Children twirl around the poles until they are so dizzy that I'm ready to catch them. The young seem to delight in making the world spin out of control for a few moments, causing them to flop about like drunks. But when dizziness, vertigo or loss of balance is neither self-imposed nor short-lived, it is anything but fun. It can throw one’s whole life out of kilter, literally and figuratively. Lisa Haven, executive director of the Vestibular Disorders Association, says “the risk of falling is two to three times greater in people with chronic imbalance or dizziness.”
FOUR TYPES OF DIZZINESS
The job of the vestibular system is to integrate sensory stimuli and movement for the brain and keep objects in visual focus as the body moves. When the head moves, signals are sent to the inner ear, an organ consisting of three semi-circular canals surrounded by fluid. It in turn sends movement information to the vestibular nerve, which carries it to the brainstem and cerebellum, which control balance and posture and coordinate movement. Disruption of any part of the system can result in dizziness. These are four types of dizziness, all of which are more common with increasing age:
• Faintness, the feeling of being about to black out when upright. This can result from dehydration, abnormal heart rhythms, overmedication with blood pressure drugs and disorders of the autonomic nervous system.
• Loss of balance, feeling unsteady and about to fall even though muscle strength is normal. This can be caused by disorders of the inner ear; the cerebellum because of stroke or chronic alcoholism; or the basal ganglia, because of Parkinson’s disease, for example. It can also result from overmedication with drugs such as sedatives and anticonvulsants, vision disturbances and neuropathy or spinal cord disease that causes a loss of position sense in the legs.
• Vertigo, a false sense that the person or the surroundings are moving or spinning. This can result from motion sickness, middle-ear infections, migraines, multiple sclerosis, damage to the vestibular nerve and reduced blood flow to the brain after a stroke or transient ischemic attack.
• Vague light-headedness, a feeling of giddiness or detachment from the world can be caused by a panic attack, depression, anxiety disorders or hyperventilation.
WHAT TO TELL THE DOCTOR
About 40% of people experience at least one of these forms of dizziness at some time during their lives. When dizziness persists, medical care is essential, and so is the ability to provide a detailed description of the symptoms and what provokes them. What does the dizziness feel like—faintness, loss of balance, light-headedness, a sensation that you or your surroundings are spinning or moving? When did the symptoms begin? How long do they last? What provokes or relieves them? What other symptoms like headache, ringing in the ears, impaired vision, difficulty walking, weakness or hearing loss accompany the dizziness? Treatment will depend on the cause of the dizziness. For example, for benign paroxysmal positional vertigo, a simple head-turning manoeuvre that repositions crystals in the inner ear may bring lasting relief. If ministrokes are the cause, the treatment may involve anticlotting drugs or opening a blocked artery with a stent.
If medication is the problem, adjusting the dose or changing the drug can relieve dizziness. If dizziness persists despite treatment, lifestyle adjustments—such as avoiding sudden movements, keeping often-used items within easy reach, standing up slowly and clenching hands and flexing feet before standing—can help. Physical therapy can help, as can exercises that strengthen muscles and that combine eye, head and body movements.
©2008/The New York Times