Dizziness, vertigo and balance disorders

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Summary

Read the full fact sheet

• Dizziness is often caused by problems of the inner ear and is treatable.
• Common causes of dizziness related to the inner ear include: benign paroxysmal positional vertigo (BPPV), migraine and inflammation of the inner ear balance apparatus (vestibular neuritis). 
• Dizziness may also be caused by other conditions such as low blood pressure and anxiety.
• Vertigo is a type of dizziness that feels as though you or your surroundings are spinning.

About dizziness, vertigo and balance

Dizziness is one of the most common health problems for adults.

Dizziness can be a range of sensations including feeling light-headed, faint, woozy, giddy, unsteady, off-balance or weak.

Vertigo is a type of dizziness that feels as though you or your surroundings are spinning.

Dizziness is often caused by illnesses that affect the inner ear, such as benign paroxysmal positional vertigo (BPPV), migraine and inflammation of the inner ear balance apparatus (called vestibular neuritis).

While some people understandably find it difficult to describe their dizziness, a description of your dizziness and the circumstances in which it occurs may be very helpful in reaching a diagnosis.

Symptoms of dizziness

Descriptions of dizziness may include:

• a sensation of movement (including spinning), either of yourself or the external environment
• unsteadiness, including finding it difficult to walk in a straight line
• light-headedness
• feeling faint.

Other symptoms that may accompany dizziness include:

• headache
• nausea and vomiting
• fatigue
• ringing or other sounds in the ears (tinnitus)
• difficulty hearing
• staggering gait and loss of coordination (ataxia)
• unusual eye movements, such as flitting of the eyes (nystagmus)
• blurred vision
• finding it difficult to see clearly when moving, for example, when reading a sign while walking or driving
• difficulty concentrating.

Symptoms may be constant or come and go. Episodes can last from minutes to days.

Balance explained

Your sense of balance is controlled by signals to the brain about body movement and your position in relation to the environment. The brain integrates this information and sends signals back to the muscles on how to maintain balance.

Three sensory systems manage balance:

• vision
• proprioception – movement sensors in the skin, muscle and joints
• inner ears – the organ of balance in the inner ear is called the vestibular system. It includes 3 fluid-filled loops (semicircular canals) which respond to the rotation of the head. Near the semicircular canals are the utricle and saccule, which detect gravity and back-and-forth motion.

Good balance needs at least 2 of these 3 sensory systems working well. If one system is not working, the other 2 systems help keep you balanced.

If the brain can’t process signals from all of these systems, or if the messages are not functioning properly, you may experience a loss of balance.

Causes of dizziness

Dizziness rarely indicates a serious or life-threatening condition, even though it can be very disturbing and disabling. Symptoms can often disappear with no treatment.

Inner ear disorders cause about half of all dizziness cases including:

• Benign paroxysmal positional vertigo (BPPV) – involves intense, brief episodes of dizziness related to moving your head, often when turning over in bed or sitting up. It occurs when particles (otoconia) break loose and fall into the wrong part of the semicircular canals in the inner ear. This gives a sensation of spinning (vertigo). The cause of BPPV is not always known, but it may be a result of ageing or head trauma.
• Acute vestibular neuronitis or labyrinthitis – an inflammation of the inner ear causing sudden, intense vertigo that may persist for several days, with nausea and vomiting. This can be very disabling and may require bed rest initially. Fortunately, vestibular neuronitis generally subsides and clears up on its own. The cause of this condition is unknown but it may be a viral infection.
• Meniere’s disease – involves the build-up of fluid pressure in the inner ear. This leads to repeated sudden episodes of vertigo lasting 20 minutes or longer, with changing hearing loss, the feeling of fullness in the ear and buzzing or ringing in the ear (tinnitus). The cause of Meniere’s disease is unknown.
• Vestibular migraine – can cause vertigo lasting from minutes to days with or without headache. Attacks may be triggered by quick head turns, being in a crowded or confusing place, driving or riding in a vehicle, or watching movement on TV. Vestibular migraine may also cause unsteadiness, hearing loss, and ringing in the ears (tinnitus).
• Anxiety and stress – can intensify inner ear dizziness symptoms. Anxiety and stress are also the most common causes of dizziness that are not caused by the inner ear.
• Other causes – including brain related disorders and medical conditions such as low blood pressure.

Diagnosis of dizziness

In trying to work out the cause of a person’s dizziness, investigations may include:

• medical history, including careful questioning about the nature of the dizziness
• physical examination, which may include observing eye movements, positional testing and a blood pressure check
• specialised hearing or balance testing
• CT or MRI scans of the inner ear or brain
• other tests relating to specific conditions.

Treatment of dizziness

Treatment for dizziness and balance disorders varies depending on the diagnosis and severity. In mild cases, symptoms may go away on their own as the vestibular system heals or the body learns to adjust.

Treatments may include:

• medication
• changing your diet
• counselling
• simple home exercises
• physical therapy
• surgery, in rare cases.

Vestibular rehabilitation is a physiotherapy program that includes balance activities and eye movement exercises, easily practised at home. The activities restore the best use of your remaining vestibular function, vision, sensation in your feet and balance reactions to help maintain your balance.

Where to get help

• Your GP (doctor)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Neuro-otology Investigation UnitExternal Link, The Royal Victorian Eye and Ear Hospital Audiology Service Tel. (03) 9929 8270

• Dizziness and balance disordersExternal Link, The Royal Victorian Eye and Ear Hospital.
• Outline of causes of dizziness, imbalance and hearing disordersExternal Link, Hain TC 2021, Dizziness and Balance, USA.

This page has been produced in consultation with and approved
by:

This page has been produced in consultation with and approved
by:

Give feedback about this page

Was this page helpful?

More information

Content disclaimer

Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 11-08-2022

Dizziness, vertigo and balance disorders

Actions for this page

Summary

Read the full fact sheet

• Dizziness is often caused by problems of the inner ear and is treatable.
• Common causes of dizziness related to the inner ear include: benign paroxysmal positional vertigo (BPPV), migraine and inflammation of the inner ear balance apparatus (vestibular neuritis). 
• Dizziness may also be caused by other conditions such as low blood pressure and anxiety.
• Vertigo is a type of dizziness that feels as though you or your surroundings are spinning.

About dizziness, vertigo and balance

Dizziness is one of the most common health problems for adults.

Dizziness can be a range of sensations including feeling light-headed, faint, woozy, giddy, unsteady, off-balance or weak.

Vertigo is a type of dizziness that feels as though you or your surroundings are spinning.

Dizziness is often caused by illnesses that affect the inner ear, such as benign paroxysmal positional vertigo (BPPV), migraine and inflammation of the inner ear balance apparatus (called vestibular neuritis).

While some people understandably find it difficult to describe their dizziness, a description of your dizziness and the circumstances in which it occurs may be very helpful in reaching a diagnosis.

Symptoms of dizziness

Descriptions of dizziness may include:

• a sensation of movement (including spinning), either of yourself or the external environment
• unsteadiness, including finding it difficult to walk in a straight line
• light-headedness
• feeling faint.

Other symptoms that may accompany dizziness include:

• headache
• nausea and vomiting
• fatigue
• ringing or other sounds in the ears (tinnitus)
• difficulty hearing
• staggering gait and loss of coordination (ataxia)
• unusual eye movements, such as flitting of the eyes (nystagmus)
• blurred vision
• finding it difficult to see clearly when moving, for example, when reading a sign while walking or driving
• difficulty concentrating.

Symptoms may be constant or come and go. Episodes can last from minutes to days.

Balance explained

Your sense of balance is controlled by signals to the brain about body movement and your position in relation to the environment. The brain integrates this information and sends signals back to the muscles on how to maintain balance.

Three sensory systems manage balance:

• vision
• proprioception – movement sensors in the skin, muscle and joints
• inner ears – the organ of balance in the inner ear is called the vestibular system. It includes 3 fluid-filled loops (semicircular canals) which respond to the rotation of the head. Near the semicircular canals are the utricle and saccule, which detect gravity and back-and-forth motion.

Good balance needs at least 2 of these 3 sensory systems working well. If one system is not working, the other 2 systems help keep you balanced.

If the brain can’t process signals from all of these systems, or if the messages are not functioning properly, you may experience a loss of balance.

Causes of dizziness

Dizziness rarely indicates a serious or life-threatening condition, even though it can be very disturbing and disabling. Symptoms can often disappear with no treatment.

Inner ear disorders cause about half of all dizziness cases including:

• Benign paroxysmal positional vertigo (BPPV) – involves intense, brief episodes of dizziness related to moving your head, often when turning over in bed or sitting up. It occurs when particles (otoconia) break loose and fall into the wrong part of the semicircular canals in the inner ear. This gives a sensation of spinning (vertigo). The cause of BPPV is not always known, but it may be a result of ageing or head trauma.
• Acute vestibular neuronitis or labyrinthitis – an inflammation of the inner ear causing sudden, intense vertigo that may persist for several days, with nausea and vomiting. This can be very disabling and may require bed rest initially. Fortunately, vestibular neuronitis generally subsides and clears up on its own. The cause of this condition is unknown but it may be a viral infection.
• Meniere’s disease – involves the build-up of fluid pressure in the inner ear. This leads to repeated sudden episodes of vertigo lasting 20 minutes or longer, with changing hearing loss, the feeling of fullness in the ear and buzzing or ringing in the ear (tinnitus). The cause of Meniere’s disease is unknown.
• Vestibular migraine – can cause vertigo lasting from minutes to days with or without headache. Attacks may be triggered by quick head turns, being in a crowded or confusing place, driving or riding in a vehicle, or watching movement on TV. Vestibular migraine may also cause unsteadiness, hearing loss, and ringing in the ears (tinnitus).
• Anxiety and stress – can intensify inner ear dizziness symptoms. Anxiety and stress are also the most common causes of dizziness that are not caused by the inner ear.
• Other causes – including brain related disorders and medical conditions such as low blood pressure.

Diagnosis of dizziness

In trying to work out the cause of a person’s dizziness, investigations may include:

• medical history, including careful questioning about the nature of the dizziness
• physical examination, which may include observing eye movements, positional testing and a blood pressure check
• specialised hearing or balance testing
• CT or MRI scans of the inner ear or brain
• other tests relating to specific conditions.

Treatment of dizziness

Treatment for dizziness and balance disorders varies depending on the diagnosis and severity. In mild cases, symptoms may go away on their own as the vestibular system heals or the body learns to adjust.

Treatments may include:

• medication
• changing your diet
• counselling
• simple home exercises
• physical therapy
• surgery, in rare cases.

Vestibular rehabilitation is a physiotherapy program that includes balance activities and eye movement exercises, easily practised at home. The activities restore the best use of your remaining vestibular function, vision, sensation in your feet and balance reactions to help maintain your balance.

Where to get help

• Your GP (doctor)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Neuro-otology Investigation UnitExternal Link, The Royal Victorian Eye and Ear Hospital Audiology Service Tel. (03) 9929 8270

• Dizziness and balance disordersExternal Link, The Royal Victorian Eye and Ear Hospital.
• Outline of causes of dizziness, imbalance and hearing disordersExternal Link, Hain TC 2021, Dizziness and Balance, USA.

This page has been produced in consultation with and approved
by:

This page has been produced in consultation with and approved
by:

Give feedback about this page

Was this page helpful?

More information

Content disclaimer

Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 11-08-2022

Dizziness with hearing loss treatment

It turns out that there is often a connection. Nausea, rotation before the eyes and the onset of hearing loss can signal Meniere’s disease and other disorders in the inner and middle ear, which are closely related to the vestibular apparatus.

Catch me falling

When the ground slips from under your feet

What does a layman do if for no reason at all he starts to feel dizzy, he is disoriented in space and / or experiences nausea, photophobia? She is frightened, of course, but she is in no hurry to go to the doctor. First, he tries to somehow wait out the unpleasant symptoms, blames everything on nerves, hypertension, or on the fact that he has not eaten in the morning, and women also find the reason in the peculiarities of the cycle.

When dizziness, even severe, disappears, few decide to go to the doctor for a diagnosis. After all, one must be puzzled, to which specialist to sign up, and indeed why? Nothing else worries.

“In fact, there is a wide range of diseases that lead to the so-called systemic or vestibular dizziness,” says Zinaida Morozova, an audiologist-otorhinolaryngologist at MasterSluh-Moscow LLC. – And each of these ailments once had that very first episode that the patient attributed to nerves or pressure.

Causes of dizziness can be:

• Viral infection and acute inflammation of the vestibular nerve – vestibular neuronitis.
• Entry of otolithic particles into the canals of the vestibular apparatus.
• Violation of cerebral circulation.
• Various autoimmune diseases.
• Previous traumas (probably even those you forgot about).
• Tumors.
• Cervical osteochondrosis.
• The combination of attacks of dizziness, tinnitus, photophobia and hearing loss often signals Meniere’s disease (hydrops of the ear labyrinth).

In Meniere’s disease and other inner and middle ear problems, vertigo is rare at first. Only over time, their frequency and strength increase almost to daily and extremely unpleasant: when everything around starts to rotate rapidly and you can only be saved in a lying position.

The task of the doctor is to try to catch the disease in the early stages, to find the cause. So more likely to get rid of the problem. One episode of dizziness can still be experienced (maybe the nerves really are to blame), but when the symptoms add up to the system, run to a specialist.

Which doctor should I go to with my dizziness?

It is logical – to see a therapist or immediately to a neurologist. A good specialist will not brush aside if the patient is really worried about some symptom, will not say: “Well, what do you want? Age … “Or:” Yes, you have vegetative-vascular dystonia.

Unfortunately, the above diagnostics for most patients is a bit of an ideal world. Otherwise, people would not have been looking for the root of their problems for years, turning to various neurologists and other doctors of evidence-based and not very medicine.

Therefore, the rule is this – if after the appointment of a neurologist (or even a change of doctor) the condition does not improve, or even worsens, you are not sent for new tests or put in a queue for a long time, take matters into your own hands.

The main task for the patient at any stage is not to be silent, hoping that the doctor himself will figure it out. If your head is spinning and it seems that your hearing seems to be getting worse, or your ears are buzzing / ringing, talk about everything at the reception! This way you are more likely to make a correct diagnosis.

It is possible, bypassing the local therapist, to immediately go to the ENT or audiologist, this is usually done by those who have mild dizziness, but the ears really bother. Meniere’s disease and other disorders in the work of the inner ear are dealt with by specialized specialists.

Inner ear disorders that cause dizziness can be diagnosed with special tests that evaluate your stability, gait, eye tracking, and vestibular response to changes in body position. The stages of diagnosing dizziness include: conversation, tests, additional diagnostic research methods if necessary, diagnosis.

The medical centers of the MasterSluh network employ professionals who know everything about the functioning of the auditory system. They carry out high-quality diagnostics and accurately interpret its results, and most importantly, they are always in contact with other narrow specialists. You will not be left alone with your problem for sure.

You can make an appointment by calling the numbers listed on the contacts page of the MasterSluh centers or using a single multi-channel number 8 (800) 775-11-07.

What is the prevention and treatment?

The list of ailments associated with the work of the inner ear, not to mention other possible causes of dizziness, is huge. Everything is individual. But in any case, an excellent prevention would be a healthy lifestyle, physical education and sports with an emphasis on pumping the vestibular apparatus – Nordic walking, cycling, etc.

The general risk group is adults, often with changes in salt and calcium metabolism, the same changes are recorded in diseases of the inner and middle ear, vascular diseases, and reduced physical activity. So we draw conclusions and strive for a healthy lifestyle.

Treatment is prescribed depending on the diagnosis, because dizziness is only one of the symptoms. Until you get tested, you won’t know what’s going on. Some will need surgery, others just a couple of visits to the doctor.

Dizziness is not an independent disease, but only its symptom. In some cases, it signals serious disorders in the body, in particular in the work of the vestibular apparatus. Find out the cause, try to eliminate it or mitigate the manifestations only with the help of a doctor. Which specialist should be contacted for dizziness, especially frequent ones, is an ambiguous question. You can go a long way and start with a local therapist in a polyclinic, but it’s easier and faster to contact the MasterSluh specialized medical center and make an appointment with an audiologist-otolaryngologist.

We advise our specialists in different cities:

Astrakhan

• Evgenia Anatolyevna Grigorieva;
• Nadezhda Alekseevna Khonina

Kaliningrad

• Ruslan Magomedovich Tursunov;
• Yana Vladislavovna Kravchenko

Kurgan

• Natalya Aleksandrovna Lipnevich

Moscow

• Zinaida Nikolaevna Morozova

Pyatigorsk

• Irina Fedorovna Evteeva

Rostov-on-Don

• Elena Anatolyevna Anokhina;
• Irina Viktorovna Vnukova

Samara

• Anastasia Aleksandrovna Sladkova;
• Irina Sergeevna Platonova

Simferopol

• Vasily Vladimirovich Bogdanov

Sochi

• Nauruz Ismailovich Bayramkulov

Taganrog

• Natalya Vitalievna Andreeva

Mines

• Olesya Vyacheslavovna Zhuravleva

Dizziness and tinnitus

S. Ya.Kosyakov, G.Z.Piskunov

Dizziness

Introduction
Dizziness is a general term describing a large number of symptoms. In general, it means an abnormal sensation of movement, it can also mean imbalance, pre-syncope, blackout, disorientation, weakness and other sensations. Symptoms can vary in intensity from mild and short in duration to severe rotational attacks accompanied by nausea and vomiting.

For a more precise definition of symptoms, the following definitions are used:
Dizziness: a general term describing the symptoms of imbalance and stability.
Balance disorders: difficulty in maintaining balance, especially when standing and walking.
Pre-syncope: A “switching off” sensation similar to that experienced when holding one’s breath for a long time.
Systemic dizziness: sensation of rotation, whirling, twisting of surrounding objects.
The ability to maintain balance is the result of a complex interaction of various organs and systems. The brain is the main center for processing all information about balance, coming from the senses to the muscles that maintain balance.
Information in the form of nerve impulses comes from the main systems: visual, vestibular, proprioceptive and tactile (joints and feet). Visual information is the most important for the brain and signals movement in relation to surrounding objects.
Anatomy
There are two components of hearing: mechanical and electrical (neural). The mechanical component ensures the delivery of a sound wave through the external auditory canal, the movement of the tympanic membrane and three auditory ossicles in the middle ear. The inner ear is represented by a cochlea, consisting of two halves, interconnected and filled with liquid. The cochlea is responsible for the electrical component of hearing and converts the mechanical signal into electrical, which in turn enters the brain.
Another part of the inner ear is responsible for balance and the vestibular system. Three semicircular canals are located in mutually perpendicular planes. Depending on the direction of movement of the head, fluid moves in the channels, the resulting electrical impulse is transmitted to the brain through the vestibular nerve, transmitting information about the direction of movement. The inner ear fluid is renewed daily. The source of its origin is the cerebrospinal fluid, absorption occurs in the endolymphatic sac. In Meniere’s disease, the suction capacity of the endolymphatic sac deteriorates. Increased pressure in the inner ear leads to dizziness and hearing loss.
In close relationship with the ear, there is a facial nerve. The facial nerve carries out the movements of the facial muscles and provides taste discrimination with the tip of the tongue. When it is damaged, the eye closes poorly, liquid pours out of the corner of the mouth, and mimic movements on the side of the lesion are impossible.

Balance function
Balance function is provided by the interaction in the brain of nerve impulses coming from the inner ear, cervical muscles, muscles and joints of the lower extremities. Violations in any of these systems can lead to a subjective feeling of dizziness and unsteadiness. General disorders of body functions (for example, low or high blood pressure, myopia, and many others) can lead to dizziness, affecting the coordination of impulses in the brain.

The brain’s response to distorted or uncoordinated impulses can lead to false sensations of movement (dizziness), which in turn leads to unsteady gait and falls.
Dizziness is often accompanied by cold sweats, nausea and vomiting.
Visual and muscle and joint signals (tactile and proprioceptive) to the brain warn us that we are on the right track or that our head is tilted. The brain interprets this information, along with information from the vestibular system, and instructs the muscles to maintain balance accordingly. Dizziness occurs when sensory information is distorted. Some people experience dizziness when they are in a high place, for example. This is partly due to the inability to focus on nearby objects. Standing on the ground, a person can sway slightly. A person maintains balance, identifies his position of the body relative to something. When a person is in a high place, it is difficult for a person to correlate the position of his body relative to objects far away and, accordingly, it is more difficult to maintain balance. As a result, anxiety, fear, dizziness can occur, which sometimes makes a person sit down.
It is believed that motion sickness, a disorder that occurs when rolling, in a car, flying occurs when the brain receives conflicting sensory information about the movement and position of the body. For example, when reading while riding in a car, the inner ear perceives the movement of the vehicle, but the gaze is fixed on a stationary book that does not move. As a result, sensory conflict can lead to the typical symptoms of motion sickness, dizziness, nausea, and vomiting.
Another form of vertigo occurs with repeated rotation and sudden stop. Rotation causes movement of the endolymph. The movement of the endolymph causes impulses, which in turn tell the brain that we are moving, but other sensory systems tell us that we have stopped, so the patient feels dizzy.

Causes of dizziness
Vertigo can be classified into types depending on the part of the vestibular system that is not working properly. Violations can occur at the level of the inner ear, brain, eyes and limbs (muscles of the back, neck, legs and joints react to maintain our position).
Inner ear vertigo
Part of the inner ear (cochlea) is used for hearing, the other part is used for balance (labyrinth). If there are disturbances in the labyrinth or in the nerve connecting it to the brain, then this leads to dizziness. Various types of disorders in the inner ear can lead to vertigo, including Meniere’s disease, labyrinthitis, positional vertigo, vestibular neuronitis, and nerve tumors. Typically, these disorders cause balance disorders, a sensation of rotation of objects and nausea. Also, these phenomena may be accompanied by tinnitus and hearing loss on the corresponding side.
Vertigo of the central nature
Vertigo of the central nature is usually caused by disturbances in the area of ​​the brain responsible for balance. Symptoms may include fainting spells, confusion, unsteadiness, and sometimes loss of consciousness. Causes of central vertigo include low blood sugar, low blood pressure, stroke, multiple sclerosis, migraines, head injuries, tumors, and aging. Treatment of this type of dizziness is usually associated with the elimination of problems leading to disruption of the brain.
Musculo-articular vertigo
This type of vertigo is rare. If there are diseases of the muscles, joints or the sensitivity of the lower extremities is impaired, then difficulties arise in the reaction of the body to movement and in maintaining an upright position. Musculoskeletal vertigo can be caused by atrophic muscle changes (muscular dystrophy), severe forms of diabetes, arthritis, joint implantation, and trauma. Symptoms: Usually unsteadiness and imbalance.
Visual dizziness
Eye muscle instability and poor vision can impair balance function. The brain relies on visual information to maintain balance. Motion sickness in a car or at sea are examples of visual vertigo because the eyes are constantly fixed on a moving object and “confuse” the vestibular part of the brain. This leads to dizziness, nausea and vomiting.
Dizziness is not a fatal condition and may resolve with treatment, but balance disorders may remain.

Diagnosis of dizziness
Dizziness can be caused by various disorders in the body. Based on the history of the disease and examination data, the doctor selects the necessary amount of examination to obtain a more complete picture of the disease. The usual set of examinations includes a study of hearing and vestibular function, computed tomography and nuclear magnetic resonance, blood tests, and ultrasound examination.
The most commonly used test for vertigo is electronystagmography (ENG). This test measures inner ear endurance and eye coordination. The method includes observing eye movements while blowing cold and warm air into the external auditory canal. This usually causes a brief feeling of dizziness. It is important not to take drugs before the study that could affect the test results (for example, Valium, alcohol, etc.). When prescribing such an examination, it is necessary to find out from the doctor the effect of the drugs taken on the test results.
Transcranial dopplerography is another test specific to the examination of vertigo of vascular origin. It is a safe, fast way to see blood flow disturbances in balance areas of the brain.
Computed tomography (CT) of the temporal bones and, in some cases, magnetic resonance imaging (MRI) may also be considered.
The purpose of these examinations is to achieve confidence in the absence of life-threatening pathology and to determine the exact location of the violation. This is the basis for effective treatment. The scope of the examination is determined by the doctor in each case. Several tests are needed to diagnose the cause. Perseverance and understanding are necessary for both the doctor and the patient, which is also the basis for effective treatment.

Most common types of vertigo
Benign paroxysmal positional vertigo (BPPV)
BPPV is the most common type of vertigo. With this disease, dizziness occurs only when the position of the head changes (usually when turning in bed, tilting the head backward or forward). This type of vertigo is caused by microcrystals that float in the fluid of the inner ear and cause a sensation of rotation. The most common cause of BPPV is head trauma or viral infections, but sometimes it starts without any apparent cause.
The treatment of BPPV consists of certain exercises to return the crystals to a place where they will not cause dizziness. When at rest, in a certain position, for 48 hours, they often lock in place. Exercise can reduce symptoms. If these actions are ineffective, then surgical treatment (eg, occlusion of the posterior semicircular canal) may be necessary.

Vestibular neuronitis
Neuronitis (inflammation of the nerve) usually occurs with a viral infection, may affect the balance centers or the vestibular nerve. When this happens, the balance centers in the brain are overstimulated, resulting in significant imbalance and systemic vertigo. Fortunately, vestibular neuronitis usually subsides over time and does not recur. Drugs such as betaserc help in the initial stages and reduce the severity of the main symptoms, later vestibular rehabilitation exercises can speed up the healing process. In some cases of persistent course, surgical treatment is recommended.
Ménière’s disease (Endolymphatic hydrops)
Ménière’s disease is the result of disorders in the inner ear due to increased pressure in the endolymphatic space. This is usually due to an increased concentration of sodium in the fluids of the inner ear. In addition to an imbalance that lasts for hours, patients may experience fluctuations (fluctuations) in hearing, tinnitus, and a feeling of fullness in the diseased ear. Sometimes the lesion affects both ears.
The full cause of this violation is not fully known. Sometimes seizures can be caused by excessive salt intake, excitement, weather changes, and other reasons.
Treatment usually includes salt restriction and the use of diuretics, fluid restriction, the use of sedatives, and certain other vestibular depressants. Betaserc is the only drug designed for long-term treatment of vertigo. Treatment helps to reduce the severity of seizures, but a complete cure of the disease cannot be achieved. Vestibular rehabilitation exercises can speed up the recovery process and increase the patient’s resistance to vestibular disorders. All prescriptions of drugs should be carried out only by a doctor.
In severe cases of Meniere’s disease, there are surgical treatments. The list of these methods is long and more often they are destructive for the structures responsible for balance.

Vascular vertigo
The correct functioning of the balance system requires not only the flow of information to the inner ear, but also the appropriate transmission of impulses along the nerves to the brain. If not enough blood is supplied to the areas of the brain responsible for balance, even for a short time, then dizziness may occur.
Causes of vascular vertigo are different. The phenomena of osteochondrosis in the cervical spine can lead to compression of the arteries going to the brain, atherosclerotic plaques can narrow the arteries, also causing a decrease in blood flow. Often blood pressure in the vessels going to the brain can temporarily decrease when standing up abruptly, especially in older patients receiving blood pressure-lowering drugs. Special examinations such as MRI or Doppler sonography help in the diagnosis of such diseases.
Another fairly rare cause of dizziness is Perilymphatic fistula
The inner ear is a fluid-filled space located in the temporal bone. If there is an outflow of fluid from the structures of the inner ear, then hearing loss may occur, which may be either greater or less, and dizziness.
The most common leakage of fluid occurs through the membranes of the windows of the inner ear, which can occur after exercise or injury. In some cases, there are congenital disorders that characterize an enlarged connection between the inner ear and the brain (“dilated vestibular aqueduct”). Sometimes this can be seen with a special X-ray examination – computed tomography. Sometimes the membrane rupture heals on its own, sometimes minor surgery is required. Perilymphatic fistula or as it is also called – labyrinth fistula can result from chronic inflammation of the middle ear, especially with cholesteatoma. Cholesteatoma is a compacted skin scales. In the presence of a hole in the tympanic membrane, the skin grows into the middle ear cavity, and its waste products, like the formation of a pearl, form a lump of cholesteatoma, which presses on the walls of the middle ear cavities and destroys the bone in particular, the semicircular canal. Therefore, the treatment of chronic otitis media is very important, and if the hole is located in the upper part of the tympanic membrane (epithympanitis), it must be surgical without fail, because. most often in these cases find cholesteatoma.

Tumors
Rarely, vertigo can be caused by tumors. Most tumors are benign. Acoustic neuroma is a benign tumor of the vestibular nerve. The presence of a neuroma can lead to unsteadiness, hearing loss, and noise. The most effective method of treatment is surgical.

Treatment of dizziness
All questions about the treatment of dizziness and in particular medication should be discussed with your doctor. Treatment in each case is selected individually and depends on age, severity of dizziness, concomitant diseases and many other factors.

Tinnitus
Tinnitus is a very common symptom. Noise can be constant or periodic, of varying severity and of varying frequency. Noise can be subjective (audible only to the patient) or objective (audible to others), and may or may not be associated with hearing loss.
Noise is a symptom, not a disease, and can occur with various diseases, such as pain in the arm or leg are symptoms of various diseases. Noise appears when the auditory nerve is irritated for various reasons.
Noise may or may not be accompanied by hearing loss. Hearing is measured in decibels (dB). A hearing level between 0 and 25 dB is considered normal for listening to spoken language.
Mechanisms of hearing
To understand the possible causes of tinnitus, it is necessary to have some understanding of the mechanisms of hearing. The mechanism of auditory perception is provided by five main components: the outer ear, middle ear, inner ear, pathways and the brain.
Outer ear
The outer ear consists of the auricle and the external auditory meatus. These structures collect sound waves and transmit them to the eardrum.
Middle ear
The middle ear is located between the eardrum and the inner ear. This space contains three auditory ossicles: the malleus, anvil, and stirrup. The vibrations of the tympanic membrane are transmitted through the auditory ossicles to the fluids of the inner ear.
The middle ear is lined with a mucous membrane identical to the nose and contains mucous glands and blood vessels. The tympanic cavity is connected to the posterior parts of the nose by the Eustachian tube.
Eustachian tube serves to maintain equal pressure between the middle ear and the outer atmosphere. A clicking or stuffy sensation with a change in height is a demonstration of the ventilating function of the Eustachian tube.
Inner ear
The inner ear is encased in a dense bony capsule and contains fluids and auditory cells. The cells are covered with a delicate membrane with microscopic blood vessels. In the inner ear, fluid vibrations resulting from the movements of the stirrup are converted into electrical impulses in a nerve. Electrical impulses originating in the inner ear are transmitted to the brain via the auditory nerve. The auditory nerve to the brain is located in a small bony canal along with the vestibular and facial nerves.
Brain The auditory nerve, reaching the brain, is divided into many internal connections. In the brain, nerve impulses are recognized as recognizable sounds.

Tinnitus
Most tinnitus is audible only to patients – it is a subjective noise. Noise heard by the patient himself and by someone else is called objective.
Objective murmur may result from muscle spasms in the middle ear or auditory tube, or from abnormalities in the blood vessels surrounding the ear.
Muscular tinnitus
The tinnitus may be the result of a spasm of the muscles attached to one of the auditory ossicles or the result of a spasm of the muscles attached to the auditory tube.
There are two muscles in the middle ear: the stapedius, which is attached to the stirrup, and the tensor tympanic membrane, which is attached to the malleus. Typically, these muscles contract rapidly in response to loud noises or fear.
Sometimes one or two of these muscles begin to contract rhythmically for no apparent reason. These contractions can cause repetitive noises in the ear. The annoying clicking usually goes away on its own. Tinnitus of a muscular nature as a result of spasm of various muscles of the pharynx is quite rare, but sometimes it can be If the muscle spasm is prolonged, then drug treatment (muscle relaxants) or surgical treatment (crossing spasmodic muscles) is used.

Tinnitus of a vascular nature
There are two large blood vessels closely connected with the middle and outer ear: the jugular vein and the carotid artery. These are large blood vessels that supply the brain with blood and carry out its outflow. It is not normal to hear your own heartbeat or the sound of blood flowing through these large vessels. Sometimes this phenomenon can occur with high fever, middle ear infection, after intense physical exertion. Circulation noise in these situations is temporary and not audible to others. Sometimes the circulation noise becomes audible to others. This can occur due to the thickening of the wall of the blood vessel, the presence of a bend or narrowing in the vessel. Further examination is necessary to identify the cause and choice of treatment for this pathology.

Tinnitus due to the outer ear
Closure of the external auditory canal with sulfur, foreign body, edema leads to hearing loss and pressure on the eardrum. This often results in a pulsating type of noise.
Middle ear tinnitus
Middle ear dysfunction can be the result of an allergic reaction, infection, trauma, scarring, and ossicular limitation. These disorders often lead to hearing loss and tinnitus. However, there is no direct relationship between the degree of hearing loss and noise intensity.
Inner ear tinnitus
Any condition that disturbs the balance of fluid pressure in the inner ear can lead to tinnitus. This may be the result of an allergic reaction, infection, circulatory disorders, which lead not only to changes in the fluids of the labyrinth, but also in the membrane structures of the inner ear.
Tinnitus due to lesions of the pathways
The pathways are the most delicate structures of the hearing mechanism. Hair cells convert fluid vibrations into nerve impulses. The slightest swelling and disturbance of interference in the hair cells, regardless of the cause, lead to dysfunction and irritation. This can occur for various reasons: allergic reaction, infection, edema, systemic diseases, both acute and chronic, toxic exposure, sudden loud noises and in sensitive subjects, trauma, drug exposure, minute changes in blood supply and nutritional changes.
Changes in pressure can cause swelling both outside and inside the nerve as it travels through the bone tunnel to the brain. In these cases, tinnitus occurs on one side. Because If the bone tunnel cannot stretch, then due to compression, not only the auditory and vestibular functions suffer, but also the facial nerve.
Rupture or spasm of a small vessel occurring anywhere in the auditory pathway causes compression and circulatory disturbance. Accordingly, under such conditions, a sudden noise with a complete or partial loss of auditory function may occur. If the thrombus is small, then it can resolve with minimal consequences.
Tinnitus of the brain nature
Any disorders resulting from edema, pressure or circulatory disorders in hypertension, atherosclerosis, as a result of trauma may involve one or more pathway complexes at their entry and exit in the brain. In such situations, the symptoms are usually localized on one side, in addition, the development of symptoms and signs may tell the doctor the location and extent of the lesion.
Tinnitus associated with hearing loss
Tinnitus may or may not be related to hearing loss. In the coexistence of tinnitus and hearing loss, the intensity of tinnitus is not an indicator of the further development of hearing loss.