Why am I dizzy?

Poor balance is reported to affect 5-10% of the population. This statistic tends to increase with age and affects upwards of 40% of individuals over age 40. For those aged 60 and over imbalance and falls becomes one of the most common health concerns, and a top reason for referral to specialty care. So, what causes dizziness and why is it more problematic as we age?

Balance requires good functionality of three different systems in our bodies: vision, proprioception (touch), and vestibular (ear). These three systems function as a team in reading our environments and sending that information to our brains. Once the brain processes these signals it can send the appropriate response to our muscles that react to the environment and keep us feeling balanced. Because the brain integrates the signals from these three systems, a problem in any of these systems or their pathways to the brain can cause us to feel off balance or dizzy.

Most people are familiar with some of the major problems that can occur in our visual and proprioceptive senses. Perhaps the more common visual concerns are macular degeneration and cataracts. As for proprioception — or touch — arthritis or overall muscle or joint weakness, can cause major difficulty.

How are Ears Involved With Balance?

The inner ear is home to our vestibular system. This consists of the otolith organs (that detect up-down, and forward-backward motions) and the semicircular canals (which help us sense movement in the other planes of motion). Input from our vestibular system gives our brain important information regarding our head’s position in space. Our brain processes this information and sends signals to the muscles in our eyes, helping us to keep vision steady while our heads are moving. Because we can’t necessarily see what’s happening in our inner ears, problems in these areas are sometimes more “invisible” than issues with our vision or proprioception.

Just like vision and touch, there are many things that can affect our vestibular systems. One of the most common problems in the vestibular pathways is BPPV or BPV.  BPPV (benign paroxysmal positional vertigo) is the most common cause of vestibular dizziness. BPPV occurs when calcium crystals in our otoliths move into one of our semicircular canals. This can happen following an accident or, and often times, it is just at random. These crystals, which normally detect up-down or forward-backward motion, typically find their way into the canal that senses side to side movements. This makes an individual feel like they are spinning circles when they look up or down or lie down. Usually this spinning sensation lasts less than a minute – until the crystals dissipate. This particular type of vertigo can usually be fixed in the office, requiring a simple routine of head movements, to maneuver the crystals back to their home in the otoliths.

The second most common vestibular problem is labrynthitis or neurtitis. This is an irritation of either the vestibular organs or vestibular nerve itself and is usually caused by a viral illness.  Typically this affects only one ear, and may or may not affect hearing on that side as well. People who experience neuritis typically note one severe incident of dizziness that seems to improve over time. In the weeks following the initial attack the brain is getting different signals from each ear and attempts to “re-calibrate” and find a new normal. There are varied levels of improvement, but this can often be helped with certain vestibular exercises.

Another fairly common problem within the vestibular system is Meniere’s disease. The vestibular organs are filled with fluid that has a very delicate chemical composition. Meniere’s disease affects this chemical balance and causes a fluid buildup. Some relate it to glaucoma, in that there is excess pressure within these organs. Meniere’s attacks fluctuate, can often affect hearing, and symptoms usually disappear completely between attacks. Exact causes of Meniere’s are unknown, but there are correlations to diet and medications.
While there are several complications that can occur in each system critical to our balance, some disease processes can affect all three. Diabetes, for example, can cause neuropathy, vision loss, as well as degeneration of the inner ear and its vestibular organs. Aging, medications, trauma, acute illness, or other chronic disease processes can affect these as well.

Clearly, there are many potential causes to dizziness or imbalance. The key to helping prevent that is being informed and bringing as much of that information as possible to your healthcare provider. Any information you can provide regarding the onset of your difficultis are very important in determining the cause. Such things can be dizziness, when it occurs, if anything worsens or initiate an attack, changes in medication or diet, other symptoms (such as hearing loss). Armed with better and more complete information about your symptoms, your provider can guide you to the right solutions for your specific concerns.  

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