What Causes Dizziness/Vertigo

Millions of Americans have disorders of balance they describe as dizziness/vertigo. What can be difficult for both a patient and their doctor is that dizziness is a subjective term. For some people, dizziness/vertigo is a feeling of unsteadiness, while others can experience the whole room spinning around them. Many times in our Minnesota clinics, we have patients that can't quite explain what they are feeling, but they just know there is something different. Dizziness/vertigo can affect a person's independence, ability to work, and their quality of life. A lot of people say they feel dizzy, but what they are really feeling is an unsteadiness on their feet. Dizziness and balance disorders may also lead to other problems including fatigue, difficulty walking, depression, or disinterest in everyday activities. Generally, if someone has feelings of nausea, wooziness, and a sensation of spinning, this is usually referred to as vertigo. A common vertigo condition called Benign Paroxysmal Positional Vertigo (BPPV) is often the cause and can be treated with just a few appointments.

Some experts believe that more than 40 percent of Americans will experience dizziness/vertigo that is serious enough to go to a doctor. Even dizziness that seems minor, if undiagnosed, may be a signal of underlying disorders. Dizziness/vertigo problems are among the most common reasons that older adults seek help from a doctor. Many people are surprised to learn that the source of their dizziness may be because of an inner ear or vestibular problem. Dizziness due to a vestibular dysfunction are reported in about 9 percent of the population who are 65 years of age or older. Fall-related injuries due to dizziness or imbalance such as breaking (or fracturing) a hip are a leading cause of death and disability in older individuals. Some dizziness and balance conditions are also due to neurological conditions like Multiple Sclerosis, Parkinson's Disease, Brainstem strokes (TIA), and Cervical vertigo. Other miscellaneous conditions that cause dizziness and balance problems can be psychological disturbances, post-traumatic vertigo, and post-partum vertigo.

Dizziness and balance disorders are serious. The most important thing you can do if you think you have a balance disorder is to have a comprehensive medical evaluation to understand what is causing your dizziness/vertigo or balance problem. Before going to see your doctor, make notes on the feelings and sensations you feel during a "dizzy" episode. This will help your doctor make a more accurate initial diagnosis before recommending further treatment. When in your doctor's office, it's important to describe the feelings and sensations you feel during a "dizzy" spell very accurately, this is why it's important to take good notes. After describing your symptoms, your doctor my order some diagnostic tests to aid in accurately diagnosing your condition.
After your tests have been completed by an audiologist or technician, they are normally reviewed by your doctor and a treatment plan is established.

If your condition is appropriate, a vestibular rehabilitation program is often prescribed to treat your condition. These programs typically consist of 8-15 therapy visits and patients are normally assigned home exercises to complete alongside the therapy they receive in the clinic. The greatest benefit to patients utilizing this treatment option is that the benefits gained during the course of the rehabilitation program are long-lasting, and many patients that have been on medications for many years can now function normally again without the use of them. This is probably the single greatest advantage to this type of treatment, it offers patients a chance at being active again in their normal life without the use of additional medications.


Some additional statistics about dizziness/balance disorders:

• Dizziness/vertigo is prevalent, with estimates ranging from 1.8% in young adults to more than 30% in the elderly, and causing considerable morbidity and utilization of health services. (1)
• It has been estimated that 65% of individuals older than 60 years of age experience dizziness or loss of balance, often on a daily basis. (2)
• Dizziness/vertigo is a common symptom affecting about 30% of people over the age of 65. (10)
• It has been reported that, in the primary care setting, 70% of elderly patients present with dizziness;1 and that 3,200 per 100,000 new cases per year visit a primary care physician. (3)
• 23-30% of adults have experienced at least one episode of dizziness and 3.5% of adults experience a chronic recurrent episode greater than a one-year duration by age 65. (4)
• Approximately 12.5 million Americans over the age of 65 have a dizziness or balance problem that significantly interferes with their lives. (5, 6)
• There are an estimated 5 to 8 million physician visits for dizziness in the United States each year; dizziness is a primary reason for an office visit in the over 75 age group. (7)
• One in three people will experience dizziness or imbalance during their lifetime. (8)
• In the US, the estimated cost of medical care for patients with balance disorders exceeds $1 billion annually. (8)
• Nonspecific disequilibrium affects about 1/3 of people over the age of 75. (9)
• Dizziness/vertigo can be difficult to diagnose, particularly in elderly persons, in whom it often represents dysfunction in more than one body system. (1)
• Many cases of dizziness/vertigo are actually neurological. (7)
• In a study involving 96 asymptomatic controls and 149 dizzy subjects, ENG failed to discriminate dizzy subjects from controls and failed to differentiate various dizziness syndromes. (11)
(1). Sloan PD, et al. Dizziness: State of the science. Ann Intern Med. May 1, 2001; 134(9 pt 2):823-32.
(2). Hobeika CP. Equilibrium and balance in the elderly. Ear Nose Throat J. August 1999; 78(8):558-62, 565-6.
(3). Sloan, PD (1989). Dizziness in primary care. Results from the national ambulatory medical care survey. J Family Practice 29:33-38.
(4.) Ojala, M (1989). Etiology of dizziness: a neurological and neuro-otological study. Helsinki, University of Helsinki, Academic Dissertation.
(5.) National Institute on Deafness and Other Communication Disorders, March 1997.
(6). Ator GA. University of Kansas Department of Otolaryngology Division of Otology Talk: Vertigo - Evaluation and Treatment in the Elderly. http://www2.kumc.edu/otolaryngology/otology/VertEldTalk.htm. Accessed Mar 2003.
(7). Desmond, Advance for Audiologists July/August 2000.
(8). University of Virginia Health System, Department of Otolaryngology - Head & Neck Surgery, Vestibular & Balance Center. http://www.healthsystem.Virginia.edu/internet/otolaryngology/patient_vbc.cfm. Accessed June 2003.
(9). University of Iowa Health Care. Comprehensive management of vestibular disorders. Currents: Spring 2002, Vol 3, No 2. http://www.uihealthcare.com/news/currents/vol3issue2/03vertigo.html. Accessed Mar 2003.
(10). Colledge N, Lewis S, et al. Magnetic resonance brain imaging in people with dizziness: a comparison with non-dizzy people. J Neurol Neurosurg Psychiatry. May 2002; 72(5):587-9.
(11). Hajioff D, et al. Is Electronystagmography of diagnostic value in the elderly? Clin Otolaryngol. Feb 2002; 27(1):27-31.