Doc, I'm dizzy

Posted on Wed., April 1, 2009
By Dr. Liam Keating

"Doc, I'm dizzy" begins one of the most complex problems a doctor can face.

Dizziness is a challenging problem because this general term describes many different sensations. The diagnosis usually emerges from the patient's description of what's been happening. The doctor's examination of the patient sometimes helps, an audiogram (hearing test) contributes, and X-rays help in a few cases, but almost always the details of your story give the diagnosis.

First, be safe: don't drive or climb if you are dizzy.

Vertigo is a spinning/turning sensation. Fortunately, most cases of vertig o resolve on their own in weeks or months. Here are a few types of vertigo and some tips:

Benign Positional Vertigo: caused by certain head positions (for instance, turning to one side in bed) of brief duration, typically 30 seconds. This condition is self-limited, but since treatment exists (the Eppley maneuver) it's a diagnosis not to miss.

Labyrinthitis: These are more random attacks of vertigo, generally lasting hours. Spells may recur over the several weeks (and usually get milder and briefer with each episode). There's no "cure" but meclizine (a pill that can also cause sleepiness) can help if the spells last for an hour or more.

Sudden Hearing Loss with vertigo is an emergency — consult your doctor or go to the emergency room promptly! Medicine (such as prednisone) may need to be started right away.

Meniere's Disease is quite rare, though many who research the Internet think (incorrectly) that they have it. The classic history is quite specific: random 4-6 hour attacks, with three cardinal symptoms (need all 3):

Fluctuating hearing loss (recovers between attacks)
Disabling vertigo (need to lie down in a dark room)
Loud tinnitus (a "roaring" sound in both ears)

You'll need an audiogram first, then to see a specialist.

Disequilibrium is similar to vertigo, but rather than spinning, it's a perception of imbalance. Patients say it's "like you're drunk," or "like walking on a boat."

Disequilibrium may be the side effect of a medicine. Eye problems may cause disequilibrium, because our eyes tell us where we are in space. Benign brain tumors can cause disequilibrium: usually accompanied by hearing loss. Some migraines cause vertigo or disequilibrium, with or without a headache.

Disequilibrium associated with aging is common. Here are some things to consider:

Use a cane or a walker, which can prevent a fall and a broken hip
Studies show that exercise including Tai Chi, yoga, dance and physical therapy really help.
In any case, keep active: the worst thing to do is to limit or decrease activity.

Light-Headedness or Near-Fainting. If this occurs when getting up from lying or sitting, it reflects a drop in blood pressure called "Postural Hypotension." So, get up more slowly! Blood pressure medications may be a contributing factor.

In some cases, heart conditions like an irregular heart rhythm cause drops in blood pressure.

If you have dizziness, prepare before going to your doctor:

Write a description of your dizziness
When did it start?
How frequent is it and how long does it typically last?
Does anything seem to cause it to occur?

A diary can help your doctor make the correct diagnosis or determine what additional testing may be needed.

Dr. Keating practices otorhinolaryngology (ear, nose and throat medicine, or ENT) at the Contra Costa Regional Medical Center.