I see a lot of dizzy people. It’s really quite a common symptom that patients come to see me about and the interesting thing is the variety of ways in which people describe it. I’ve heard: ‘lightheaded, vertigo, unsteady’. Also ‘spinning, swimmy, squiffy’ and, my personal favourite, ‘squarmy’. In general terms, we try to clarify whether the patient has: True vertigo – a spinning sensation either of the person or their environment, often triggered by movement and associated with nausea • Dysequilibrium – a genuine balance disturbance or wobbliness • Faintness – a feeling that the person might black out, especially on standing or coming up from a stooped position.
It would be nice if everybody fell neatly into one of these categories but medicine is complicated and you can get combinations or poorly defined types.
True vertigo usually points to an inner ear problem or something to do with brain function. I’ve had it a couple of times so carry a certain amount of empathy for the sufferer. In my case it was due to labyrinthitis, or inflammation of the semi-circular canals that control balance, probably due to a virus. I certainly felt very motivated to lie dead still for a couple of days as even eye movements sent the room spinning, and I had to get to the bathroom on hands and knees.
The other common cause of vertigo is benign paroxysmal position vertigo (BPPV). In this condition small calcium deposits are misplaced in the inner ear and start knocking over the fine hair cells that sense 3D position and gravity. Usually a particular movement, such as looking up, triggers the dizziness and positional tests clinch the diagnosis. Fortunately most people respond to a bodily manipulation which persuades the deposits to roll into a side pocket where than can’t do any harm.
When vertigo occurs in combination with tinnitus and hearing loss it suggests Meniere’s disease, a very unpleasant episodic condition that fortunately is treatable though usually long term medication is required. Sometimes acute onset vertigo indicates a stroke and should be assessed urgently.
Balance disturbances are harder to pin down since equilibrium is maintained by a complex interplay between vision, the inner ear and position sensation in the muscles. And unfortunately balance tends to get worse with age, hence the need to become more careful about fall risk.
Finally faintness, or actual fainting, generally indicates a sudden drop in blood pressure, and warrants a thorough heart check to make sure there is no serious cause.