Dizziness

Dizziness is classified in three categories--vertigo, syncope, and nonsyncopenonvertigo--each with symptoms related to the sense of balance. In general,syncope is defined by a brief loss of consciousness (fainting) or by dimmed vision and feeling uncoordinated, confused, and lightheaded. Many people experience a sensation like syncope when they stand up too fast. Vertigo isthe feeling that either the individual or the surroundings are spinning. Individuals with nonsyncope nonvertigo dizziness feel as though they cannot keeptheir balance.

The brain coordinates information from the eyes, inner ear, and the body's senses to maintain balance. If any of these information sources is disrupted, the brain may not be able to compensate. For example, people sometimes experience motion sickness because the information from their body tells the brain that they are sitting still, but information from the eyes indicates they aremoving. The messages don't correspond and dizziness results.

Problems in the inner ear are the most frequent cause of dizziness. The innerear contains fluid that helps fine-tune the information the brain receives from the eyes and the body. When fluid volume or pressure in one inner ear changes, information about balance is altered. The discrepancy gives conflictingmessages to the brain about balance and induces dizziness.

Episodes of dizziness increase with age. Among people aged 75 or older, dizziness is the most frequent reason for seeing a doctor. More than one type of dizziness can be experienced at the same time and symptoms may be mixed. Episodes of dizziness may last for a few seconds or for days.

A person may experience dizziness for many reasons. Syncope is associated with low blood pressure, heart problems, and disorders in the autonomic nervoussystem. Syncope may also arise from emotional distress, pain, and other reactions to outside stress. Nonsyncope nonvertigo dizziness may be caused by rapid breathing, low blood sugar, or migraine headache, as well as by moreserious medical conditions.

Vertigo is often associated with inner ear problems called vestibular disorders. A particularly intense vestibular disorder, Méniére's disease, interferes with the volume of fluid in the inner ear. This disease, which affects approximately one in every 1,000 people, causes intermittentvertigo over weeks, months, or years. Méniére's disease is often accompanied by ringing or buzzing in the ear, hearing loss, and a feeling that the ear is blocked. Damage to the nerve that leads from the ear to the brain can also cause vertigo. Such damage can result from head injury or a tumor. Vertigo can also be caused by disorders of the central nervous system and the circulation, such as hardening of the arteries (arteriosclerosis),stroke, or multiple sclerosis.

Some prescription medications cause changes in blood pressure or blood flow,which in turn cause dizziness in some people. Even common drugs such as caffeine or nicotine can cause dizziness. Certain antibiotics can damage the inner ear and cause hearing loss and dizziness.

Diet may cause dizziness. The role of diet may be direct (as through alcoholintake), or indirect (as through arteriosclerosis caused by a high-fat diet).Some people experience a slight dip in blood sugar and mild dizziness if they miss a meal, but this condition is rarely dangerous unless the person is diabetic. Food sensitivities or allergies can also cause dizziness.

For diagnostic purposes, a patient's sense of balance may be assessed by moving the head to various positions or by tilt-table testing, in which the person lies on a table that is shifted into different positions, reporting any dizziness that occurs. Hearing tests help assess ear damage. X rays, computed tomography scan (CT scan), and magnetic resonance imaging (MRI) can pinpoint evidence of nerve damage, tumor, or other structural problems. If a vestibulardisorder is suspected, a technique called electronystagmography (ENG) may beused. ENG measures electrical impulses generated by eye movements. Blood tests can determine diabetes, high cholesterol, and other diseases. In some cases, a heart evaluation may be useful. Despite thorough testing, an underlying cause cannot always be determined.

Treatment is determined by the underlying cause. If an individual has a coldor influenza, a few days of bed rest is usually adequate. Other causesof dizziness, such as mild vestibular system damage, may resolve without medical treatment.

If dizziness continues, drug therapy may prove helpful. Because circulatory problems often cause dizziness, medication may be prescribed to control bloodpressure or to treat arteriosclerosis. Sedatives may be useful to relieve tension that can trigger or aggravate dizziness. Low blood sugar associated withdiabetes sometimes causes dizziness and is treated by controlling blood sugar levels. An individual may be asked to avoid caffeine, nicotine, alcohol, and any substances that cause allergic reactions. A low-salt diet may also helpsome people.

When other measures have failed, surgery may be suggested to relieve pressureon the inner ear. If the dizziness is not treatable by drugs, surgery, or other means, physical therapy may be used and the patient may betaught coping mechanisms for the problem.

Because dizziness may arise from serious conditions, it is advisable to seekmedical treatment. Alternative treatments can often be used alongside conventional medicine without conflict. Relaxation techniques, such as yoga and massage therapy are widely recommended for reducing stress. Aromatherapists suggest a warm bath scented with essential oils of lavender, geranium, andsandalwood. Homeopathic therapies may be applicable when no organic cause canbe identified. An osteopath or chiropractor may suggest adjustments of the head, jaw, neck, and lower back to relieve pressure on the inner ear. Acupuncturists and nutritionists also offer alternative care options.

Outcome depends on the cause of dizziness. Controlling or curing the underlying factors usually relieves dizziness. In some cases, dizziness disappears without treatment. In a few cases, dizziness can become a permanent disabling condition and a person's options are limited.

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