Show 1426: Why You Feel Dizzy and What You Can Do About It

This week, neuro-otologist David Kaylie of Duke Health will help us understand how balance disorders disrupt patients’ lives and what doctors can do to help.

Dr. Kaylie is a neuro-otologist who manages the whole range of disorders of the ear, hearing and balance. He is particularly interested in the impact balance disorders have on patients’ perceptions of their well-being and interactions with the world. Why are balance disorders so disruptive to patients’ lives and what can doctors do to better understand their condition?

One possible cause of dizziness is Menière disease. People with this condition often have unpredictable episodes in which they feel like they are spinning. They may also have hearing loss or tinnitus that comes and goes at first. Menière disease happens when fluid builds up in the inner ear, but doctors don’t know the underlying reasons for that.

Another reason many people feel dizzy is benign paroxysmal positional vertigo, or BPPV. This produces a spinning sensation whenever the person moves their head. It occurs when little pieces of calcium carbonate get dislodged from their normal position and move into the semicircular canals. As these inner ear structures are crucial for balance, disrupting them with wandering crystals can cause vertigo.

The inner ear is also the source of some other balance problems. An inner ear infection could cause trouble. Inflammation of the labyrinth, which includes the semicircular canal along with the otolith organs, can disrupt balance, as can inflammation of the nerves.

For some people, dizziness can be a symptom of migraine. The headache may follow later, or there may not be any actual pain, just lightheadedness or dizziness. Dehydration might trigger the attack, but not everyone can identify a recurrent trigger.

Medications can occasionally cause lightheadedness that can be troubling. If they lower blood pressure too much, an individual may need to be careful about standing up too quickly. Doctors call this reaction “orthostatic hypotension.” Another condition that can throw people off balance is “postural orthostatic tachycardia syndrome,” or POTS for short. In addition to lightheadedness–feeling as if they might faint–people with POTS may find that their heart rates zoom when they stand up.

The doctor will find it easier to diagnose why you feel dizzy if you can be precise about the symptoms. When do they happen? Does anything make them stop? Do you feel like you are spinning, or is the sensation more like you are about to faint? Nausea is common with balance disorders, so reporting it won’t help much with the diagnosis but it will help the doctor understand your experience.