Dizziness is a broad word. Vertigo means the room, or you, feels as if it is spinning. The cause may be the inner ear, the balance pathways in the brain, or something else entirely. Testing rules causes in or out. It does not always name one.
Causes an exam sorts through
Narrowed blood vessels (arteriosclerosis) can limit blood and oxygen to the inner ear and brain. Osteoarthritis in the neck can narrow the spaces the vertebral arteries pass through and do something similar. Those are central problems. They are not the same as an inner ear disease.
Inner ear causes include:
- Labyrinthitis, often after a virus. Tinnitus and hearing loss are usually absent.
- A blocked eustachian tube after a cold or allergies. Ringing and hearing loss, if they happen, tend to be temporary.
- Meniere's disease, which involves both hearing and balance. Fullness, hearing loss, tinnitus, and vertigo come in spells. See how the ear works.
- Benign positional vertigo, which involves the balance part of the inner ear only. Tinnitus and hearing loss are usually absent. Spells are brief and tied to turning the head.
An acoustic neuroma is an uncommon, noncancerous tumor on the hearing and balance nerve. Clues can include dizziness or vertigo, tinnitus, and hearing loss. Confirmation is usually an imaging study or an auditory brainstem test.
Diabetes, anemia, heart disease, and some neurologic conditions cause dizziness too. The visit is how we decide which list you are on.
Balance exercises
These movements are a form of balance rehab. Do them only after an ENT has examined you and said they are appropriate. Stop and get urgent care for fainting, chest pain, new weakness, trouble speaking, double vision, or a sudden severe headache. The exercises stir dizziness up at first. That response is expected, and it should fade if you continue.
A usual plan is about 15 minutes, twice a day, for at least three weeks, and then until the symptoms clear. Start each movement slowly, then speed up. Do about 20 repetitions.
Eyes
- Look up, then down
- Look from one side to the other
- Focus on a finger and move it from arm's length in toward your nose, then back out
Head, eyes open
- Bend the head forward, then backward
- Turn the head from side to side
- Tip the ear toward each shoulder
Once dizziness is improving, eyes closed
- Sit and shrug the shoulders
- Turn the shoulders right, then left
- Bend forward and pick up objects from the floor
- Sit, then stand, then sit again
- Stand and throw a small ball from hand to hand above eye level
Moving
- Walk across the room with eyes open, then with eyes closed if you can do it safely, near a wall or with someone nearby
- Go from standing to sitting to lying down, and reverse it
- Any ordinary game that asks you to stop and turn is useful practice
When to be seen
New spinning, hearing loss with dizziness, or dizziness after a head injury should be examined before you start a home program. Balance problems are part of our ear, nose, and throat care.
