Mr John Marshall - Consultant Otolaryngologist

Dizziness and Balance

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Dizziness may be the commonest reason for a person to seek medical attention in their lifetime.  It can affect any age group but becomes more common with age.  

It usually takes a growing child up to a year or more to balance confidently on just two feet. The mechanisms that keep us balanced thereafter are very sophisticated and we generally take them for granted. However when our balance system malfunctions the effects can very debilitating. Fortunately the balance system also has excellent powers of recuperation in most cases.  Balance problems are often very worrying symptoms for a person to have. Fortunately, serious underlying causes are uncommon and most balance problems respond very well to the right treatment.

How our balance system works:

Our balance relies on our brain receiving information from a number of different systems:

The inner ear -  Movement sensors in the ear detect movement of our heads. Three sensors are dedicated to detecting rotational movement of the head (this is partly why dizziness due to inner ear problems can cause a sensation of spinning).

Vision -  Visual input is important for balance and when our inner ear isn't working 100% we become more reliant on our vision (so our balance is worse in the dark).

"Proprioception" - Throughout our body, from the balls of our feet up to our neck, tiny sensors in the skin, muscles, joints and ligaments give information to our brain about what our body is doing. Problems with some of these sensors can affect our balance.

In addition to the above, our bodies also rely on a number of other factors such as our blood pressure being well controlled, our heart beat remaining constant etc. to remain in balance.

Once the brain receives all this information it is rapidly processed and then it sends messages out again to all parts of our body, such as our arms, back and legs, to allow us to remain in equilibrium without falling over. Problems with muscle strength, joint problems etc can contribute to this part of the balance process too.

All this usually occurs without us even thinking about it. Watching a figure skater or trapeze artist demonstrates how well the system can work.

Dizziness

The symptoms of dizziness can vary from a sensation of slight unsteadiness to the feeling of the whole world spinning, which may cause nausea and vomiting. The term vertigo is often used and is defined as “hallucination of movement” – the feeling that we are moving when we aren’t. Often but not always this involves a feeling of spinning or rotation.

Dizziness is often a symptom that causes significant anxiety, due to worry about the underlying cause and the potential effects on your life and work. However, anxiety itself can worsen the symptoms and can compound the problems. Thankfully, most causes of dizziness can be improved or cured by appropriate treatment, and extremely few are due to the serious conditions that people often imagine. 

Common causes of dizziness.

The huge variety of causes of dizziness cannot be covered here, but examples are given below:

Acute Labyrinthitis  - More accurately termed ‘vestibular neuronitis’ this is a viral inflammation of one of the nerves that connects the balance sensors in the inner ear to the brain. The onset of a spinning sensation is fairly sudden and severe, usually causing vomiting. The affected person may be bed-bound for several days and spontaneous improvement occurs over a few weeks. Recovery is usually complete. Tablets such as ‘stemetil’ can help in the first few days but should be discontinued as soon as possible. There is some evidence that immediate treatment with steroids may be beneficial.

Meniere’s disease - Caused by a pressure imbalance in the inner ear fluids, Meniere’s disease usually causes a sudden onset spinning sensation that can last about an hour or longer, together with a varying hearing loss, feeling of pressure in the ear and tinnitus (a noise in the ear).

Benign Positional Vertigo - Caused by dislodgement of tiny particles in the inner ear, BPV caused transient imbalance lasting just a few seconds, typically triggered by turning in bed or other positional changes such as looking up. Often treatment with the ‘Epley manoeuvre’, (a simple series of positional moves carried out in an outpatient setting) cures the problem, though this sometimes needs to be repeated.

Other causes

Many people have balance problems or dizziness that doesn’t fit into some of the clearly defined causes mentioned above. Usually a careful description of the symptoms and examination will point to the likely cause and appropriate treatment can be initiated. In some cases additional investigations are necessary. 

If you would like to arrange an appointment to discuss your symptoms further, please do so via using one of the available options on our contact us page