Dizziness

What is dizziness?

Dizziness affects your sense of balance. It can come in many different forms, causing a sensation of unsteadiness, spinning or general disorientation. You may feel lightheaded, nauseated, woozy or like you might faint.

To understand how dizziness occurs, it helps to know how the balance organ and vestibular system work:

The balance organ

Deep inside your ears, there are three tiny semicircular canals filled with fluid and crystals, known as endolymph and otoliths. The crystals float and move around in the fluid in response to your body's angular position.

Two other sac-like structures, the utricle and saccule, detect vertical and horizontal movements. Together, these structures are called your balance organ and they help your body detect up from down, left from right, as well as forward and backward motion. 

The vestibular system

The balance organ coordinates with your eyesight and the muscles and joints in your body to provide you with a sense of balance and orientation in your environment. This is medically known as the vestibular system.

Dizziness occurs when there is a problem with the vestibular senses or the brain areas that connect them.

What does being dizzy feel like?

Traditionally, dizziness has been divided into four main categories, according to the American Academy of Family Physicians:

• Vertigo, a false sense of motion
• Disequilibrium, feeling off-balance, unsteady or wobbly
• Presyncope, a feeling of losing consciousness or about to black out
• Lightheadedness, a vague sense of being disconnected with your surroundings

Common causes of dizziness

Inner ear issues

Some of the most frequent causes of dizziness arise from problems in your inner ear. A disturbance in the blood circulation or fluid pressure in the inner ear can trigger dizziness and tinnitus. For example, a bad cold can swell your inner ears and lead to bouts of dizziness.

Benign paroxysmal positional vertigo (BPPV) is one of the more common inner ear causes of dizziness. It's a balance disorder that occurs when your inner ear crystals become dislodged. Episodes of vertigo from BPPV usually last anywhere from a few seconds to several minutes at a time and often resolve on their own in a matter of days.

Vestibular neuritis is another inner ear condition that can cause severe spinning sensations, along with nausea and vomiting. It's caused by inflammation or damage to the vestibular nerve. Symptoms can last from hours to days. Though not a dangerous condition, the sensations are quite jarring and it's important to seek medical care to rule out a more serious cause.

What does it mean if you have hearing loss and dizziness?

Your balance and hearing are linked and share a common pathway to the brain. This is why lots of things can cause both dizziness and hearing loss, including:

• severe allergies,
• bacterial or viral infections of the inner ear, 
• medication side effects,
• and certain circulatory conditions.

If you experience sudden dizziness and hearing loss, see a doctor right away as this may be a sign of a medical emergency.

Ringing in the ears and dizziness

Additionally, many disorders that affect the inner ear can lead to ringing in the ears (tinnitus) and dizziness. These conditions include:

• Meniere’s disease 
• Third mobile window syndrome   
• Acoustic neuromas (a rare, benign tumor on the auditory nerve)

What does dizziness caused by inner ear problems feel like?

Dizziness caused inner ear problems may feel like vertigo, unsteadiness or lightheadedness. It may be constant or intermittent, and aggravated by certain head motions or sudden positional changes. Although nausea and vomiting may occur, people do not typically lose consciousness as a result of inner ear dizziness. 

Other causes of dizziness

There are many other causes of dizziness that are not related to the function of the inner ear. They are generally sorted into two categories: central and visual.

Central dizziness

Central dizziness happens when the brain cannot coordinate the inputs from the three parts of the vestibular system. Some causes of central dizziness include:

• Migraines
• Tumors
• Infections that affect the brain
• Neurological conditions like multiple sclerosis (MS)
• Head injuries

Visual dizziness

Visual dizziness is a sensation of unsteadiness or disorientation triggered by visual stimuli, like moving patterns, crowded spaces, or rapid motion in your environment. It can happen when the eye muscles are imbalanced or there are errors of refraction, such as when you borrow a pair of eyeglasses from a friend with a different prescription. It can also be caused by eye strain or vision problems like astigmatism.

Systemic causes

Dizziness can also stem from systemic issues such as heart disease, low blood pressure, certain medications, too much alcohol, and even psychological conditions like anxiety (which can be worsened by having a balance disorder).

When should you see a doctor?

Because dizziness can be caused by so many different factors, you don't always need to see a doctor for symptoms that are brief, mild and resolve on their own. However, you should see a doctor for dizziness if it’s severe, doesn't go away or affects your daily life.

Seek medical attention immediately if woozy feelings are accompanied by other concerning symptoms like chest pain, fainting, trouble walking, severe headache, numbness or weakness as these can be signs of a medical emergency.

To figure out what's causing dizziness, a medical provider will take a thorough medical history and exam. They will likely ask you about any prescription or over-the-counter medications that you take as drug interactions are a common, but sometimes overlooked cause of lightheadedness. The same is true of alcohol and caffeine–both can interact with your medications.

Testing options

There are a wide array of tests a doctor may use to evaluate dizziness, including blood tests and imaging like CT scans. They may be performed by a primary care doctor, a physical therapist, cardiologist or neurologist and will partially depend on any additional symptoms you might have.

In some cases, especially if you experience hearing loss, you may undergo a hearing test, often followed by an Auditory Brainstem Response (ABR) test.

An ABR test noninvasively records brainstem responses to sound stimuli. The brain waves are collected while you rest comfortably with your eyes closed. The presence or absence of hearing loss or auditory brainstem anomalies will provide clues to the physician about the cause of your symptoms.

Another common test for balance is VNG, or videonystagmography. A VNG test is usually done by an ENT doctor or an audiologist. It uses video cameras to record eye movements.

During the test, a patient follows a visual target. The patient is also moved into different positions. The ear canals are stimulated with warm and cool air or water. This test gives a broad picture of whether the underlying issue is related to the inner ear or not.

More: Is your dizziness from labyrinthitis, BPPV or Meniere's? How to know

Treatments for dizziness

Your treatment will be determined by the cause of your dizzy symptoms and can include medication, surgery, diet, lifestyle changes or some combination of these.

For BPPV, dizziness can be treated by a simple head positioning maneuver. There are also physical therapists who specialize in vestibular rehabilitation, which is a treatment for balance disorders that gradually retrains the brain to compensate for lost sensory input from the balance system. 

Finding an audiologist

If you are experiencing hearing loss or tinnitus in addition to dizziness, visit our directory to find a local hearing care provider to help with that part of your treatment plan.