Neurologist: How to know when dizziness is serious

You probably got here by googling “Why am I dizzy?” A good place to start is our Patient Toolkit. More current and complete information can be found in our Educational Resources Library.

It can be used to describe the feeling we get when we stand up quickly and feel unbalanced, that unstable feeling of movement when we are standing still or the feeling just before passing out.

The term “dizzy” is used to describe a variety of different feelings and sensations, and can mean something different to everyone.

Click here for a full list of vestibular symptoms.

“The way dizziness makes you feel, such as the sensation of the room spinning, feeling faint or as if you’ve lost your balance, provides clues for possible causes,” says Dr. Susan Lotkowski, D.O, director of the Memorial Hospital of Salem County in Mannington.

Vertigo causes a patient to feel like there is movement where there is none. It may cause feelings of tilting, spinning or falling, nausea, vomiting and even trouble walking or standing.

Common causes of vertigo include Benign Paroxysmal Positional Vertigo (BPPV) which is intense, brief episodes of vertigo immediately following a change in the position of your head; inflammation in the inner ear which can cause an onset of intense vertigo that may persist for several days; Meniere’s Disease which involves a build-up of fluid in the inner ear, characterized by sudden episodes of vertigo lasting as long as several hours.

Meniere’s Disease can be accompanies by fluctuating hearing loss, ringing in the ear and a feeling of fullness in the affected ear.

Acoustic neuroma — a non-cancerous growth on the vestibular nerve — which connects the inner ear to your brain can also cause vertigo.

Disequilibrium, the loss of balance or feeling unsteady when you walk, is also a condition many people refer to as being dizzy.

Click here to search for a vestibular specialist in your area.

To help diagnose the problem, keep track of dizziness and try to be as exact as possible when describing the feeling, she suggested. When visiting the doctor, always bring along a list of any medications you’re taking.

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Additional Resources:

Vestibular symptoms caused by inner ear injury or illness

What are the symptoms of a vestibular disorder?

The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. If the system is damaged by disease, aging, or injury, vestibular disorders can result, and are often associated with one or more of these symptoms, among others.

Summary of Vestibular Symptoms

• Dizziness: A sensation of lightheadedness, faintness, or unsteadiness.
• Imbalance: Unsteadiness or loss of equilibrium that is often accompanied by spatial disorientation.
• Vertigo: A rotational, spinning component, and is the perception of movement, either of the self or surrounding objects.
• Brain fog: When the brain is dedicating a great deal of energy to maintain equilibrium and stay steady, activities such as recalling details or short-term memory may become more difficult, and thinking might seem “slow”.
• Tinnitus: Abnormal noise perceived in one or both ears or in the head. May be intermittent or continuous and can be experienced as a ringing, hissing, whistling, buzzing, or clicking sound and can vary in pitch from a low roar to a high squeal.
• Hearing loss: Reduction in the ability to hear sounds is a common symptom of many vestibular disorders. When VeDA conducted a patient poll, over two thirds reported that they had hearing loss in one or both ears.
• Vision impairment: The link between the vestibular system and vision, vestibulo-ocular reflex (VOR), is described in detail with information on evaluation, treatment, coping strategies, and potential solutions for vision correction, including glasses and contact lenses.
• Nausea: The feeling of being nauseated.
• Cognitive changes: Difficulty thinking, paying attention/concentrating, recalling basic facts (such as your own phone number), short-term memory loss, etc.
• Psychological changes: Due to the unpredictable nature of symptoms and the chronic nature of most disorders, vestibular patients tend to suffer from anxiety and/or depression.
• Motion sickness: Symptoms appear when the central nervous system receives conflicting messages from the visual system and the vestibular system in the inner ears.

The type and severity of vestibular symptoms can vary considerably, and they be frightening and difficult to describe. People affected by vestibular disorders may be perceived as inattentive, lazy, overly anxious, or seeking attention. Functioning at work or school, performing routine daily tasks, or just getting out of bed in the morning may be difficult.

Symptoms may be difficult to describe, which complicates the diagnostic process. If you are unsure if you have a vestibular problem, reading this explanation of symptoms may help you. You may want to print this page and circle or highlight the descriptions that fit your symptoms, then bring it to your doctor. You may also want to download the Dizziness Symptom Profile developed by Vanderbilt University, fill it out and bring it to your doctor.

Vestibular Symptom Categories

Vertigo and dizziness

• Spinning or whirling sensation; a feeling the person or world moving when it is not (vertigo)
• Symptoms can be present while sitting still, in specific positions, or with movement
• Lightheaded, floating, or rocking sensation (dizziness)
• Sensation of being heavily weighted or pulled in one direction

Balance and spatial orientation

• Imbalance, stumbling, difficulty walking straight or when turning
• Clumsiness or difficulty with coordination
• Difficulty maintaining straight posture; head may be tilted to the side
• Tendency to look downward to confirm the location of the ground
• Tendency to touch or hold onto something when standing, or to touch or hold the head while seated
• Sensitivity to changes in walking surfaces or footwear
• Difficulty walking in the dark
• Muscle and joint pain (due to difficulty balancing)

Vision

• Trouble focusing or tracking objects with the eyes; objects or words on a page seem to jump, bounce, float, or blur or may appear doubled
• Discomfort from busy visual environments such as traffic, crowds, stores, and patterns
• Sensitivity to light, glare, and moving or flickering lights; fluorescent lights may be especially troublesome
• Sensitivity to certain types of computer monitors and digital televisions
• Tendency to focus on nearby objects; increased discomfort when focusing at a distance
• Increased night blindness; difficulty walking in the dark
• Poor depth perception

Read more about vision challenges with vestibular disorders.

Hearing changes

• Hearing loss; distorted or fluctuating hearing
• Tinnitus (ringing, roaring, buzzing, whooshing, or other noises in the ear)
• Sensitivity to loud noises or environments
• Sudden loud sounds may increase symptoms of vertigo, dizziness, or imbalance

Cognitive

• Difficulty concentrating and paying attention; easily distracted
• Forgetfulness and short-term memory lapses
• Confusion, disorientation, difficulty comprehending directions or instructions
• Difficulty understanding conversations, especially when there is background noise or movement
• Mental and/or physical fatigue out of proportion to activity

Read more about the cognitive impacts of vestibular disorders.

Psychological

• Loss of self-reliance, self-confidence, self-esteem
• Anxiety, panic, social isolation
• Depression

Read more about the emotional impacts of vestibular disorders.

Other

• Nausea or vomiting
• “Hangover” or “seasick” feeling in the head
• Motion sickness
• Sensation of fullness in the ears
• Ear pain
• Headaches
• Slurred speech

An inner ear disorder may be present even when there are no obvious or severe symptoms. It is important to note that most of these individual symptoms can also be caused by other unrelated conditions and should be discussed with a health professional.

All About Vertigo: Symptoms and Treatments

Have you even experienced a spinning sensation when you bend down to empty the dishwasher, lean back in a dentist’s chair or merely roll over in bed?   

Vertigo is a temporary sensation that makes you feel like you’re in a spinning or tilting room. This isn’t necessarily a dangerous condition, but it can feel scary when it’s happening.

Types of vertigo

There are two types of vertigo. Peripheral vertigo happens because of inner ear problems. Central vertigo happens when you have health complications in your central nervous system, which includes your brain and spine.

Although vertigo can be caused by various medical conditions, the most common disorder is Benign Paroxysmal Positional Vertigo, or BPPV. This kind of vertigo occurs more frequently in older adults as the tiny calcium carbonate crystals of your inner ear loosen and migrate into a different part of the ear canal, signally to the brain that you’re moving when you’re not. The resultant spinning sensation usually lasts only a minute or so. However, changes in head position can bring it on multiple times a day and at times can be intense enough to cause nausea.

Risk factors for vertigo

Besides inner ear and nervous system problems, you can be at risk of having vertigo if:

• You have a head injury
• You’ve overindulged in alcohol
• You take antiseizure medications

Though women over 65 are more at risk for vertigo, it can happen to anyone at any age. For example, Meniere’s disease often affects people between 40 and 60 years of age.

Symptoms of vertigo

If you suddenly feel like the world around you is tilting or spinning, you may have vertigo. Along with a spinning sensation, you may feel nauseous, headachy and lightheaded. If you feel like you want to faint, it’s probably not vertigo.

While vertigo itself isn’t dangerous, people who experience it are more likely to have balance issues. This can lead to a higher fall risk and make people less able to complete those daily activities such as bathing and dressing due to fear and balance issues. Some feel so unsteady that they hold onto walls or furniture for safety when walking.

If you think you are suffering from vertigo, you’ll want to see your health care provider to get properly diagnosed.

Treatments for vertigo

An episode of peripheral vertigo usually goes away on its own in a few minutes. Sometimes it lasts for hours or weeks. If your vertigo lasts a long time, there is treatment. Doctors often prescribe anti-nausea drugs to slow down the dizziness. You can also use a cane or walking device to prevent falls.

Good news with BPPV specifically, it is treatable. This is accomplished by a repositioning technique known as the Epley maneuver. The process is quick and generally symptoms can be resolved in just several treatments.

Feeling dizzy isn’t a normal part of aging. If you suffer from vertigo, consult your physician regarding BPPV specifically. A referral to Mercy Health Rehabilitation Center where trained therapists can evaluate your condition and provide treatment will have you feeling better in no time. 

Benign Paroxysmal Positional Vertigo – NORD (National Organization for Rare Disorders)

In some patients, the exact underlying cause of BPPV is unknown. Researchers believe that most cases of BPPV are caused by abnormalities affecting the inner ear. The inner ear contains the cochlea, which converts sound pressure from the outer ear into nerve impulses that are sent to the brain via the auditory canal. The inner ear also contains a vestibular apparatus for balance that includes of the semicircular canals. Fluid moves through these canals enabling the brain to detect turning movements of the head.

Two additional structures found in the inner ear are the utricle and saccule (otolith organs). The utricle and saccule are fluid-filled sacs or cavities that detect acceleration movements of the head including gravity. The utricle and saccule contain small calcium carbonate crystals. For unknown reasons, in individuals with BPPV these crystals may partially erode and small pieces of the crystals fall off and end up in one of the adjoining semicircular canals. Within the canals, these crystals may stimulate specialized sensing organ of the inner ear tubes that is called the cupula. This results in the body being sensitive to certain head position changes that normally would not cause dizziness. Basically, the brain is sent powerful asymmetric nerve signals that resemble the kind of asymmetry associated with spinning. This gives a patient the same sensation that would occur with spinning.

Two specific theories proposed in regard to the underlying cause of BPPV are the canalithiasis and cupulolithiasis theories. These proposed mechanisms are not mutually exclusive and there is scientific evidence that both occur, but that canalithiasis is more common than cupulolithiasis. Canalithiasis refers to calcium crystals that are freely mobile within the semicircular canals and, whenever the head changes position, these crystals move through the canal. As these crystals move, they are believed to drag the fluid within the canals, known as endolymph, behind them. As the endolymph moves through the canals, it stimulates the hair cells of the cupula causing vertigo and nystagmus. When the head is not moving, the crystals (and therefore the endolymph) do not move as well. Consequently, there is no stimulation of the cupula and no associated vertigo or nystagmus. It is believed that these crystals eventually dissolve or fall back into the vestibule (the cavity at the entrance to one of the canals). Canalithiasis appears to best explain most cases of BPPV.

Cupulolithiasis refers to crystals that have become stuck or attached to the cupula in one of the three semicircular canals, usually the posterior canal. BPPV caused by cupulolithiasis is believed to account for the more persistent cases of BPPV that do not respond as well to positioning treatments.

Neither the canalithiasis nor the cupulolithiasis theories address why the crystals become dislodged. There are many different theories as to what conditions can cause crystals to become dislodged and enter the semicircular canals. Such conditions include head trauma, surgery, chronic middle ear infections (otitis media), a severe cold or infection or vestibular neuritis. There are some possible associations with osteoporosis.

Additional factors that may predispose individuals to BPPV include alcoholism, inactivity, age, and certain central nervous system disorders. In many cases, no such precipitating cause can be identified.

Is It Vertigo? Possible Causes Of Dizziness Explained

We may not think of it this way, but standing on two feet is complicated business. When you’re feeling unexpectedly dizzy, off-balance or lightheaded, though, you start to appreciate the normally invisible “sixth sense” of balance. Because being in balance happens “automatically” for most of us, we don’t realize what a complex system it really is. Only when something goes wrong and our world turns upside down and spins, do we even realize there is something TO go wrong.

While “dizzy spells” can be unnerving, they’re very common: Most adults experience an occasional bout of dizziness. Vertigo, the sensation of spinning, is also surprisingly common, affecting an estimated 35 percent of people over age 40 at least once during their lifetime.

“Because vertigo is not a diagnosis, but rather a symptom of an underlying problem, the first step in helping the newly “dizzy” patient is to understand what they are experiencing. This gives us the information we need to formulate a diagnosis and treatment plan,” explains Laura Brainard, M.D., an ear, nose and throat specialist at Henry Ford Health System.

This means you have to be able to describe your experience of dizziness. Some people can’t see or walk straight due to the sudden sensation of spinning and experience extreme nausea. Some people have associated ear symptoms, like ear fullness, ringing in the ear and decreased hearing. Others become light-headed, feeling like they might black out. And many feel a combination of sensations.

Some people’s symptoms last a few seconds and others’ last hours, days or weeks. Whatever the experience, it is often sudden in onset, and very upsetting, leading many people to call 911 or have family take them to the ER.

The balance system is a complex system that relies on the brain’s coordination of three main sensory inputs:

• Visual: Your eyes tell you whether you’re sinking into sand or trying to navigate an icy sidewalk.
• Vestibular: Balance sensors in your inner ear’s bony labyrinth help you maintain your equilibrium by detecting changes in head movement, the pull of gravity and whether you are moving or standing still.
• Proprioceptive: Sensors on the bottom of your feet, in your joints and muscles, and in your spine and neck tell your brain WHERE you are in space and “sense” changing positions.

As you can see, your brain relies on a complex set of inputs to keep your body upright and your visual field stable. Depending on which one of these systems is out of whack, you may experience vertigo, dizziness or imbalance.

Common Causes of Dizziness

How you feel during an episode – your experience of dizziness or vertigo – offers valuable insight about what’s causing your symptoms. Here, Dr. Brainard shares some of the most common causes of dizziness – and how to address them.

1. Dehydration. Even mild dehydration can cause you to feel dizzy, lightheaded or off balance. Dehydration not only depletes your blood volume, it can also cause your blood pressure to drop, which can make you feel woozy.
2. Medication. The number of drugs linked to dizziness is too long to list. Check the side effects of any medications you’re taking to see if they include dizziness, vertigo or loss of balance. And if you feel dizzy consistently, talk to your pharmacist and physician to see if it could be medication-related and if there’s an alternative.
3. Blood pressure. Often related to medication changes, change in health status, or to underlying heart problems, low blood pressure can cause feelings of lightheadedness, like you are going to faint. These are often most notable when standing up after laying or sitting for a long time.
4. Inner ear problems. A common cause of dizziness is something called benign paroxysmal positional vertigo, or BPPV. This kind of vertigo tends to be very short-lived, lasting seconds to minutes, and very predictable – happening in response to certain head movements. It occurs when the crystals in your inner ear get dislodged from their normal spot and float into your ear’s semicircular canals. The good news: This type of vertigo is easily corrected with physical therapy.
5. Heart disease. Sometimes dizziness can indicate a heart condition. Leaking or narrow heart valves, heart arrhythmias and narrowing arteries (also known as atherosclerosis) can reduce blood flow to the brain and make you feel dizzy.
6. Migraine headaches. According to the Vestibular Disorders Association (VEDA), about 40 percent of people who suffer from migraines also experience dizziness or vertigo. You might suffer from dizziness before, during or completely independent of your migraine. Food, temperature changes, hormonal fluctuations and other environmental factors can trigger both dizziness and migraine headaches.
7. Stroke. Rarely, a stroke can cause vertigo. For an initial episode of severe vertigo, it is important to go to the emergency room to identify if something serious is happening.
8. Meniere’s disease. This is a classic inner ear disorder caused by too much fluid in the inner ear and characterized by episodic spinning dizziness, nausea, ear pressure, decreased hearing and ringing in the ear, with episodes lasting from minutes to hours. While this kind of dizziness can be severe and temporarily disabling, doctors can offer many strategies to help patients with this disease live as normal a life as possible.
9. Anemia, thyroid disease, other medical problems. Because balance is such a complex system, it can be caused by many things.

How do you know if your dizzy spells are worrisome? “While most dizziness is not suggestive of an underlying severe problem, as with any new symptom, new onset vertigo or dizziness should be thoroughly evaluated,” says Dr. Brainard.

Your doctor can help rule out health problems related to dizziness, such as heart disease, rare vestibular conditions or a stroke, and get to the bottom of why you’re feeling these symptoms.

To find a doctor at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).

Dr. Laura Brainard is an otolaryngologist (ear, nose and throat specialist) who sees patients at Henry Ford Medical Center – Fairlane and Henry Ford West Bloomfield Hospital.

The Ear, Nose & Throat team at Henry Ford Hospital was recently ranked 23rd in the nation by U.S. News & World Report on its 2018-19 Best Hospitals list.

Vertigo

Many different factors can affect the inner ear and cause vertigo. One way to distinguish them is by the duration of the dizziness.

Short-lived episodes of dizziness (few seconds to minutes)

An extremely common type of vertigo is benign positional vertigo. This is typically a very sudden onset of dizziness, which settles rapidly after a few seconds or at most a couple of minutes.

It is often started off by the person suddenly looking upwards or sideways, and some people get it when they turn over in bed. In between attacks, the sufferer feels entirely normal. It is probably caused by a little piece of lining coming loose in the inner ear and floating into the balance receptor, causing a sudden increase in nerve stimulus to the brain.

Sometimes the attacks start following a whiplash injury or other head injury, but often there appears to be no reason that they should have started. The attacks usually disappear with time.

Medicines do not help, but a manoeuvre known as Epley’s Manoeuvre can be extremely effective in some patients. This can be carried out either by the ear nose and throat surgeon or physiotherapy department, depending on the hospital.

Medium length episodes of dizziness (half-hour to several hours)

These types of vertigo are rarer and are thought to be due to an increase in pressure of the fluid in the inner ear, although nobody really knows for sure.

Menière’s disease or endolymphatic hydrops result in episodes of severe vertigo that can last up to several hours. The dizzy episodes are usually linked with vomiting, and the sufferer can often tell an episode is about to start because he or she notices a drop in their hearing, a feeling of fullness in the ear and some tinnitus. The hearing recovers once the vertigo has settled, but may gradually deteriorate with time.

Treatment of Menière’s disease can involve medicines and, more rarely, surgery, but this will be organised by your local ear nose and throat department once the diagnosis of Menière’s disease has been made.

Longer episodes of dizziness (days to weeks)

An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks.

Again, the initial episode is often associated with vomiting and the patient can be bed-bound because the dizziness is so severe. This is best treated at first with a vestibular sedative such as Stemetil, but any treatment should be stopped quite quickly to allow the brain to compensate and recover from the dizziness. Recovery is much quicker in the long run if treatment with anti-dizziness medicines is not prolonged.

Investigations

The majority of patients who experience episodes of vertigo will recover without any long-term ill effects and usually within a few weeks or month of the onset of the symptoms.

In the majority, specialist investigations do not help with the diagnosis but they can be helpful in certain circumstances. If they are thought necessary, investigations of vertigo will generally be carried out in a hospital by a neurologist, general physician or ear nose and throat surgeon or a audiological physician. Types of test that may be requested include: audiological (hearing) tests, tests of balance, blood tests (rarely), and radiological examinations such as an MRI scan or CT scan.

Treatment

In general the treatment of vertigo is symptomatic, ie treatment is given to control the symptoms without regard to the specific cause of the vertigo. The body is very good at overcoming the imbalance experienced during inner ear disease, and so symptomatic treatment should be short because it can delay this natural compensation.

Rehabilitation (including Cawthorne Cooksey Exercises)

There are specifically targeted exercises to speed up the brain’s natural compensation after inner ear disease. Recovery can be hastened by these exercises which can be organised by your local ear nose and throat or physiotherapy department.

Vestibular sedatives

The inner ear may be ‘suppressed’ (or made sleepy) by the use of drugs such as Stemetil or Stugeron. These drugs reduce the overactivity of the balance organ and so reduce the dizziness and vomiting that can occur in inner ear problems.

However, they are not a long-term solution and should be used for as short a time as possible because they prolong the time taken for the body to readjust after the vertigo.

Menière’s disease

This is a longer term disease and there are two aims of treatment. One is to treat the acute episodes of dizziness with vestibular sedatives (see above), and the other is to try to reduce the frequency of the dizzy episodes.

Frequently advice will be given to restrict intake of salt, caffeine and alcohol, which can help some patients with Menière’s disease. Increasing the bloodflow of the inner ear may help and so drugs like Betahistine (Serc) are often prescribed.

Some people with Menière’s disease may benefit from surgery if the episodes of vertigo are frequent and disabling and not responding to medical treatment.

When is Surgery needed?

Surgery may be advised if medical treatment proves ineffective and the episodes of vertigo are disabling. The options range from those such as the simple insertion of a grommet through to operations which completely destroy the inner ear, or divide the nerves leading from the inner ear to the brain.

Unfortunately, many (although not all) effective surgical operations also destroy the hearing of that ear and so the vertigo is usually severe before a patient opts to undergo such treatment.

Because there are so many different causes of vertigo, there are several different operations and so it would take too much space to detail them all here, but your ear nose and throat consultant will go through them with you.

New treatments

There are always new treatments being developed and there is very encouraging progress being made using drugs delivered directly into the ear which selectively destroy the inner ear balance mechanisms without affecting hearing.

Further work is still to be undertaken in this area and will no doubt result in improved techniques for the control of vertigo in patients who are long-term sufferers. Anyone suffering from persistent recurrence of vertigo should consult their doctor in order to find the cause and to arrange effective treatment.

By D Bowdler and R Lloyd Faulconbridge, University Hospital Lewisham

Disclaimer: The details in this section are for general information only. ENT UK can not assist in providing further information on the content below or booking appointments. Always check with your own doctor.

Understanding Vertigo and Its Causes

What Is Vertigo?

Vertigo itself is a symptom that something else is going on in the body, it is not a condition. Vertigo is actually a false sensation that you or things around you are moving. Most people describe the sensation as a spinning or whirling movement that can occur horizontally or vertically. Vertigo attacks can be sporadic and can last for seconds or they can be more constant and last for days. There are many specific causes of the symptom and it is important to figure out the root cause in order to treat the symptom.

Benign Paroxysmal Positional Vertigo

This is one of the most common causes of vertigo and is often called BPPV for short. It’s a sudden sensation that you are spinning or that the inside of you heat is spinning. BPPV can cause brief instances of intense to mild dizziness. Most of these vertigo incidents are bothersome, but they are not generally serious. The symptom comes and goes and is usually short-lived. There are several physical therapy maneuvers that can help balance things out and help the symptoms. The Epley maneuver is gentle and requires a series of easy movements to get things back in balance.

Migraines

Migraines are well-known for causing intense head pain that can be coupled with other symptoms. One such symptom is vertigo. Some people who have migraines have symptoms before the headache occurs and there are often things that go along with the migraines. Vertigo can come on before the migraine, or it can occur while your migraine is in full force. Those who get motion sickness easily are more likely to have vertigo in conjunction with migraines. Migraines have a number of treatments, but those looking to suppress vertigo may be interested in vestibular suppressants to balance the center in the inner ear.

Labyrinthitis

Labyrinthitis is an inner ear disorder between the two nerves in the inner ear that send information to the brain. The information is important to a person’s balance control. If one of those nerves is inflamed, Labyrinthitis is the condition that results. The symptoms that come from that condition include nausea, hearing loss, and vertigo. People can take over-the-counter antihistamines to help ease these symptoms. Doctors may prescribe something stronger for several symptoms.

Vestibular Neuronitis

This disorder is recognized as a sudden and severe vertigo attack. When the vestibular nerve is inflamed, the false sense of moving or spinning can result. This nerve is a cranial nerve that helps to control balance. Those who suffer from this disorder could be prescribed with vestibular suppressants to reduce their motion sickness and aid them in dealing with the issue.

Getting Help For Vertigo Symptoms

While there are several different conditions that can cause vertigo including BPPV, migraines, labyrinthitis, and vestibular neuronitis, if the symptoms of vertigo persist and are bothering your everyday life, it’s best to visit with a doctor about the condition that is causing the discomfort. Breathe Clear Institute offers treatments for ear issues that could be causing vertigo as a symptom If you think you have inner ear troubles, or you want to rule that out before you move on to other treatment options, contact the professionals at Breathe Clear for help.

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Dizziness

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What is vertigo?

True dizziness (vertigo) is a condition in which a person has a sensation of rotation of surrounding objects around him or a sensation of his own rotation or movement. An example of true, but not related to the disease, dizziness is the dizziness that occurs after riding the carousel, when, after an abrupt stop of the carousel, a person continues to see the movement of surrounding objects relative to himself, as if the carousel were still in motion.

The onset of true dizziness is most often a symptom of diseases of the balance system, which includes: the vestibular apparatus of the inner ear, eyes and sensory receptors of muscles, bones and joints of a person. Dizziness caused by a malfunction of the balance system is often accompanied by nausea and vomiting.

Which symptoms are not dizziness?

In folk life, dizziness is called a number of other symptoms, which, in fact, are not dizziness.The following phenomena are most often called “dizziness”:

• Darkening of the eyes after a sudden rise to the feet from a sitting or lying position
• Shroud before the eyes
• Weakness, feeling of confusion and unsteadiness in the legs
• Nausea
• Feeling close to fainting (loss of consciousness)
• Feeling of imbalance and unstable gait

Unlike true dizziness, which, as mentioned above, is a consequence of a violation of the balance system, false dizziness, which is described by a person as a feeling of instability, weakness, veils before the eyes, darkening in the eyes, etc., most often it can be a sign of chronic fatigue, hypovitaminosis, anemia, vegetative dystonia, hypotension. Also, episodes of lipotimia (a sharp decrease in muscle tone at the time of strong physical exertion), fainting, short-term seizures of epilepsy can be confused with dizziness.

We draw special attention to attacks of acute dizziness and weakness in patients with diabetes mellitus. In this category of patients, dizziness and weakness can be a sign of a dangerous decrease in blood glucose levels.

Most common causes and forms of dizziness

According to modern research, dizziness is most often a symptom of the following diseases:

• Benign paroxysmal positional vertigo (BPPV)
• Basilar migraine
• Meniere’s disease
• Inflammation of the vestibular nerves (vestibular neuritis)
• Psychogenic dizziness
• Osteochondrosis of the cervical spine
• Vertebrobasilar insufficiency
• Brain tumors

It should be noted that BPPV accounts for more than 80% of all cases of true dizziness.

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo is one of the most common forms of true vertigo. The name of this disease is deciphered as follows: “Benign” means – a favorable and not dangerous course of the disease, “paroxysmal” – means the sudden appearance of dizziness; “Positional” – means the appearance of dizziness when turning the head in a certain direction.

The reason for the development of benign positional vertigo is irritation of the receptors of the vestibular apparatus by otolith stones located in the semicircular canals of the inner ear. BPPV can occur spontaneously in a person of any age, but it most often occurs in people over 50-60 years old, after an infection or injury.

• The main symptoms of benign positional vertigo are as follows:
• The onset of severe dizziness when turning in bed, when bending or turning the head to the side, or when throwing the head back.
• Severe dizziness lasts from several seconds to several minutes and may be accompanied by severe nausea or vomiting, and weakness.
• Dizziness attacks can occur in series, and then disappear without a trace for a while.

Treatment of BPPV is carried out with a special technique performed by a neurologist.

Dizziness with Meniere’s disease

Meniere’s disease is characterized by recurrent attacks of severe dizziness and deafness (most often in one ear), which gradually lead to hearing loss.

The exact cause of Meniere’s disease is currently unknown. There are suggestions that in some cases the disease may be caused by viral infections, trauma, or allergies.

A typical manifestation of Meniere’s disease is an acute attack of severe dizziness, which lasts several hours or days, accompanied by nausea, vomiting, hearing loss (in one ear), tinnitus and a feeling of pressure inside the ear.

Attacks of Meniere’s disease usually occur one after another for several weeks, and then disappear for a while, but sooner or later begin again.

Vertigo with vestibular neuritis

Vestibular neuritis is an inflammation of the vestibular nerve that conducts impulses from receptors in the inner ear to the brain. As a result of inflammation, the vestibular nerve temporarily loses its ability to conduct impulses, which is manifested by severe dizziness, nausea, vomiting and unstable gait.

Viral infections are considered the main cause of vestibular neuritis, therefore attacks of associated dizziness may be accompanied by fever, weakness, runny nose or cough.

Psychogenic dizziness

Psychogenic dizziness is the second most common after BPPV.

In contrast to benign paroxysmal dizziness, psychogenic dizziness is not true dizziness, that is, it is not associated with disruption of the vestibular apparatus.

The main characteristics of psychogenic vertigo are:

• Description of vertigo as a sensation of confusion, fog in the head, or fear of falling and losing consciousness, but not as objects circling or the subject himself
• Dizziness attacks occur spontaneously, often in stressful situations, in crowded places and in a confined space (elevator, transport)

In addition to dizziness, patients have many other complaints that resemble some diseases of internal organs: sore throat or a lump in the throat, pain in the chest, in the heart or in the abdomen, feeling short of breath, pain and tension in muscles, feeling of inner fear and tension, disturbed sleep, anxiety, irritability, strong and unfounded concern for the state of one’s own health and the health of loved ones, etc.

Psychogenic dizziness can be considered as one of the most common manifestations of vegetative dystonia. Especially often attacks of false dizziness are observed in patients with panic attacks and anxiety disorders.

With psychogenic dizziness, treatment intended for vegetative dystonia (psychotherapy, sedatives) will be much more effective than specific drugs for dizziness that are prescribed in all cases of true dizziness.

When should you see a doctor immediately if you feel dizzy?

You should consult a doctor as soon as possible in all cases when dizziness is accompanied by the following symptoms:

• Temperature rise
• Severe headache and muscle weakness in the legs or arms
• Persistent vomiting
• Severe dizziness does not go away for more than an hour
• With dizziness, the patient fell and was badly injured
• During an attack of dizziness, the patient lost consciousness
• Severe dizziness occurred in patients with diabetes mellitus or hypertension
• Diagnosis of dizziness

The diagnosis and treatment of vertigo is carried out by neurologists and otolaryngologists.To clarify the cause of dizziness and prescribe the correct treatment, the patient needs to go through:

• audiographic examination
• examination by an ophthalmologist
• computed tomography (CT) or magnetic resonance imaging (MRI)
• duplex scanning of neck arteries
• X-ray of the skull and cervical spine

Dizziness as a symptom of neurological diseases

Thus, when choosing an individual complex for the treatment of dizziness, it is necessary to include, if necessary: ​​anticholinergics (scopalamin, etc.), anticholinergics (atropine, etc.), benzodiazepine tranquilizers (diazepam, etc.), phenothiazines (thiethylpyrosine, etc.), antispasmodics (platifillin, papaverine, no-shpa, etc.), antihistamines (diphenhydramine, suprastinavegil, others), calcium antagonists (cinnarizine, obsidan, etc.) [3, 6, 8, 11, 15, 16, 20, 22]. The use of betahistine dihydrochloride (betaserc, betahistin-ratiopharm) is important in the treatment of dizziness, as well as in its prevention. The recommended dose is 48 mg per day [2, 3, 18, 19].Ginkgo biloba preparations (tanakan, memoplant, bilobil) are also effective in the treatment of vertigo [5]. With the existing herpetic lesion of the vestibular node of Scarpa, acyclovir and other antiviral agents are used. This therapy is combined with the use of corticosteroids [3]. In the treatment of vestibular migraine, a combination of anticholinergics and blockers is used
a-adrenergic receptors, diphenin and tranquilizers. In the period between attacks, a course of treatment with b-adrenergic receptor blockers, antiserotonin drugs and calcium antagonists is prescribed [6].The above material will help a neurologist and general practitioner to remember and systematize knowledge on dizziness issues in neurological practice. It is known that a large number of diseases of the nervous system lead to dizziness, both systemic and non-systemic. In this case, it is important to correctly differentiate the dizziness itself and the cause of its occurrence. This requires a detailed collection of patient complaints with an explanation of the very sensation of dizziness and a complete history of the disease.In the course of communication with the patient, the doctor, taking into account the information received on complaints and anamnesis, determines the required range of additional studies and examination methods. Depending on the prevailing general picture of pathology, the doctor prescribes a course of adequate drug therapy, taking into account the pathogenetic mechanisms of the onset of this condition in a particular patient. Such a scheme in aggregate will help to timely and accurately determine the nosological form of the disease of each individual patient, which will allow to adequately carry out therapeutic measures in the early stages, and subsequently to reduce or completely prevent the development of neurological deficit and disability of the patient.

References are being revised.

90,000 The child is dizzy – causes of dizziness in children

By Ekaterina Dovlatova,

otorhinolaryngologist, otoneurologist-vestibulologist, Ph.D.

Dizziness can be systemic and non-systemic. Abroad, they even use two separate concepts: vertigo (systemic dizziness) is a feeling of rotating oneself or surrounding objects around, a feeling of falling, and dizziness (non-systemic) – a feeling of swaying, blurredness in the head, weakness, approaching loss of consciousness, difficulty concentrating.The type of dizziness depends largely on the underlying cause. In children, the pathological conditions leading to dizziness are somewhat different from the pathologies of adults.

Causes of dizziness in a child

The most common causes and types of systemic vertigo in children :

1. Benign paroxysmal vertigo of childhood. These are short (less than a minute) episodes of sudden dizziness and imbalance.Usually go away by themselves by the age of 5 and are often replaced by migraine attacks.
2. Migraine. In this case, dizziness occurs simultaneously with a headache or is a harbinger of a migraine attack (aura). Its duration can be different: from 15-20 minutes to several hours. At the same time, there are no signs of damage to the vestibular system.
3. Otitis media. With inflammation of the middle ear in children, dizziness can occur for two reasons: due to irritation of the vestibular system due to an increase in pressure in the tympanic cavity or with the development of labyrinthitis (inflammation directly in the inner ear).Therefore, when diagnosing dizziness, an otoscopy is required.
4. Motion sickness (kinetosis, motion sickness). Despite the name, this condition is not a disease. This is just an individual feature of the vestibular system. Science still cannot explain why someone is numb and someone is not. With kinetosis, the head may spin while moving on land, water and / or air. In addition to dizziness, nausea occurs, there may be vomiting, pallor and sweating.Such manifestations can persist for several days after the end of the trip.
5. Injuries to the head or middle ear, such as fracture of the temporal bone, concussion, whiplash, and others. In this case, dizziness is pronounced and prolonged, often accompanied by vomiting. Requires urgent specialist advice.

Slightly less often, the cause of systemic dizziness in children is vestibular neuronitis (viral lesion of the vestibular part of the VIII cranial nerve), accompanied by prolonged severe dizziness with nausea and vomiting.

Dizziness can also be a side effect of certain drugs (for example, aminoglycoside antibiotics, loop diuretics, cytostatics, and others). Psychogenic vertigo associated with anxiety or depressive disorder sometimes occurs in adolescents.

Very rare but dangerous conditions that can cause dizziness: infections of the central nervous system (meningitis, encephalitis, brain abscess), neoplasms of the brain, stroke (rare, but can also occur in children), poisoning with certain substances (ethanol, ketamine, barbiturates).

Most common causes of non-systemic vertigo in children :

1. Anemia – a decrease in the number of red blood cells (erythrocytes) in the blood or a decrease in the concentration of hemoglobin (a protein that carries oxygen to organs and tissues). Other common symptoms of anemia include pallor of the skin, tachycardia, fatigue, drowsiness, and many others.

2. Infectious diseases accompanied by fever and intoxication.

3. Anxiety or depression. In addition to dizziness, mood disorders will be noted here: depression, apathy, or, conversely, anxiety, increased excitability. Sometimes dizziness is one of the manifestations of a panic attack, for which the other most characteristic symptoms are palpitations, feeling short of breath, severe anxiety or fear.

4. Orthostatic hypotension – a temporary decrease in blood pressure by more than 20 mm.Hg, with a sharp rise from a lying or sitting position. In this case, a short-term (several seconds) dizziness occurs, there may be weakness in the legs, darkening in the eyes, tinnitus. Occasionally, this condition can lead to loss of consciousness.

The last two points are more typical for adolescence.

Uncommon but dangerous causes of non-systemic dizziness include arrhythmias and other heart diseases, hypoglycemia (low blood sugar), heatstroke or poisoning (overdose of antidepressants, anticonvulsants, etc.))

When to see a doctor if your child is dizzy

If a child complains that he is dizzy, or you notice an imbalance, unsteadiness when walking, be sure to consult a specialist. It is very important to exclude dangerous, life-threatening conditions as soon as possible. After they have been eliminated, you can begin to identify the cause of the dizziness.

First, you need to determine whether dizziness is associated with damage to the vestibular system – this will help a vestibulologist (ENT doctor specializing in dizziness).If such a lesion is found, then the next step will be to establish the level of the lesion: if a pathology of the inner ear or vestibulocochlear nerve is suspected, you should contact an otorhinolaryngologist, if signs of damage to the structures of the central nervous system are detected, it is better to consult a neurologist.

In the absence of problems with the vestibular system, the cause of dizziness should be sought among cardiovascular and endocrine pathologies. Sometimes a psychogenic disorder or anemia can also be the cause.Usually, all these pathologies are manifested not only by dizziness, but also by some other symptoms.

Each disease has its own manifestations, therefore a detailed conversation with the child and his parents is important. Based on complaints, the child’s life history and illness, as well as studies of the vestibular function, an individual plan for further actions is drawn up: additional studies, analyzes, specialist consultations.

Behavior of young children with dizziness

It is more difficult to identify the cause of dizziness in a small child, since it is still difficult for him to describe his feelings, and most tests involve the patient’s attention and cooperation.Nevertheless, this is a very important and quite doable task.

What to do if a child has dizzy

If your child is dizzy, keep him calm and comfortable to minimize the risk of falling. And see your doctor as soon as possible.

How to avoid complications of dizziness in a child

Dizziness in itself is not dangerous, because it is only a symptom, but it can be a manifestation of one of the potentially dangerous conditions listed above.That is why dizziness itself has no complications, in addition to falling due to impaired balance function. But the complications of the disease, which led to the appearance of dizziness, can be avoided by timely identifying it and starting treatment.

Author: Ekaterina Dovlatova, otorhinolaryngologist, otoneurologist-vestibulologist, Ph.D.

90,000 Dizziness – treatment, symptoms, causes, diagnosis

Vertigo is a term used to describe the sensation of body rotation and disturbance of body stability.Dizziness is one of the most common reasons adults see a doctor, as well as chest pain or fatigue.

Although frequent dizziness or persistent dizziness can significantly disrupt the patient’s usual life, nevertheless, this symptom is rarely a sign of a serious illness in a life-threatening patient. Treatment for vertigo is directly related to the cause and is usually quite effective.

Symptoms

Vertigo can generally be described as:

• Feeling a sense of movement or rotation
• Faintness or feeling of impending fainting
• Loss of balance or instability
• Other sensations such as “floating” or heaviness in the head

A variety of medical conditions can cause dizziness.In some diseases, there is a violation of the transmission of nerve impulses from one or more sensory systems to the brain, which leads to an incorrect analysis of the information received. These abnormalities can affect the following sensory systems:

• Eyes that help determine the location of the body in space and its movement
• Sensory nerves (proprioception) that send messages to the brain about body movements and positions in space
• Inner ear, which contains sensors that help sense gravity and reciprocation

Some types of dizziness require urgent medical attention.

These are the following conditions accompanied by dizziness:

• Traumatic brain injury
• Severe, severe headache
• Neck stiffness
• Blurred clarity
• Severe acute hearing impairment
• Speech Disorders
• Weakness in the leg or arm
• Impaired consciousness
• Gait disorder or fall
• Chest pain or cardiac arrhythmias.

Reasons

Inner ear and body balance

A type of vertigo, such as feeling dizzy, feeling lightheaded, or feeling as if the body is losing balance – often provide clues to the possible causes of this sensation. Specific triggers, such as certain activities or positions, can provide clues to the underlying cause of dizziness. The duration of any episode of dizziness and any additional symptoms a person experiences can also help determine the true cause.

Vertigo

Vertigo, most often, occurs as a result of an episode or temporary change in the activity of the vestibular structures of the inner ear (vestibular apparatus) or due to a violation of the interaction of structures in the brain responsible for balance. These sensory analyzers sense movement and changes in head position. Getting up from a sitting position or moving around the room can make the dizziness worse. Sometimes the dizziness is severe, leading to nausea, vomiting, and problems with body balance.But, as a rule, vertigo does not last long. After 2-3 weeks, the body usually adapts to anything that makes a person dizzy.

Causes of vertigo may include:

• Benign paroxysmal positional vertigo (BPPV). BPPV causes intense, short episodes of vertigo immediately after a change in head position, often when the person turns in bed or sits at a table in the morning. BPPV is the most common cause of vertigo.
• Inflammation of the inner ear. Signs and symptoms of inner ear inflammation (acute vestibular neuritis) include the sudden onset of intense, persistent dizziness that persists for several days, along with symptoms such as nausea, vomiting, and balance problems. These symptoms can be so severe that the patient has to stay in bed. When these symptoms are combined with sudden hearing loss, the condition is called labyrinthitis. Fortunately, vestibular neuritis usually subsides quickly and recovers on its own.But early medication and rehabilitative vestibular therapy can help speed up the recovery process.
• Meniere’s disease. This condition is associated with an excess accumulation of fluid in the inner ear. This condition is characterized by sudden episodes of dizziness, lasting up to several hours, associated with episodes of hearing impairment, tinnitus, and a feeling of fullness in the affected ear.
• Vestibular migraine. Migraines are more than just a headache.Just as some people with migraines experience a visual “aura,” other patients may have episodes of dizziness due to migraines, even when they do not experience severe headaches. These episodes of vertigo can last from several hours to days and can also be accompanied by headaches and sensitivity to light and noise.
• Acoustic neuroma. This condition is a benign tumor (schwannoma) of the auditory nerve that connects the inner ear to the brain.Symptoms of acoustic neuroma usually include progressive hearing loss and tinnitus, on the one hand, accompanied by dizziness or imbalance.
• Other reasons. Rarely enough, dizziness can be a symptom of a more serious neurological condition such as stroke, cerebral hemorrhage, or multiple sclerosis. In such cases, other neurological symptoms are present, such as double vision, speech impairment, changes in facial expressions or numbness, impaired coordination of movements in the limbs, or severe body balancing problems.

Feeling “sick”

Dizziness can lead to a feeling of weakness and lightheadedness, without loss of consciousness. Feelings of lightheadedness are sometimes accompanied by nausea, pallor, and clammy skin. Causes of this type of vertigo include:

• Decrease in blood pressure (orthostatic hypotension). A sharp drop in systolic blood pressure – This can lead to dizziness or lightheadedness. This can happen after a sudden change in body position, such as getting up from a chair.
• Insufficient release of blood from the heart. Certain conditions, such as diseases of the heart muscle (cardiomyopathies), abnormal heart rhythms (arrhythmias), or a significant decrease in blood volume, can cause inadequate blood flow from the heart.
• Imbalance

Imbalance is manifested by a feeling of instability when a person walks. Reasons may include:

• Problems in the inner ear (vestibular).Pathological processes in the inner ear can lead to the fact that a person will feel staggering when walking, especially in the dark.
• Sensory impairment. Visual impairment and peripheral neuropathy (in the lower extremities) are common in older adults and can lead to problems maintaining body balance.
• Joint and muscle problems. Muscle weakness and osteoarthritis can contribute to imbalance, especially if there are problems in the large weight-bearing joints.
• Neurological conditions. Various neurological diseases can lead to progressive imbalance, such as Parkinson’s disease and cerebellar ataxia.
• Medicines. Imbalance can be a side effect of certain medications, such as anticonvulsants, sedatives, and tranquilizers.
• Other types of vertigo

Other non-specific sensations of “dizziness” are those sensations that the patient finds it difficult to describe and perceives as spinning or floating.Some causes of this dizziness include:

• Medicines. Antihypertensives can cause weakness if they significantly lower blood pressure. Many other medications can cause a non-specific feeling of dizziness that disappears when the drug is discontinued.
• Diseases of the inner ear. Some diseases of the inner ear can lead to a persistent feeling of dizziness.
• Neurotic disorders. Certain neurotic disorders, such as panic attacks and fear of leaving the house or being in an open space (agarophobia), can also trigger dizziness.
• Low hemoglobin level (anemia). Along with dizziness with anemia, as a rule, other symptoms are present, such as fatigue, weakness, and pallor of the skin.
• Low blood sugar (hypoglycemia). Typically, hypoglycemia occurs in diabetic patients with an overdose of insulin. Dizziness with hypoglycemia can be accompanied by symptoms such as sweating and confusion.
• Ear infections. Ear infections can sometimes cause dizziness.This type of dizziness disappears after the infection has cleared.
• Overheating and dehydration. If a person is active in hot weather, or if they do not drink enough fluids, then the person may feel dizzy from overheating of the body (hyperthermia) or from dehydration. Resting in a cool place and drinking water will usually relieve dizziness.
• Chronic subjective dizziness. It is a specific clinical syndrome characterized by persistent nonspecific vertigo that has no apparent medical cause.Chronic subjective dizziness is associated with increased sensitivity to their motor functions. This type of vertigo is exacerbated by being in complex visual environments (such as a grocery store), visual movement (such as watching a video), visualizations, and precise visual tasks.

Risk factors

Factors that can increase your risk of developing dizziness include:

• Age. People over 65 are more likely to have medical conditions that cause dizziness.They are also more likely to take medications that can make them dizzy.
• Taking certain medications. Certain medications, such as blood pressure medications, anticonvulsants, sedatives, and tranquilizers, can make you feel dizzy.
• Previous episodes of dizziness. If a person has experienced dizziness before, then the likelihood of repeated episodes of dizziness is higher.

Complications

Dizziness may increase the risk of falls and injury.Episodes of dizziness while driving or operating heavy machinery can increase the likelihood of an accident. Inadequate treatment of diseases associated with dizziness can lead to complications.

Diagnostics

Diagnostics begins, first of all, with a doctor’s consultation. The doctor may be primarily interested in the answers to the following questions:

• Is the dizziness continuous or intermittent?
• If dizziness occurs in episodes, how long did the episode last?
• How often do episodes of dizziness occur?
• What triggers the development of episodes of dizziness?
• Does the body feel spinning, moving around, or spinning dizzy?
• Is dizziness accompanied by a feeling of weakness?
• Does imbalance cause dizziness?
• Is dizziness accompanied by ringing, stuffy ears, or hearing impairment?
• Are there any visual impairments?
• Does the dizziness get worse when you change your head position?
• What medications, vitamins or nutritional supplements does the patient take?

The doctor thus narrows down the range of conditions that can cause dizziness.A neurologic examination helps to identify the presence of neurologic symptoms. After the physical examination, the doctor may prescribe additional examination methods.

• Test for the movement of the eyeballs. The doctor can observe the movement of the patient’s eyeballs while tracking a moving object, or a test can be performed where cold or warm water is poured into the ear and the eye movements are observed.
• Posturography. This method allows you to determine which departments of the balancing system are out of order.
• Vestibular testing can also determine the degree of stability of the vestibular apparatus.

In some cases, magnetic resonance imaging (MRI) may be required. An MRI can be done to rule out an auditory neuroma or other problems in the brain that may be causing dizziness.

Laboratory research methods are necessary in cases where there is suspicion of somatic diseases (for example, anemia).

Treatment

Treatment for vertigo depends on the cause and symptoms.

• DPPG. BPPV treatment involves a simple procedure in which a doctor or physical therapist maneuvers to reposition the head. This procedure usually starts working after one or two procedures.
• Diseases of the inner ear. Vestibular repair exercises are used to treat acute vestibular neuronitis or labyrinthitis.To provide relief from nausea and dizziness, your doctor may prescribe medications such as meclizine (Antivert) and diazepam (Valium), or may recommend dimensionhydrinate (Dramamine). In some cases, a short course of corticosteroids may be prescribed that may improve vestibular function.
• Meniere’s disease. Treatment for Meniere’s disease involves reducing body fluids through the use of diuretics or dietary adjustments (lowering the salt in food). Sometimes injections are given through the eardrum, or surgery may be recommended.
• Vestibular migraine. To combat vertigo associated with vestibular migraines, attack triggers need to be identified and eliminated, focusing on nutrition, stress, normal sleep, and adequate physical activity. Certain medications can help prevent or reduce vestibular migraine attacks, especially when there is nausea and vomiting. You can also do specific exercises to help make the balancing system less sensitive to movement (vestibular rehabilitation).
• Anxiety disorders. In such cases, both medications and psychotherapy can be recommended.

Lifestyle

• The patient should be aware that dizziness can lead to loss of balance, which can lead to falls and serious injury.
• Try not to move abruptly.
• It is necessary to get up slowly.
• Carpets or electrical cords must be removed from the room. Anti-slip rugs must be used in the bathroom.
• If the patient feels dizzy, sit or lie down.
• Avoid driving a car or operating heavy equipment if the patient experiences frequent dizziness.
• It is necessary to use good lighting on the stairs and where the patient walks at night
• When walking, use a walking stick for stability if necessary.
• Avoid the use of caffeine, alcohol and tobacco. Overuse of these substances can make dizziness worse.

Dizziness | Metropolitan Medical Clinic

Cost of diagnostics and treatment

Appointment of a leading specialist

Appointment (examination, consultation) of a neurologist (primary)

Appointment (examination, consultation) of a reflexologist (primary)

Corporate acupuncture (acupuncture therapy)

UZD 1 session

carotid and vertebral arteries, brachiocephalic (great vessels of the head and neck)

Serum creatinine (with GFR determination)

until 9:00 the next day

Serum urea

until 9:00 the next day

Serum uric acid

Direct bilirubin

until 9:00 the next day

Total bilirubin

until 9:00 the next day

Total serum protein

until 9:00 the next day

Serum albumin

until 9:00 the next days

Plasma glucose

until 9:00 the next day

Total cholesterol

Triglycerides 900 05

until 9:00 the next day

Serum calcium

until 9:00 the next day

Potassium, Sodium, Chlorine in serum (K +, Na +, Cl-)

until 9:00 the next day

Phosphorus in serum

until 9:00 the next day

Dizziness in itself is not a disease.This is a symptom that manifests itself in the development of various diseases that lead to disorientation, a false sensation of mobility of stationary objects and various objects surrounding a person. This phenomenon is especially common in older people and women (in men, this phenomenon is less common).

It is quite difficult to diagnose the causes of dizziness, since the sensations of instability of the surrounding space are subjective in nature. Symptoms depend on many factors and differ significantly in different patients, both in terms of the sensations that arise and the degree of their manifestation.These symptoms can occur unexpectedly and be episodic. The patient can feel something like shocks to the sides, complain that he is being “led”.

What’s going on

Dizziness often occurs suddenly. This is not a permanent feeling, the condition manifests itself sporadically. For different people, the duration of such sensations can vary from a few minutes to an hour. Typically, patients describe their feelings as if they were spinning on a merry-go-round for a long time, after which they were a little “stormy”.

Often, sensations are more manifested in the general instability of either the patient himself or the objects around him, there are problems with a sense of balance. As a result, a person cannot walk confidently or even stand. The feeling that he can fall or stumble at any moment does not leave him. People describe it as if “the earth is slipping out from under their feet.” In some cases, the symptoms can be so severe that the person will grab onto the surrounding objects with their hands to stay on their feet.At the same time, the patient also often experiences lightheadedness, as if before loss of consciousness. More often this problem is observed in adults, adolescents and children are less prone to dizziness.

Other symptoms may also occur, depending on the cause and the degree of dizziness.

Main symptoms

The symptomatology of the phenomenon of dizziness depends on the causes and characteristics of the patient’s body and manifests itself in varying degrees. Systemic and non-systemic dizziness is accompanied by the following symptoms:

• Feeling as if a person is spinning, or objects around him are rotating, a feeling of violation of the position of the body in space (tilt to the side)
• Sensation of coldness in the limbs
• Dizziness is often accompanied by hyperhidrosis (excessive sweating), both on the arms and legs, and throughout the body
• Inexplicable feeling of fear and lack of air
• Unnatural lightness in the head, complete absence of any thoughts
• Feeling of numbness on the lips and muscles of the face, other symptoms are also possible, harbingers of loss of consciousness (faintness, weakness)
• Nausea and vomiting
• Increased pressure, increased heart rate
• Hearing impairment, tinnitus
• Darkness before the eyes, the appearance of “flies”
• Involuntary contraction of the muscles of the eyeballs

Similar signs can appear or intensify at moments of sudden changes in body position, head rotation, bending over, and even if a person just looks at fast moving objects (also when traveling in any type of transport).

Causes of dizziness

Various diseases can cause dizziness. The most common causes of this phenomenon:

• The cause of dizziness can be a traumatic brain injury or otitis media, the presence of a viral infection or intoxication of the body. In these cases, seizures most often occur at the time of a sharp change in the position of the body or head (positional vertigo). The duration of such a phenomenon can be from a few seconds to 2-3 minutes (most often it passes if the body and head return to their previous position).Usually, the treatment of such phenomena is reduced to performing special gymnastics exercises
• Dizziness occurs due to reversible dysfunctions of the brain, resulting from interruptions in the blood supply to the vertebrobasilar basin. In these cases, the symptoms appear for no particular reason, unexpectedly and unpredictably. Dizziness can be accompanied by loss of balance, feeling of nausea, visual impairment (double vision), speech, etc.
• About 5% of cases of dizziness occur due to Meniere’s disease.This disease is characterized by an increase in the volume of fluid in the inner ear cavity. This is what causes severe dizziness, which are accompanied by vomiting, nausea, tinnitus, and hearing impairment.
• Dizziness attacks can also occur as complications after a viral illness, or as a result of drug intoxication of the body. In such cases, the disease manifests itself in sudden attacks of dizziness, nausea and vomiting, leading to a light-headed state.With sudden head movements, these symptoms may worsen.
• The term migraine-associated vertigo is used to describe all manifestations of vertigo that accompany migraine. Most often, all other symptoms appear before headaches, forming an “aura” – the so-called feeling that a migraine is coming soon. Vertigo in such cases can also increase or decrease, depending on the position and condition of the head and body.

These are the most common causes of vertigo.But other, more serious diseases can also cause them. In such a situation, a comprehensive diagnosis and consultation of an experienced doctor is necessary. This will help avoid serious consequences and the development of diseases. Diseases that can lead to periodic dizziness:

• Inflammation of the inner ear is often a complication of other diseases (otitis media, cold, flu) or mechanical injury. At the same time, prolonged attacks of dizziness, hearing loss (short-term deafness may even occur), fever and nausea are noted.Treatment usually involves a course of antibiotics. Necessarily carried out under the supervision of a specialist.
• In case of disorders in the circulatory system of the brain, chronic cerebrovascular insufficiency occurs. The causes of the disease can be diabetes mellitus or hypertension. As a result, the arteries begin to narrow, which leads to ischemia. All this becomes the cause of headaches, tinnitus and dizziness. Factors that can aggravate the disease are alcohol abuse, smoking, problems with being overweight.First of all, when treating a disease, it is necessary to adhere to a diet and get rid of bad habits.
• Dizziness can also occur as a result of previous brain injury. In this case, the causes of the disease lie in the circulatory disorders of the brain, or in its damage. Dizziness due to brain injury is often accompanied by vomiting and nausea, headaches, etc. Certain functions that were controlled by the damaged area of ​​the brain may fail.
• Dizziness and chronic headache may indicate the presence of a brain tumor. Also, in such cases, vomiting, nausea, impaired coordination and a sense of balance are common. Decrease in sensitivity is possible. The reason for this is that the tumor presses on certain parts of the brain and prevents them from functioning normally.
• Inflammation (otitis media), often accompanied by headaches, general weakness, fever and pain in the ear, can also cause dizziness.To eliminate the risk of the disease spilling over into the chronic stage, it is necessary to seek medical help in a timely manner. Complications of otitis media are quite serious – up to meningitis, hearing loss and brain abscess.

The causes of dizziness are divided into normal (physiological), and

pathological resulting from various diseases.

Among the physiological causes of dizziness, the following are most common:

• Abrupt or fast movements (jumping from a height, riding rides, etc.)n.)
• Fright, causing psychogenic dizziness (stressful condition affects the work of the cardiovascular system)
• The cause of the phenomenon may be hyperventilation of the lungs (occurs when oversaturation with oxygen, for example, during diving with underwater equipment)
• Dizziness may occur due to low levels of iron in the body (often caused by unbalanced diet)
• Often the cause of dizziness lies in a low-calorie diet or prolonged fasting, which leads to depletion of the body’s energy reserves
• In women, dizziness is also observed in the premenstrual period, or during pregnancy

There are also pathological causes of dizziness:

• The cause of unpleasant sensations can be a disease of the inner ear, which leads to a violation not only of perception, but also of impulses directed by the auditory and vestibular apparatus to the brain
• Dizziness with osteochondrosis or hernias in the cervical region is explained by squeezing of blood vessels, which leads to disruption of the functioning of the blood supply system of the brain
• Thrombosis and strokes, panic attacks also lead to circulatory disorders of the brain
• Tumors and climacteric syndrome are also among the causes of dizziness.A number of medications can also cause them

In total, there are about 80 diseases that can cause dizziness. Only a comprehensive examination will help to identify the cause and eliminate it.

Diagnostics and treatment

If you are haunted by dizziness, treatment should begin with a diagnosis of the causes of this phenomenon. First of all, the doctor will establish the cause of the dizziness, and only then will he prescribe a course of treatment.In this case, various methods are used. These include both drug therapy and dietary and activity adherence recommendations.

In the course of drug therapy, vasodilators and antihistamines are usually prescribed to improve blood flow. For neurogenic vertigo, effective treatment includes taking nootropics to also increase the conduction of nerve circuits. Medical treatment in women, in addition, can be aimed at normalizing the hormonal background of the body.

Recommendations for the regimen are to observe the periods of wakefulness and sleep, a reasonable alternation of physical and mental stress. Nutritionists in this situation recommend excluding foods that increase blood pressure and can cause vasospasm from the diet. It is also better to give up the use of substances that stimulate the nervous system (this is strong tea and coffee, nicotine and alcohol, spicy and salty foods).

To reduce the risk of dizziness, especially in the elderly, it is worth doing regular simple exercises:

• Standing straight, rotate your head and body in different directions, closing and opening your eyes
• Swinging will be useful for the vestibular apparatus
• You can check the functioning of the vestibular apparatus and train it by performing a stand on one leg with your eyes closed
• Of the sports, swimming is the most effective in the fight against headaches

This set of exercises is an excellent prevention of dizziness.

In what cases it is impossible to postpone a visit to the doctor

Despite the fact that people often ignore headaches, when the following symptoms appear, it is impossible to postpone a visit to a specialist:

• When symptoms are detected for the first time, with dizziness accompanied by occipital headache, vomiting and nausea
• Loss of consciousness
• There is weakness, trembling in the limbs, increased sweating, heart palpitations, pain in the chest, feeling of lack of air
• Dizziness continues for a long time (hours or more)
• Simultaneously with dizziness, there is a decrease in sensitivity and weakness appears in the limbs or in one of the halves of the body (face)

If you are concerned about these symptoms, immediately contact us by phone +7 (495) 642-88-62.Our clinic provides complete confidentiality, comfortable conditions and a high level of service. We are waiting for you in Moscow at st. Sretenka, house 9.

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DOCTORS OF THE OFFICE Dizziness

Kusochkina Natalya Alexandrovna

Physician-neurologist-reflexologist. Doctor of the first qualification category. Leading Specialist.

Anastasia Gennadievna Chernova

Physician – therapist – gastroenterologist

90,000 panic attack symptoms and how to deal with them

14 February 2020

Anxiety disorders are not uncommon for residents of megacities.The editorial staff of WMJ.ru talked with a psychotherapist and learned all about panic attacks firsthand. Details are in our material!

What is panic attack

A panic attack is an attack of sudden fear and intense anxiety for no apparent reason. The origins of panic disorder are not fully understood. However, it is believed that the disease has a genetic predisposition and more often affects the fair sex. Women are more prone to panic attacks and suffer from this disorder 2-3 times more often than men.

Panic attacks cannot lead to death, despite the fact that it is this feeling that most often accompanies them. The more often attacks occur, the worse the quality of life becomes. People who have experienced repeated anxiety attacks become more anxious and subconsciously try to avoid places or situations where and when they succumbed to fear. Those who have experienced a nighttime attack at least once experience sleep disorders.

What are the symptoms of panic attack

A panic attack is a case of an attack of fear with a feeling of imminent death or anxiety, accompanied by certain symptoms.Most often these include: rapid heartbeat and pulse, sweating, chills or a feeling of heat, tremors, shortness of breath and suffocation, dizziness, fainting, fear of death, and others. If 4 of these symptoms are present, we can talk about an attack of a panic attack.

What to do in case of panic attack

The most important thing to do with a panic attack is to shift your focus. Any method will work as a distraction. If an attack hits you in a public place, you can clench and unclench your fists, rub your earlobes, or step from foot to foot.If panic is caught by surprise at home, try to turn on the music, start doing household chores: washing dishes, dusting. Any activity that involves muscle work and requires attention will do.

Since a panic attack is accompanied by a rapid heartbeat and a feeling of stuffiness, it will not be superfluous to take a couple of sips of water and concentrate on breathing. It is best to learn a few techniques that will quickly release tension.In case of an attack, start with an exhalation – slow it down, and the pulse will also slow down. The ratio of the length of inhalation and exhalation should be 1: 2. You can experiment and choose the technique that will help you. A smartphone will also help to distract from panic. Games, social media – all of this will divert attention and distract from a panic attack.

How common anxiety differs from panic attack

The mechanism that triggers a panic attack does not differ from that that causes ordinary anxiety – both are psychophysical reactions to danger.The difference is that a panic attack is a response to danger in the absence of danger. Nevertheless, a false alarm triggers the same cascade of reactions as a regular alarm – the sympathetic system is activated, an adrenaline rush occurs.

A panic attack can occur against a background of excessive physical exertion, overwork and exhaustion, as well as against the background of the abuse of stimulants and alcohol. In addition, stress and unresolved conflict situations can provoke an attack.Lack of understanding of one’s own experiences and feelings, a tendency to avoid and ignore negative emotions also increase vulnerability to panic disorder.

How to prevent a panic attack from escalating into panic disorder

Panic disorder is characterized by a number of symptoms, one of which is panic attack. In order to diagnose panic disorder, it is necessary that panic episodes appear constantly throughout the month and are not associated with threats, dangers and past illnesses.In addition, seizures should be accompanied by the following symptoms: anxiety about repeating attacks, loss of control over oneself, and a sharp change in behavior.

How to treat panic attacks and when to see a specialist

Seeing a specialist for repeated panic attacks is mandatory. Therapy is tailored to the individual and usually includes psychotherapeutic work and drug therapy. Psychotherapy implies various techniques aimed at understanding and understanding the causes of problems, learning how to deal with the symptoms of the disease, methods of relaxation.Psychotherapy can take the form of individual meetings with a therapist or in the form of group sessions with other patients. Medication for panic disorder is carried out with a variety of drugs that can help reduce levels of anxiety and fear. Appointment, dosage adjustment and cancellation of treatment must be carried out under the supervision of a physician.

Modern neurotechnologies can also help in the treatment of panic attacks. Methods of neurofeedback training for patients with panic disorder have been developed.During trainings, patients learn to manage their emotional state, they form new neural connections, and the level of anxiety decreases. In addition to professional help, lifestyle plays a significant role in the treatment and prevention of panic attacks. Try not to abuse alcohol and caffeine, get more rest, do sports, better yoga.

Source: https://www.wmj.ru/krasota/telo/golovokruzhenie-zhar-i-dazhe-udushe-simptomy-panicheskikh-atak-i-kak-s-nimi-borotsya-razbiraem-s-vrachom.htm

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90,000 How I cured dizziness: after many years of ordeal, forty minutes were enough

Come out to start. I get dizzy from time to time. Quite a long time ago, from twenty-five years. Spins when you throw it back. Or, conversely, when you look down. Or in a dream when you roll over on the other side.

Such garbage rolls over unexpectedly and lasts from several days to a month.Gradually, the head stops spinning and may no longer do this for a whole year. Or two years. Or three. There is no system in her behavior. I don’t know why it starts up and why it stops.

Many times I tried to find out why she is spinning and how to treat her all the same. I went to various specialists. All the doctors I have turned to in my life can no longer be recalled. But those whom I came to in the last five or six years were definitely good professionals.

All of them were receiving appointments in state and commercial polyclinics and medical centers.Real doctors, not paramedics. Someone was recommended to me. Having saved up money, I went to someone myself, deciding that I can trust him, since he works in an expensive and prestigious medical institution, because they won’t take a bad specialist there.

I do not mention the names of medical centers here, so as not to make them anti-advertising advertising. But, believe me, they are all very worthy, well-known and have been working in Moscow for many years.

With dizziness, you have to go to a neurologist – that’s what they told me in any clinic.And the therapist also always referred to the neurologist. So I went to neurologists.

Neurologists examined me very carefully. They tapped them with hammers, put them down, crushed them, sent them to ultrasound of the vessels of the neck, MRI of the brain and upper spine, and demanded to pass all sorts of cunning blood tests.

According to the results of research, on which I spent about ten thousand each time, if not more, it turned out that I, of course, had osteochondrosis. The vertebrae in the neck are displaced from working on a computer or perhaps from a birth injury.Because of this, some vessels are clamped in the neck and the blood supply to the brain is disrupted. And the head is spinning.

Neurologists wrote terrible diagnoses in their reports. And some kind of encephalopathy, and something vascular, and something vegetative.

I was upset, of course. “Unfortunately, the vertebrae cannot be moved back,” kind neurologists reassured, “it will get worse with age. High blood pressure, stroke, you are at risk. But now we will treat you and you will feel better. In general, you need to sit at the computer less, sleep more, walk, relax, exercise therapy and a pool, swimming is very useful for you. “

Treatment for all doctors was the same – for ten days to go to IVs with some kind of vascular strengthening drugs plus massage, chiropractor, acupuncture, physiotherapy and therapeutic gymnastics. Or all together, or something to choose from. But in any case it cost a lot of money.

Once I decided to limit myself to droppers. A month later, my head really stopped spinning, but before it stopped even without droppers, so I didn’t have much faith in such treatment.

Another time I had fatty insurance, which paid not only for IVs, but also for procedures. “Any whim for your money,” said the neurologist, writing out a thick stack of referrals, and for three weeks I went to this medical center as if to work. Dropper, electrophoresis, magnets, massage, manual loosening of the head, needles. My head, however, became even more dizzy and stopped only after my treatment stopped and passed again for about a month.

I must say that a long time ago – about ten years ago, probably, I casually told my friend about the head.She graduated from the Moscow Medical Institute back in Soviet times. Then she went abroad and works there as an ordinary general practitioner. “And how dizzy – like on a ship or like a merry-go-round?” She asked immediately. I said it was more like a carousel. “Go to the earhogolonos,” she advised. In our youth, the name of an otolaryngologist was called “Ukhogorlonos”. A friend explained that she was dizzy because of the crystals in her ears. They were somewhere out of place with me, and the “ear-throat” will return them to the right place with elementary manipulations.They know how, it’s not difficult.

While dragging about neurologists, I sometimes recalled this strange advice and once decided to follow it. I went to an otolaryngologist of the highest qualifications, to a paid, reputable clinic with an excellent reputation.

Here, I say, my head is spinning. Put the crystals back in my ears.

A highly qualified otolaryngologist looked at me as if I were a fool who had fallen from the sky. She had never heard of crystals. “With dizziness to the neurologist. You shouldn’t have come to me. “

This was the end of my relationship with the uhohorlonos. And with the neurologists, the sluggish ones continued.

***

A couple of months ago – at the beginning of summer – my head was not spinning at all. And it hadn’t been spinning for so long that I forgot to think about it.

Without any connection with my head, I decided to make my old dream come true – I signed up for a “light swimming” course in order to learn how to crawl long distances in open water and eventually swim across the Volga at its widest point or even the English Channel.

Contrary to the assurances of neurologists in the exceptional benefits of swimming in osteochondrosis, the head began to spin dangerously after the third lesson. I did not give up, I continued my studies. Do not give up, once it is packed.

Completed the course. But the head spun as much as it had never spun in my life.

She behaved well only when looking straight ahead. But from turns and tilts to the right, left, up, down, a rapid rotation of everything that is in the field of view began.

I could only sleep while sitting. To brush my teeth, I had to undress and get into the bathtub, because it was impossible to bend over to the sink. My head began to spin so that I could easily bump my forehead into this sink. Behind the wheel, you had to look only straight, and park on the mirrors, in no case turning your head sharply. In general, I was desperate, to be honest. Damn neck. My poor brain. He is not supplied with blood at all. What to do? Go to a neurologist again? But how can he help if useless droppers and massage are his entire arsenal.

Photo: Gennady Cherkasov

In addition to the head, a tooth ached. In dentistry, for some reason, I was seen by an otolaryngologist. Leaving the dentist, I went to him. Absolutely non-pathetic specialist. Fortunately, there was no queue or entry. And she told about the head. And about the crystals.

The diagnosis was made instantly: benign positional vertigo. “You need to see an otoneurologist,” said the otolaryngologist. – He will manipulate you.There is only one specialist in Moscow who will do it competently, and he has all the necessary equipment. If you go, then to him. ”

And I went to him. And everything worked out. Three weeks of agony and years of depression from the “poor blood supply to the brain” ended in forty minutes.

The otoneurologist put special glasses on me, laid me down on the couch and began to turn somehow cunningly and carefully. At first, my head was spinning mercilessly at every turn. It was sickening, disgusting, I wanted to sit down immediately in order to calm the rotation.But by the fourth series of turns, everything had somehow improved. I rolled over both on the left side and on the right and looked forward to how I would sleep lying down – forgotten happiness! – already tonight.

***

Benign positional vertigo occurs due to irregularities in the vestibular apparatus. Osteochondrosis, constricted blood vessels and poor blood supply to the brain have nothing to do with it. It’s all from another opera altogether.

In the human inner ear, there are two receptors – auditory and vestibular, which are directly involved in the balance system.The inner ear (ear labyrinth) contains calcium crystals. They lie there in the so-called bags and provide a sense of gravity.

These crystals are called kanalits. They can break down for various reasons. The released crystals can float out of the sacs into the semicircular canals filled with fluid. There are three such semicircular canals in total. Most often, the canals float into the vertical channel. But they can swim in any.

If they swam, a change in the position of the head can cause a shift in the channels, and then the person will have a feeling of rotation.It is very strong. Lasts less than a minute, but causes nausea, imbalance, and these sensations last for hours.

Such vertigo happens to both children and the elderly. No regularities have been identified that would allow to indicate their cause. Apparently, these are structural features of the vestibular apparatus. Some kind of pathology. But quite common.

In general, the head can be spinning from a variety of reasons. But the crystals that come out are the most common. About 20% of all people suffering from dizziness suffer from them precisely because of the fact that they have “untied” canalitis.

It cannot be cured by medicines. Massages and manuals – too. The crystals that have come out just need to be driven back to where they should be. This is exactly what the otoneurologist did to me. With a series of light movements, I moved the emerging canals to the area of ​​the ear labyrinth, where they would not damage the balance system.

Someday they may swim again into the semicircular canals. Then I will go to him again, and he will drive them back into place. Since this does not happen often, this is not a big problem.

***

I wrote about the interesting behavior of crystals on my page in social networks. Those who live in our country responded with comments like “my case, give the coordinates of the doctor, for many years I have been sinning on blood vessels and osteochondrosis, I am poisoned with drugs, there is no sense.” Those who live abroad were also surprised. But not that there is such a dizziness, which is “repaired” by manipulations, but that in Russia very few people know about it. “Physiotherapists do it here, they teach such manipulations in the first year,” wrote the Swede.“I had the same, but I was immediately referred to the ENT,” wrote the Israeli woman. “In America, it is treated with one session of physiotherapy,” – wrote the American.

The otoneurologist who “repaired” me said that doctors relatively recently learned that positional dizziness is caused by floating crystals. This became known only in 1995 – due to an unsuccessful operation performed by a Canadian surgeon.

Over the past 22 years, foreign medicine has “incorporated” a new disease into its health care system, defining a clear place for it: how it is diagnosed, by what symptoms, at what stage of examination, by what specialists, who treats, whom to teach to treat.

This did not happen in our health care system.

Yes, many experts know about positional vertigo. But many do not even know.

Although if they are referred to neurologists with dizziness, neurologists should definitely know about it. And it’s not easy to know. It should be included in the algorithm of their actions: before looking for vasoconstriction and a brain tumor, it is nevertheless necessary to check whether the patient is dizzy because of crystals. Because if because of the crystals, then he should not be driven by apparatus studies and droppers, but sent to another specialist – an otoneurologist.

Otherwise, the health care system is ineffective. Patients are not cured, and huge amounts of money are spent – both by insurance companies and by the patients themselves.

***

Who should I ask why benign positional vertigo is in a suspended state? Minister of Health? But the minister cannot keep track of all the news of medicine and look for a place of practical application for each news. This is not the task of the ministry. This is the task of the professional medical community.

Clinical practice requires clinical guidelines – a specific list of necessary diagnostic and treatment methods for a specific disease. In the West, such recommendations are developed by professional associations of doctors of various specializations. The Association of Surgeons designs for surgeons, an association of physicians for general practitioners, and an association of neurologists for neurologists. Doctors are guided by these clinical guidelines.

It’s not like that with us.

There are no clinical guidelines, and they are not being developed, and even Western ones are not translated into Russian, although it would be faster and easier.Clinical gaps are filled by chance rather than systematically.

“For ten years we have been telling everyone about benign positional vertigo at meetings of the Moscow City Scientific Society of Physicians,” said Professor Pavel Vorobyov, having learned about my ordeal with my head. – It’s a frequent thing, people are poisoned with senseless medicines, and the chest opens simply. Yes, there are other causes of dizziness, but it is a shame that most of the sufferers can be helped. “

Moscow City Scientific Society of Physicians – professional association. Okay, she’s doing her job – talking about positional vertigo at meetings. But who hears her? A handful of “living” doctors who are really interested in the profession. It’s useless to tell the rest. They need an order from the head physician, where an algorithm will be written, how, when and who should be examined in order to detect positional dizziness. Then they will examine. If there is no order, they will not.

This is the order we have – both in state medical institutions and in private ones. Bureaucratic. Reliable, time-tested.

Still it would work, and it would be very good.

***

Massage of the collar zone, to which neurologists first directed me, turns out to be harmful in case of positional vertigo. “It will be even worse,” the otoneurologist-savior warned. The neck usually hurts terribly with this dizziness, yes. But it hurts not because of the crooked vertebrae, but because the muscles are constantly trying to hold the head and stop the rotating picture.

And swimming is also not useful. Especially crawl. Because the position in which the body is located can provoke a massive “swim” of the canals. It seems that this is exactly what happened to me. So the English Channel will wait.

P.S. I know very well what will happen after the publication of this article. Different people who need an otoneurologist will start calling and writing to me to find out where he is taking. People will solve their particular problems in this way. And they will decide. But I wrote the article not for the sake of solving particular problems, but in order to highlight a general problem.Systemic. The health care system is not working the way it should. And someone in power should finally understand this.