The room is spinning. Or you feel unsteady, lightheaded, oddly disconnected or faint. Or like you are swimming.
However it feels, you probably describe it in one word: ”dizzy.”
But dizziness isn`t just one feeling, and it can be caused by a host of things, ranging from serious and irreversible to mild and transitory.
Among the causes-take a deep breath-are inner-ear disorders, including the fluid-imbalance known as Meniere`s syndrome; blood or circulatory problems such as irregular heartbeat, hardening of the arteries, high cholesterol, anemia or low blood pressure; nervous-system problems such as brain tumors, head injury or multiple sclerosis; illnesses such as diabetes, syphilis, arthritis and acquired immune deficiency syndrome; anxiety attacks, allergies, cataracts and reactions to a wide array of drugs, including blood-pressure medicines, alcohol, nicotine and caffeine. Simply adjusting to bifocal glasses or standing up quickly can cause some people to feel dizzy.
Treatment varies accordingly. Medication, including antihistamines, tranquilizers or diuretics (water-loss pills) are prescribed, as are low-salt diets, although there is no proof of the effectiveness of some of these treatments. Balance exercises are sometimes suggested, or inner-ear and even brain surgery.
Often, dizziness goes away by itself. If you injure one ear, for instance, your brain may compensate within a few weeks by using only the information from the unharmed ear. Other times, sensations of dizziness cannot be cured, and people have to learn to live with the unpleasant or even debilitating sensations.
It`s not just cures that may be elusive; a third of dizzy patients never arrive at a definitive diagnosis, said Dr. J. Cameron Kirchner, of Yale University School of Medicine.
The confusion lies in the difficulty of describing and measuring dizziness and the complexity of the body`s balance system.
We derive our sense of where we are in space through information sent to the brain by our eyes and sensory receptors in our muscles and joints. Those messages are analyzed together with information sent to the brain from the balance mechanism of the inner ear. Tiny hair cells in the inner ear, bathed in specialized fluids, detect head motion the way other hair cells detect sound waves.
A problem at any level-joints, muscles, eyes, ears, brain-can throw off your sense of balance.
To make things still more complicated, the information fed to the brain from these sources can be contradictory. One ear can be damaged while the other works properly. They send disparate messages to the brain, and the result can be dizziness.
Some specialists believe that this is what lies behind motion sickness. If the body detects motion and the eyes don`t-say, if you are reading in a car or riding in a plane-your sense of balance may be disrupted enough to cause nausea. If you spin around, then stop, the fluid in the inner ear keeps moving, signaling the brain you still are moving. But the eyes tell the brain you have stopped.
The result: dizziness.
Dr. Antonio de la Cruz, of the House Ear Institute and Otologic Medical Group in Los Angeles, suspects that many patients cannot get precise diagnoses because their dizziness is caused by multiple insults to the balance system. With a little extra fluid in the inner ear, some arthritis in the neck, a little degeneration of nerve function because of aging, and the use of medications that cause balance problems, he said, you may be quite dizzy without having a particular disorder.
If you have a false sense of movement, if you feel you or your surroundings are spinning, whirling, tilting or swimming, that is vertigo, a specific dizziness that usually points to a problem in the inner ear or occasionally the brain. Vertigo may be accompanied by sweating, nausea and vomiting.
If you also have ringing in the ears or trouble hearing, it is even more likely the problem is in the ears.
Perhaps the best known balance problem of the inner ear is Meniere`s syndrome, something of a ”wastebasket diagnosis” for many kinds of dizziness. It actually is a specific disorder marked by spells of ringing in the ears, hearing loss and vertigo that come and go and can last several minutes to several hours. The spells may occur several times a month or may not recur for years.
Most of the time, Meniere`s dizzy spells end on their own within five years, said Dr. Joseph B. Nadol Jr., chief of otolaryngology at Massachusetts Eye and Ear Infirmary and chairman of otolaryngology at Harvard Medical School.
The finding that about 70 percent of Meniere patients have ”spontaneous remissions” was a highlight of a recent international symposium Nadol directed at Harvard. The remissions make it hard for researchers to tell whether the treatments for Meniere`s have any effect; patients are likely to get better whether or not they take medicine, adhere to a low-salt diet or have surgery. And because some of the operations damage hearing or sever nerves to the brain, assessing their effectiveness is important, Nadol said.
If you feel you are about to black out or you do faint, the doctor probably will suspect cardiovascular or circulatory problems. If your blood circulation is poor or you are anemic, you are not getting enough oxygen to the brain, and you will feel dizzy as a result.
Lightheadedness often is a symptom of anxiety-related dizziness, said Dr. Hugh O. Barber, professor of otolaryngology at the University of Toronto and director of the dizziness clinic at Sunnybrook Medical Center.
Dizziness covers so many specialties, it may be hard to decide what doctor to see. You may need a cardiologist, a neurologist or an
otolaryngologist (ear-nose-throat specialist.) If your case is tricky, you may end up seeing all three. Probably the best first step is to see your family doctor for a checkup.
For a free pamphlet, write Dizziness, Hope Through Research; NIH/NINCDS, Room 8A16, Building 31, Bethesda, Md. 20892.
THE DOCTOR WILL WANT TO KNOW
Because the causes of dizziness are so many and so diverse, doctors say the first step toward getting help is to describe, as specifically as possible, how you feel.
A good place to start is not to use the word ”dizzy.” It`s just too vague to guide your doctor. ”There`s a semantic barrier,” said Dr. Steven D. Rauch, of Massachusetts Eye and Ear Infirmary, in Boston. ”It`s hard to tell if you and the patient are talking about the same thing. We can`t get inside their heads.”
Said Dr. Hugh O. Barber, professor of otolaryngology at the University of Toronto: ”Patients may say they`re dizzy. My ploy is to say, `That`s the last time you use that word until I know what you`re talking about.` ”
Dr. J. Cameron Kirchner, of Yale University School of Medicine, said it also helps if you can answer these questions for your doctor:
– How often does the dizziness occur, and how long does it last? Does it come in spells, or are you dizzy all the time?
– Is the dizziness associated with other problems, such as hearing loss, vomiting or sensations of pressure in the ear? Slurred speech? Numbness?
– Does anything in particular seem to bring on the dizziness? Does being in certain positions make you dizzy?
– Are you taking any medications or using any drugs?
