Dizziness and unbalanced state (vertigo)

Dizziness and unbalanced state (vertigo)

Dizziness and unbalanced state (dizziness) are two different concepts. They are often seen together in various organ pathologies. The concept of vertigo is generally used to describe dizziness and it mostly indicates rotational circling in people (circling of surroundings or a man himself / herself). Basically it is a condition that is caused by diseases of the inner ear.

But the dizziness causes the feelings such as escape of the earth under the feet of a man, the feeling of unbalanced state, feeling of a drunken and the feeling of having impact. Most of the time, it is formed in relation to the circumstances such as brain disorders, hormonal disorders and internal cervical disease. Vertigo, which is the true dizziness basically, has nausea and vomiting.

How is the balance ensured?

Ensuring the balance is not yet fully clarified and this case is the condition that many organs play a role in it. Brain, spinal cord, inner ear (the maze), eyes, the joints and muscles refer to the organs and systems which have roles in it. Any disease that affects these organs can cause the emergence of other symptoms belonging to this organ together with the dizziness. Dizziness, which includes the role of many organs, cannot be assessed by a field doctor. Although, it is mainly examined by ear, nose and throat doctor (otolaryngologist) and neuropathist at the beginning, it might later need to be examined by eye doctor (ophthalmologist), therapist or physical therapy doctors.

Which complaints can happen?

Dizziness is explained in various forms by different patients. Many complaints such as “Everywhere is turning, the ground is running under my feet, I am slipping to one side, my eyes run through” are heard much. All of them are generally called dizziness. Patients with dizziness have other complaints depending on the type of complaint. In parallel with dizziness related to ear diseases there might be ear chink, lack of hearing, feeling of pressure in ear, nausea, vomiting, ear discharge and abnormal movements of the eyes (nystagmus). And in dizziness associated with neurological diseases there may be headache, convulsions, palsy, abnormalities in eye movements. These complaints, along with dizziness are very changeable. But many patients have only dizziness.

Dizziness and unbalanced state-forming diseases:

Causes related to the ear: 70% of all true vertigoes are connected with the ear. Menieres disease, positional vertigo, chronic diseases of the ear discharge, ear diseases leading to hearing loss, ear diseases connected to the injury of the balance nerve after viral infection, the state of fewer blood supply to the inner ear in the people with vascular obstruction, and sometimes for no reason depending on the damage of the inner ear membranes there may be vertigo attacks.

Traumas: After the fracture that happens in head and also damages the inner ear, there may be nausea and vomiting together with the dizziness. The patient feels obvious dizziness even with a slight movement of his / her head. It may take weeks or months to remedy this situation. In this case, severe dizziness for a few seconds can stay in the patient in change of such positions even after some years.

Infection: Dizziness may occur originating from ear particularly, after an acute flu infection.

Neurological diseases: Multiple sclerosis, syphilis, various brain tumors, Parkinsons disease and other diseases may violate balance by affecting the nervous system.

Allergic causes: Mostly during the spring and fall, there may be vertigo attacks in the people with allergic skin in response to the pollen and allergic environment. Antihistamines are effective in its treatment.

Cervical causes: Apart from very severe neck aches they do not cause dizziness.

What should be done to know the relation of diseases to the organs in the balance system?

It is possible to get accurate information with the help of many technological methods (audiometric tests, electronystagmography, electrocochleography, electromyography, dynamic post urography etc.) in the centers. And after the reason is convicted, appropriate treatment can be appointed.

There are measures to reduce dizziness and they vary according to the type of disease. For example, a man with Menieres disease should avoid stressful environment, alcohol, caffeine, very salty foods. A patient having “Benign Paroxysmal Positional Vertigo (BPPV)” should avoid sudden head movements (most basic cliff edge, porch side). In this case, when there is dizziness, the most important advice is to avoid the situations such as driving a car, using a dangerous tool, or doing something that needs to focus on.

What are the symptoms of examination?

If the dizziness is related to the inner ear, in this case no problem is seen with the examination. But if there is dizziness related to the impact of inflammation of the middle ear to the inner ear, in this case a hole in the membrane of the ear and middle ear inflammation can be seen. The patient may have abnormal eye movements. The direction of movement of these eye actions can give some information about the ill ear. The doctor can test the patient while standing, lying or even walking.

Which analyzes are conducted?

This is known after examination. If it is revealed after the treatment that, there is no disease connected with the ear, then your doctor will assign you to other suitably qualified doctors. However, when making decisions some studies are conducted after the examination. Among these, the most common test is called audiometry and gives information both about the hearing and inner ear functions. Besides, computed tomography of the ear or Magnetic resonance tomography (MRT) is conducted. These tests may include some blood examinations. But, in some ear diseases it is impossible to do something with this examination. These tests are basically conducted to deny more serious problems, such as tumor.

Treatment:

Dizziness is not a disease itself and as it is a symptom of other diseases, you may need to cure the major disease in its treatment. But in many cases the cause is unknown. In this case the main purpose is to eliminate dizziness. Dizziness related to the ear diseases (except tumors) shorter or longer passes away on its own. Because, the other ear eventually compensates for patient ear problem. This can sometimes take 6 months or up to 1 year. If the dizziness is benign paroxysmal positional vertigo (BPPV), then its treatment happens with the movements called Epley maneuver and applied to you by your doctor on doctors examination table. These movements allow some particles in the inner ear to come into its place. But the other causes demand treatment. Although some drugs are used for this purpose, almost all of them decrease occurred dizziness. Patients with severe dizziness are sometimes placed in the hospital by connecting a system to them. And in the dizziness connected to the tumor, the tumor is removed. Menieres disease which is not subject to drug treatment sometimes needs surgical treatment.

Menieres disease:

The balance of the fluid in the inner ear, is the problem connected with its formation. Exact cause of the disease is unknown. It is connected with the inner ear, hearing and the balance and was formed from a liquid-filled capsule inside. The pressure of this fluid increases in Menieres disease. Increasing pressure can lead to ear chink, blockage feeling in the ear, lack of hearing and dizziness. The disease is characterized with dizziness, fluctuations in hearing and ear chink. Nausea, vomiting, balance disorders, sweating and diarrhea can also be observed.

Mainly attacks start suddenly and can last between 20 minutes to 24 hours. In many cases, the attacks are coming one after the other. There are attacks lasting several weeks, often repeated, and they become normal after continued for months. Hearing loss depends on damage in the auditory nerve. In the first stages of the disease, hearing loss is observed with seizures, then it becomes normal. Rarely, there is only dizziness without any hearing loss, ear pressure or ear chink. In the same manner, without any dizziness, there may be hearing loss, the feeling of ear pressure or ear chink. Menieres disease basically occurs in one ear, but it can occur in both ears.

Drug treatment:

The aim of treatment is to reduce the pressure of fluid in the inner ear. And this is provided by eating less salty foods and diuretic substances. Salt causes water to remain in the body and, therefore, the salt is restricted. Diuretics are used for the same purpose. This treatment may take months or even years in order to get the disease under control. Drugs affecting the balance system are also included in the treatment. These drugs in norm provide the brain not considering the abnormal signals coming from the ear.

Surgical treatment:

Surgical treatment is carried out unless the effect of drug therapy is seen and there is still dizziness. Efforts are underway to protect hearing. The type of operation is due to the loss of hearing in the ear. Although sometimes decrease of hearing occurs after the operation, but mostly it remains the same. Depending on the type of operation dizziness can be treated effectively.

Benign paroxysmal positional vertigo (BPPV):

This is the most common reason of dizziness related to the inner ear. Complaints arise in connection with the precipitation of calcium in the inner ear. These sediments float freely in the inner ear fluid. It may occur spontaneously, after viral disease or after the skull trauma. When the position of head and body is changed in this disease then in some cases, there occurs dizziness together with the nausea. This can last a few seconds or minutes. When the causing ear is oriented towards the ground complaints emerge. The complaints such as loss of hearing, feeling of pressure in the ear or ear chink do not exist. Its diagnosis is Dix-Hallpike, and treatment is Epley maneuver. If not Maneuver, it can be self-reversible within weeks, months, sometimes a year. Drugs weakening the balance system are used.

Vestibular neuritis (labyrinthitis):

In this disease there is swelling of the nerve cells in the inner part of the ear. It is thought that it occurs due to the virus. People say that before the start of this disease they had upper respiratory tract infection. There occurs sudden dizziness, nausea and loss of balance but hearing is normal. Complaints are severe at the beginning; they need assistance while walking up to 10 days and person need weeks, months to do all its works and to drive a car. When the patient suddenly turns its head, he / she feels temporary dizziness or drowsiness. For the passage of the complaints, drugs are used to weaken the balance system. These drugs are effective when using three times a day. When the dizziness begins to decrease, the number of drugs also decreases and seizes. Rarely, if the complaints continue more than a year operation may be advised.

Acoustic neuroma:

Acoustic neuroma is the name given benign tumor derived from nerve poise. The tumor grows very slowly, therefore complaints continue for years without being noticed. There is almost no dizziness, because tumor grows slowly, the brain and other ear takes over this function. The patient may feel unbalanced state. The first emerging complaint is ear chink. The ear chink arises with the growing tumor compressing the nerve. When the tumor grows, the portion of the auditory nerve is injured and lack of hearing occurs. Diagnosis is put on computed tomography or magnetic resonance tomography. Treatment is surgically to remove the tumor.

Aging-related dizziness:

Related to aging, there occur some changes either in balance system as the other parts of the body. These changes include reduction in hearing. The reduction can be in nerve irritation or brain is unable to estimate exactly irritations. In both situations it shows itself as dizziness. Reduction of seeing, blurred vision or eye fatigue joins to it. The reason for this is the decrease in elasticity of the eye lens and the situation is reversed with bifocal glasses. Eye pressure situations such as cataracts also can cause the vision and may reduce the information going to the brain.