Dizzy spells are the primary reason people over the age of 45 visit their doctor. In addition to discomfort and disruption in daily living, the symptoms may indicate underlying health issues. Pinpointing the source, however, will require some digging.
More than 35 percent of adults aged 40 and older experience vestibular dysfunction (inner-ear and balance disorders) at some point, and for many it can become chronic, according to the Vestibular Disorders Association (VeDA).
“It’s quite an encompassing topic because there are so many different causes of dizziness,” says Dr. Joshua Zahabian, a board-certified primary care physician at Jupiter Medical Center. From cardiovascular and neurological issues to hypoglycemia and anemia, there are various reasons for wooziness, but most indicators are related to the vestibular function of the inner ear that provides balance for the body. And if left unchecked, the condition may result in a potentially harmful fall.
Here are some common causes of dizziness and treatments for them.
Patients often describe their vertigo as feeling like a room is spinning or a floating sensation, perhaps resulting in motion sickness, whether they’re moving or not. “You have all of these input systems that work together to help coordinate movement. It’s spatial awareness, which allows you to catch a ball, or walk in a dark room so you're not tripping over your own feet,” says Zahabian, who lectures on the subject.
A main cause, he says, is benign paroxysmal positional vertigo (BPPV), which occurs when calcium carbonate crystals—which act as inner-ear sensors to help a person maintain balance—become dislodged. Head trauma and aging often contribute to BPPV, but cardiovascular or neurological problems, dehydration, stress, genetics, and low-blood sugar are also culprits. “It can happen to the elderly, the young,” Zahabian says.
Ménière disease is an inner ear disorder resulting in fluid buildup in constricted blood vessels, according to the National Institutes of Health (NIH). It may be accompanied by vertigo, hearing loss, and tinnitus (ringing or buzzing in the ear). Underlying causes include viral infection, allergies, autoimmune reactions, or genetics. The disease is rare—affecting 0.02 percent of the U.S. population—but there is currently no cure. It is most common in adults 40 to 60 years old, particularly among women, according to NIH.
This condition is commonly caused by inflammation of the vestibular function of the inner ear, most often caused by viral infections, according to VeDA. When that is disrupted, patients may experience vertigo, nausea, and imbalance while moving. Medication is often prescribed, and the serious symptoms typically subside within weeks, VeDA says.
Labyrinthitis is another inflammatory disorder of the inner ear that causes sudden vertigo and can imitate a stroke, according to NIH. Symptoms typically include dizziness, nausea, vomiting, hearing loss, and tinnitus. “While most cases are viral in origin, bacterial infections, autoimmune disorders, or systemic diseases may also be responsible,” the NIH says. Rest and medication commonly clear up the swelling, and the condition generally resolves in 40 to 72 hours.
Referred to clinically as presyncope, lightheadedness is defined by the NIH as “feeling like one was going to pass out but without actual loss of consciousness.” The condition may be accompanied by general weakness, warmth or sweatiness, nausea, palpitations, or blurry vision—and it is different from the spinning sensation of vertigo.
The causes are many, such as standing up too quickly after laying down because of gravity’s pull of blood from the brain down to the feet, Zahabian explains. Other causes include dehydration, stress, certain medications, low blood sugar, a heart attack, or stroke, according to Harvard Medical School.
For people who are experiencing these daunting conditions, the good news is that they can be remedied through services offered at the JMC Cary Grossman Health & Wellness Center. Specially trained physical therapists in the vestibular rehabilitation (VR) program give patients a comprehensive evaluation before initiating a tailored rehabilitation regimen.
VR is exercise-based therapy designed to moderate vertigo and dizziness, reduce an unstable vision field, and reduce imbalance and fall risk. It also addresses secondary issues such as fatigue and cognitive problems, according to VeDA.
Methods include balance-training exercises to improve steadiness to successfully perform daily activities such as self-care, work, and leisure, as well as gaze stabilization routines to improve control of eye movements when the visual world appears to bounce or jump around.
Conditions such as labyrinthitis and vestibular neuritis can be treated with medication, including steroids or antibiotics, Zahabian says. Physical injuries or conditions might require surgery, he says. For example, “a perilymphatic fistula [an abnormal connection between the inner ear and surrounding structures] can cause a hole,” Zahabian explains. " It would have to be surgically repaired with a patch."