majority of our “inputs” or senses are telling us the correct information, while a few of our senses are telling us the opposite. The brain is left confused as to what is actually the correct representation of one’s surroundings in three-dimensional space, leading to an uneasy and confusing feeling.

The MUSC Health Vestibular Program gives patients the opportunity to receive a comprehensive evaluation of their dizziness. Our evaluation starts with a detailed discussion of your symptoms. We feel strongly that it is important you have ample time to fully express your problem. A thorough physical examination of your balance system follows. Next, we complete a variety of vestibular tests to assess the balance system in the inner ears. Depending on the symptoms, we also use a test called posturography to study the movements of the body undergoing different motion stresses. With all of this important information in hand, we will work closely with you and our multidisciplinary team ranging (neurologists, physical therapists, and even psychiatrists) to develop an individual treatment plan. In certain cases such as Meniere’s disease or vestibular migraines, lifestyle modifications are needed, and especially dietary modifications. Our registered dietitian holds a 45-minute educational session for interested patients three Fridays a month, in an effort to help with the difficult task of identifying their triggers and managing them.

Our web page entitled Vestibular and Balance Disturbances offers  information about the many causes of dizziness, the tests we do in our vestibular lab and animations for certain conditions and treatment maneuvers.