Dizziness is a common medical complaint among people of any age, particularly affecting the older population.
When visiting your primary care physician with this complaint, your doctor's initial recommendation may be to see an otolaryngologist, as dizziness can sometimes be a result of issues in the inner ear.
An otolaryngologist, or ENT (ear, nose, and throat specialist), will often ask a series of deeper questions, as this all-encompassing symptom of dizziness can take many forms and requires further description to determine the underlying cause.
The first order of business is to make sure you're on the same page with your doctor about what dizziness means to you. Your ENT may ask many questions about onset, description and duration to help narrow down potential causes.
Your doctor may ask you to describe the feeling. Do you feel as if you're spinning? Is the room spinning? Are you off balance? Do you feel like you're going to fall over? Are you lightheaded like you're going to pass out?
Other questions might include: How long does it last? Is it episodic? Does the feeling last for seconds, minutes, hours or days at a time?
These different classifications can point to different conditions of the ear, or signify that another health issue is at play.
Most commonly, patients may have Benign Positional Vertigo, which is the most common cause of vertigo and the most treatable. Some patients may feel that when they lay down to sleep and roll over, the room begins to spin. This spinning lasts less than a minute and there is no hearing change.
If dizziness or other symptoms come on after a cold or upper respiratory infection, are coupled with vomiting and feeling incapacitated, lasts several days, it could be an indication of vestibular neuronitis, an infection of the inner ear's nerve caused by a bacteria or virus.
Another ear problem that can cause unpleasant symptoms is Meniere's disease. If a patient experiences spinning that lasts hours, spinning that makes them feel incapacitated, hearing that fluctuates or experiences a fullness sensation in the ear, and/or ringing, then Meniere's disease could be at play.
With this condition, the fluid that bathes the inner ear, called endolymph, can be overproduced or not be resorbed appropriately, leading to a build up. This fluid overload is thought to be the cause of Meniere's disease.
When symptoms are coupled with a headache, however, the culprit of the dizziness may not be the ear at all. Those with a history of headaches or migraines may experience vertiginous migraines.
In these cases, spinning can accompany the typical headache symptoms. In this case, seeing a neurologist would be the best course of action to find the cause and help eliminate the symptoms.
Additionally, there are a number of medications that can affect your blood pressure, causing sudden changes in blood pressure, which can lead to difficulty in maintaining balance. For these types of conditions, like orthostatic hypotension, a cardiologist may be in the best position to improve the condition.
The combination of multiple medications, like those for anxiety, depression, and other mental illness, can also lead to similar symptoms. These medications are playing a role in metabolism and can lead to problems with maintaining your balance.
If your ENT is able to rule out the ear as the cause of your symptoms, he might refer you to another physician or for additional tests such as blood work or an MRI. Depending on accompanying symptoms, your physician may want to rule out other neurological diseases.
One to two small symptoms can mean the difference between a number of diseases or conditions, so it's important to be as clear and thorough as possible with your primary care physician when describing your symptoms. By paying close attention to describing what's wrong, your physician will be best able to point you in a direction of relief.