Dizziness and Vertigo

DizzinessDizziness and vertigo are common symptoms reported during office visits. They can result from an inner ear peripheral vestibular disorder or a central vestibular disorder involving the brain. It is important to differentiate the between them so as to make an accurate diagnosis and recommend appropriate treatment. Dizziness is a sensation of feeling faint, unsteady, or being lightheaded. Vertigo is more specific and refers to a frank spinning rotational perception of movement.

Vestibular dysfunction can be caused by head injury, aging, viral inflammation, autoimmune disease, loose crystals within the inner ear, etc. Below is a short list with appropriate description:

  1. Vestibular neuronitis – This is typically caused by a viral infection. There is inflammation of the inner ear sometimes also associated with hearing impairment. Patients can be severely ill for days with severe imbalance, nausea, and vomiting.
  2. Cholesteatoma – A skin tumor within the middle ear that can erode into the inner ear and temporal bone.
  3. Benign positional vertigo – Related to loose crystals (otoconia). This can occur following a head injury but sometimes occurs simply to aging and degeneration within the inner ear.
  4. Autoimmune disease – Diseases such as Cogan’s syndrome, lupus, rheumatoid arthritis, or Wegener’s granulomatosis can sometimes harm the inner ear due to an over aggressive immune system.
  5. Acoustic neuroma arising from the vestibular cochlear (hearing) nerve – Although this is benign in pathology, it can enlarge in size and lead to severe hearing impairment, dizziness, hydrocephalus, and brain compression.
  6. Meniere’s disease – This is a common, sometimes progressive condition. There is abnormality involving the pressure and composition of the inner ear fluid. Patients can have an aura with roaring tinnitus followed by severe vertigo, nausea, and vomiting. Milder forms as well can occur with ear pressure and fullness associated with lightheadedness. Middle ear space appears clear on evaluation. Disease is bilateral in 25% of patients.
  7. Otosclerosis – Involves improper bony growth within the middle ear that can lead to mixed or conductive hearing loss as well as dysfunction within the inner ear.
  8. Migraine and vertigo are fairly common – Patients will typically have an aura, sensitivity to light and sound, dizziness, and severe headaches. This condition is typically treated by a neurologist.

Non vestibular causes of dizziness include a cardiac condition (e.g., arrhythmia), aneurysm, aging with atherosclerosis and limited blood supply to the brain, dehydration, degenerative arthritis of the cervical spine interfering with blood supply to the brain, heart attack, hyperventilation, anxiety, stroke, medications, multiple sclerosis, orthostatic hypertension, brain tumor, etc.