Don’t ignore feelings of dizziness

The Los Angeles real estate agent still vividly remembers the day her dizziness started. It came without warning.

“I was in my office,” recalls Anne Russell Sullivan. “I felt a pressure creep up the back of my neck and suddenly I was dizzy. I put my head between my legs and took a couple of deep breaths, but when I got up a few minutes later, the whole room was spinning.”

Her problem is not uncommon. Each year, dizziness drives millions of Americans into doctors’ offices, accounting for 1% of all physician visits in this country.

Dizziness is not a disease, but a symptom. The list of medical conditions that can cause it is long and varied -- ranging from serious problems such as heart disease and stroke to less-alarming ones such as anxiety and excessive caffeine intake.

In many cases, the problem can be traced to the inner ear. Because the body’s balance mechanism resides there, something as simple as an inner-ear infection can cause severe dizziness. Even visual problems can trigger it, since the brain relies on visual cues to determine the body’s position and orientation.

In order to appropriately treat dizziness, doctors must identify the cause. Some causes will resolve themselves; others require intensive and, sometimes, immediate treatment.

A careful history is perhaps the most important part of the exam. Although many people suffering from dizziness wind up undergoing expensive tests such as brain scans, they are often unnecessary. “In more than 80% of patients with dizziness, a careful history and thorough physical exam are all that’s needed to make an accurate diagnosis,” says Dr. Jennifer Derebery, an otolaryngologist at the House Ear Institute in Los Angeles.

Important clues can usually be found through simple questioning: When did the dizziness start and how has it changed over time? What triggers the dizziness? Is it constant or does it come and go? Is the dizziness associated with hearing loss, ringing in the ears, a feeling of fullness in the ear, or pain in the ear?

Someone who experiences brief episodes of vertigo every time he turns over in bed, for example, probably suffers from a condition called benign paroxysmal positional vertigo; someone with vertigo who also suffers from hearing loss and ringing in the ear, however, is more likely to have Meniere’s disease (a condition caused by an overproduction of fluid in the inner ear).

Another important goal of the medical history is to determine what someone means by “dizziness,” because this word is frequently used to describe a variety of sensations. “It can mean virtually anything when a patient says they’re dizzy,” says Derebery, president of the American Academy of Otolaryngology -- Head and Neck Surgery. Medical experts generally categorize dizziness into four types: vertigo, presyncope, disequilibrium and lightheadedness.

Vertigo is the sensation that the body or the environment is moving, usually spinning. (There is, however, no real movement.) People suffering from vertigo often feel nauseated or perspire excessively. Presyncope is the sensation that you are about to faint, while disequilibrium refers to the sensation of being imbalanced or feeling that you are going to fall down. The term lightheadedness is used to describe feelings of mild or vague dizziness that do not fall clearly into one of the other categories.

Although subtle, these distinctions between different types of “dizziness” can be extremely helpful in correctly identifying the underlying cause.

“It helps us pinpoint where the likely problem is,” says Derebery. “For example, if it’s vertigo and there’s spinning, the inner ear is usually involved.”

The physical exam can also be extremely revealing. The presence of abnormal jerky eye movements, for example, points toward an inner-ear problem; an enlarged thyroid, on the other hand, suggests that an overactive thyroid may be to blame.

Once the cause of the problem is identified, appropriate treatment can begin. It turns out Sullivan suffers from Meniere’s disease. She’s now being treated with medications to help eliminate fluid from the inner ear along with drugs to control the dizziness and nausea.

“As quickly as it came, it disappeared,” she says. “I haven’t had an episode in two years.”

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Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears the first Monday of the month.