Vertigo & Dizziness
The brain uses information to maintain our balance from three sources:
1. Inner Ear Balance System: The balance organs (vestibular system) are situated next to the organ of hearing in the inner ear. They respond to information from head and neck movements
2. Vision: Eyesight
3. Feeling in joints: Signals are sent from receptors in our joints, such as the neck, and our feet (called proprioception)
You may have been experiencing some or all of the following:
- Vertigo; the sensation that you are spinning or the world is moving
- Nausea or vomiting
- Unsteadiness on your feet
- Hazy or blurred eyesight
- Changes to your hearing or ringing in your ears. It may feel as though your ears are blocked
You may also have other symptoms that you find difficult to describe for example; detached, spaced out.
People often become very frightened if they suddenly experience an episode of vertigo and worry that something is seriously wrong.
Often the symptoms are a result of the organs in the ear not working properly. There is a connection between the inner ear and eye movements. A disorder of the inner ear can result in certain eye movements, which gives the impression that something is moving.
What Happens At The ENT Appointment?
If you present to an ENT Consultant with a balance problem or disorder they will initially take a full medical history. They may refer you for a hearing test and if indicated following the test, an MRI scan. Part of your initial assessment will include looking at your eye movements and simple activities such as standing and marching on the spot. Your specialist will use the information that they have gathered, to work towards a diagnosis and they will discuss the treatment options with you. You may need to have more balance tests undertaken before a further diagnosis can be made.
What Causes These Symptoms?
Disorders of the inner ear balance organs are quite common. Below is further information about some of these conditions:
Labyrinthitis and Vestibular Neuritis
These disorders are usually the result of a viral infection which causes swelling to the nerve that supplies the inner ear balance organ.
Because the balance organ lies next to the organ of hearing, you may experience changes or reduction in hearing as well as vertigo or dizziness.
Symptoms are often severe for the first day or two. After this, vertigo may appear in spells lasting for seconds or a minute or two.
Common ear disorders such a Labyrinthitis can cause permanent weakness to the balance organ. However, the brain is very good at readjusting (this is called compensation) so symptoms usually improve during the next six weeks to six months. Many people make a complete recovery.
BPPV (Benign Positional Paroxysmal Vertigo)
BPPV is the most common cause of dizziness. Although the vertigo can be quite disabling it is not due to serious disease. The vertigo is provoked specifically by movement from and to certain positions, such as:
- Lying flat
- Sitting up from lying flat
- Turning over in bed
- Looking up (e.g. hanging washing)
- Bending down, especially if also looking to the side.
The dizziness usually occurs in short burts lasting 5-30 seconds, but very occasionally can last up to 2 minutes. The vertigo in BPPV is caused by loose crystals which move into the Semicircular Canals in the inner ear balance system. These fluid filled canals are responsible for sensing rotational movement. Following specific head movements this causes these loose crystals to move along the affected Semicircular canal, stimulating it and giving the sensation of rotation - resulting in vertigo.
Many people who experience vertigo or dizziness with head and neck movements find that additional balance exercises are often very effective. These exercises are called vestibular rehabilitation which work by speeding up the natural recovery process. They are often focused on the reflex between the eyes and the inner ear balance organ.