Dizziness (unsteadiness or balance problem) is the third commonest patient complaint seen in doctor’s offices and emergency departments after back pain and fatigue. It’s a complex diagnostic challenge for medical personnel ranging in severity from benign to life threatening. For the age 1 toddler, balance is a sometimes humorous learning curve. Likewise the swoon demonstrated by a teen at their first rock concert; but for the rest of us, balance problems can bring about significant degree of incapacitation and even death. In general though, the older the patient, the more likely that dizziness means the presence of serious pathology– not to be ignored. Balance is controlled by a complex neurological network with primary components in the eye, the inner ear, and what I will call our muscle minions, a vast connection of position sensors in soft tissues and joints constantly feeding which-end-is-up data to processors in the brain.
Obviously, any disease in any part of this information network can impair the interpretation of the messages. Common examples of interfering factors would be the bed spins after excess alcohol consumption, the low blood pressure (postural hypotension) unsteadiness on waking especially if the person is on BP meds–even inactivity from long term bed confinement in nursing homes produces significant injury risk. Seniors should avoid as much as possible sedatives and/or analgesics. Sometimes the diagnosis is missed because of the way the patient describes their condition. Vertigo is most commonly presented as “spinning” and often accompanied by queasiness or actual nausea. Its possible the source is middle ear infection in the child or impacted external ear canal wax in the adult but in the senior its more likely the problem is in the inner ear.
The trick is to differentiate between ear problems and actual strokes which many times present with other symptoms including numbness, speech changes, one sided headache and/or gait impairment. There is a condition called benign positional vertigo, (less serious but still incapacitatingand treatable) resulting from dysfunction in the three semicircular canals of the inner ear. Think of them being lined with a fuzz like the outside of a tennis ball. Inside are series of otocona crystals in a gel bouncing off the lining sending a constant stream of information to the brain. Meniere’s disease is another significant balance problem. It consists of the triad of sudden and severe nausea/vomiting accompanied by tinnitus or roaring within the ear only audible to the patient and a paradoxical loss of hearing in the lower decibel ranges noted by everyone else when the patient cranks the audio to a satisfactory level. At present the suspect unproven cause is likely pressure changes in the canal gel. Treatment is available but only partially effective. My apologies if this comes across as Neurology101 for my readers but as I’ve attempted to show, dizziness is a complex anatomical and diagnostic challenge which is never safe to ignore and which sometimes requires a lot of patience on the part of the patient before it is diagnosed and treated.
By: Dr. David Carll