Common Causes of Dizziness

Definition | Benign Paroxysmal Positional Vertigo (BPPV) | Vestibular Neuritis | Labyrinthitis | Ménière’s Disease | Orthostatic Hypotension | References

Definition

Dizziness is a common term used to describe a range of sensations such as feeling faint, woozy, weak, or unsteady. It can be classified into several types based on the underlying cause, including vertigo (a spinning sensation), presyncope (feeling of faintness), disequilibrium (loss of balance), and non-specific dizziness.

Benign Paroxysmal Positional Vertigo (BPPV)

Definition: BPPV is characterised by brief episodes of vertigo triggered by changes in head position.

Aetiology: Caused by the dislodgement of otoliths (calcium carbonate crystals) from the utricle into the semicircular canals.

Pathophysiology: The displaced otoliths move within the semicircular canals, causing inappropriate stimulation of the vestibular nerve and resulting in vertigo.

Risk Factors: Ageing, head trauma, prolonged bed rest.

Signs and Symptoms: Sudden, intense vertigo triggered by head movements, nausea, and imbalance.

Investigations: Dix-Hallpike manoeuvre to diagnose BPPV by provoking vertigo and observing nystagmus.

Management:

• Canalith repositioning procedures (e.g., Epley manoeuvre)
• Patient education on avoiding provocative head positions
• Referral to a specialist if symptoms persist or recur

Vestibular Neuritis

Definition: Vestibular neuritis is an inflammation of the vestibular nerve, causing acute onset of vertigo without hearing loss.

Aetiology: Often associated with viral infections.

Pathophysiology: Inflammation of the vestibular nerve disrupts the transmission of sensory information from the inner ear to the brain, resulting in vertigo.

Risk Factors: Recent upper respiratory infection, immunocompromised state.

Signs and Symptoms: Acute onset of vertigo, nausea, vomiting, imbalance, no hearing loss.

Investigations: Clinical diagnosis, exclusion of other causes of vertigo.

Management:

• Supportive care (e.g., antiemetics, vestibular suppressants)
• Vestibular rehabilitation exercises
• Referral to a specialist if symptoms persist or if there is diagnostic uncertainty

Labyrinthitis

Definition: Labyrinthitis is an inflammation of the inner ear (labyrinth), affecting both hearing and balance.

Difference from Vestibular Neuritis: Unlike vestibular neuritis, which affects only the vestibular nerve, labyrinthitis also involves the cochlear nerve, leading to hearing loss alongside vertigo.

Aetiology: Often follows a viral or bacterial infection.

Pathophysiology: Inflammation in the labyrinth disrupts both balance and auditory pathways, causing vertigo and hearing impairment.

Risk Factors: Recent viral or bacterial infections, autoimmune diseases.

Signs and Symptoms: Sudden vertigo, hearing loss, tinnitus, nausea, vomiting.

Investigations: Audiometry to assess hearing loss, exclusion of other causes through imaging if necessary.

Management:

• Supportive care (e.g., vestibular suppressants, antiemetics)
• Antibiotics for bacterial cases, antiviral therapy in some cases
• Vestibular rehabilitation exercises if symptoms persist
• Referral to an otolaryngologist for persistent or severe cases

Ménière’s Disease

Definition: Ménière’s disease is a disorder of the inner ear causing episodic vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear.

Aetiology: Exact cause unknown, but associated with fluid buildup in the inner ear (endolymphatic hydrops).

Pathophysiology: Excessive endolymphatic fluid distorts the inner ear structures, leading to vertigo, hearing loss, and tinnitus.

Risk Factors: Family history, autoimmune disorders, allergies.

Signs and Symptoms: Episodic vertigo, fluctuating hearing loss, tinnitus, ear fullness.

Investigations: Audiometry, MRI to rule out other causes, electrocochleography (ECoG).

Management:

• Low-sodium diet and diuretics to reduce fluid buildup
• Vestibular suppressants and antiemetics during acute attacks
• Surgical options for refractory cases (e.g., endolymphatic sac decompression)
• Referral to an otolaryngologist for specialised management

Orthostatic Hypotension

Definition: Orthostatic hypotension is a form of low blood pressure that happens when standing up from sitting or lying down.

Aetiology: Dehydration, blood loss, prolonged bed rest, certain medications, autonomic dysfunction.

Pathophysiology: Inadequate vasoconstriction upon standing leads to decreased cerebral perfusion and dizziness.

Risk Factors: Ageing, certain medications (e.g., antihypertensives, diuretics), chronic conditions (e.g., diabetes, Parkinson’s disease).

Signs and Symptoms: Dizziness upon standing, lightheadedness, fainting, blurred vision.

Investigations: Blood pressure measurements in different positions (lying, sitting, standing), blood tests to rule out anaemia or electrolyte imbalances.

Management:

• Increased fluid and salt intake
• Compression stockings
• Gradual changes in position
• Review and adjustment of medications
• Referral to a specialist if symptoms persist

References

1. NICE. (2024). Dizziness and Vertigo: Assessment and Management. Retrieved from NICE
2. NHS. (2023). Dizziness. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Dizziness: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). (2021). Clinical Practice Guideline: Dizziness. Retrieved from AAO-HNS