Vertigo (Dizziness)

Many disorders of the balance system appear as dizziness. Balance is a complex mechanism. The balance organ in the inner ear, the eyes and the sensors in the muscles and joints all work together, and the brain coordinates them. For this reason dizziness can be the first sign of many different diseases.

The inner ear leads

The balance organ in the inner ear is the organ mainly responsible for balance. The hearing organ and the balance organ sit side by side in the inner ear, and both hold a fluid called endolymph. A disease that affects one of them often affects the other. Balance problems and hearing loss therefore appear alone or together.

When hearing loss comes with dizziness, the problem most probably starts in the inner ear. The reverse is not true. Dizziness without hearing loss does not mean the inner ear is healthy.

Overall, 80 per cent of dizziness involves the inner ear and the balance organ. The balance organ on each side works symmetrically with the other.

What the balance organ does

Its most important task is to send the brain a constant report on the position of the head in space. That flow of information keeps us upright. It is why we can stand with our eyes closed, or in a pitch dark room.

Take an example. You turn your head to the right, towards your shoulder. The lateral semicircular canal in each inner ear senses the movement, and both send the brain the message that the head is turning right. The brain reads the new position from that.

Now suppose the balance organ in the right ear is damaged. When you turn your head, the lateral canal on the right does not sense it. The healthy left canal reports that the head is turning, while the right one keeps reporting that the head is still. That mismatch is what you feel as dizziness.

As this example shows, an imbalance between the two balance organs is the commonest cause of dizziness.

Treatment

Treatment has four parts:

1. Finding the disease that causes the dizziness, and treating that cause.
2. Stopping the attack while it is happening.
3. Preventing further attacks.
4. Vestibular rehabilitation with specific manoeuvres and exercises.