Dizziness & Balance


Dizziness can be described in many ways, such as feeling lightheaded, unsteady, giddy, or feeling a floating sensation. Vertigo is a specific type of dizziness experienced as an illusion of movement of one’s self or the environment. Some experience dizziness in the form of motion sickness, a nauseating feeling brought on by the motion of riding in an airplane, a roller coaster, or a boat. Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Your sense of balance is maintained by a complex interaction of the inner ear, eyes, receptors in the back and lower extremities, your spinal cord and brain.  Symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems.

Feeling unsteady or dizzy can be caused by many factors such as poor circulation, inner ear disease, medication usage, injury, infection, allergies, and/or neurological disease. Dizziness is treatable, but it is important for your doctor to help you determine the cause so that the correct treatment is implemented. While each person will be affected differently, more concerning symptoms that warrant a visit to the doctor include a high fever, severe headache, convulsions, ongoing vomiting, chest pain, heart palpitations, shortness of breath, inability to move an arm or leg, a change in vision or speech, or hearing loss.

There are many varied causes of dizziness and balance issues.  Given the complexity of interactions controlling your balance and equilibrium, that probably isn’t surprising.  Circulation of blood to your brain is critical. If your brain does not get enough blood flow, you feel lightheaded. Almost everyone has experienced this on occasion when standing up quickly from a lying-down position. When this occurs regularly, there may be poor blood flow that needs to be evaluated and could lead to a stroke.  Drugs that decrease blood flow to the brain include blood pressure medication but nicotine is also a culprit. Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension.

Vertigo is an unpleasant sensation of the world rotating, usually associated with nausea and vomiting. Vertigo usually is due to an issue with the inner ear. The most common cause is due to the dislocation of calcium crystals in your inner ear; when displaced, they float like the snowflakes in a snow globe.  As free floating objects, they send signals to your eyes and your brain that are misinterpreted as movement.  Fortunately, when recognized by a doctor with experience at looking for this, it can often be treated by a procedure called a repositioning maneuver.  This condition can happen for a variety of reasons but has an increased risk after head injury or in low calcium states.  Meniere’s disease is marked by vertigo that lasts minutes to hours with ear fullness, noise in the ear and changes in low frequency hearing.

Other causes include migraine syndromes, viral and bacterial infections, alterations in blood supply to the inner ear, and nerve injury to the inner ear.  Some people have chronic motion sickness which usually is evident by history.  Many people can adapt to loss of function in one inner ear; it is much more difficult when both ears are affected.  When adaptation is incomplete based on symptoms and diagnostic evaluation, patients can be treated with physical therapy to help them learn to regain their balance.

Neurological diseases such as multiple sclerosis, Parkinson’s Disease, syphilis, and certain brain tumors are relatively uncommon causes, but your doctor may perform certain tests to evaluate for them.  Head trauma and whiplash injury

Anxiety can be a cause of dizziness and lightheadedness. Unconscious overbreathing (hyperventilation) can be experienced as overt panic, or just mild dizziness with tingling in the hands, feet, or face. Instruction on correct breathing technique may be required.