Dizziness and balance problems

Dizziness and balance problems Dizziness and balance problems, Action on Hearing Loss Information, May 2011 1

Dizziness and balance problems This factsheet is part of our Ears and ear problems range. It is written for people who have balance or dizziness problems. If you are concerned about your balance or have balance problems, or you are feeling dizzy, you should visit your GP. Read this factsheet to find out: Why do I feel dizzy? How is balance controlled? What causes balance problems? How do I know if I have a problem with my balance? What treatment is there for balance problems? How long does it take to recover? Where can I get further information? If you would like this factsheet on audio tape, in Braille or in large print, please contact our helpline see the front page for contact details. Medical disclaimer The information given in this factsheet is not medical advice, and by providing it we do not undertake any responsibility for your medical care, nor accept you as a patient. Before acting on the information contained in this factsheet, or deciding on a course of treatment, you should discuss the matter with your GP or other medical professional. Why do I feel dizzy? Everyone feels dizzy sometimes. Dizziness is a normal feeling that you get when your brain receives conflicting messages from your inner ears or from your eyes. You can feel dizzy for many different reasons and in many ordinary situations. For example: If you move your head suddenly, you may feel dizzy. You might feel dizzy if you ve drunk too much alcohol. Fairground rides often make people feel dizzy, as do many kinds of travel. If you are very dizzy, you may feel sick or actually be sick because your balance organs are stimulated for example, if you are on a boat when the sea is rough. Dizziness and balance problems, Action on Hearing Loss Information, May 2011 2

These are day-to-day reasons for feeling dizzy, and people are not usually worried about them, even if they find them unpleasant. This is because the effects are usually temporary and the symptoms disappear when your balance system is given a chance to settle down. How is balance controlled? You use your balance every time you move from one position to another and when you walk, stand, sit or lie down, but it is something you are usually hardly aware of. You only realise how much you rely on your balance if it stops working properly. You get your sense of balance from three sources: vision your eyes give you a picture of the world and where you are in relation to everything in it sensors in your joints, muscles and feet balance organs within your inner ears. Your inner ear holds both your organ of hearing, the cochlea, and your organ of balance, the labyrinth. The labyrinth is made up of five sections. Each section detects head movement in a different direction. The sections contain tiny hair-like cells, which send messages to your brain when you move your head about. The information from your balance organs, vision and sensors in your joints passes to your brain, where the information is put together. This allows you to control your eye movements so that your vision is steady and you move naturally without having to think about it. Normally, the information coming from your ears perfectly matches the information coming from your eyes and the sensors in your joints. The result is that you feel steady and don t have any balance problems. What causes balance problems? At first, many people with balance symptoms are worried that they may be suffering from a serious illness, such as a stroke or a brain tumour. Fortunately, this is very unlikely although you should see a doctor if you are worried about your balance. There are immediately recognisable symptoms of stroke: see the Stroke Association s website for more information on the FAST test. Most balance problems are rarely serious, even though the symptoms can be very unpleasant. Many different medical conditions can give you symptoms of dizziness and unsteadiness, although the most common causes are problems with the inner ear. Dizziness and balance problems, Action on Hearing Loss Information, May 2011 3

Migraine Migraine is a very common cause of dizziness, particularly in children, but it is also quite common in adults. Often the dizziness is severe and is accompanied by vomiting, but it is important to understand that a migraine may make you feel dizzy whether or not you have a headache. Benign paroxysmal positional vertigo This is a specific inner ear disorder that can give you severe, short spells of dizziness, especially if you tip your head backwards for example, if you look up at the sky, or when you first lie down in bed. It is thought that this condition is caused by small crystals floating in the fluid in the inner ear falling onto one of your balance sections. Your specialist can alleviate some, if not all, of the symptoms by using a particle repositioning procedure known as the Epley or Semont manoeuvre. The movements move the crystals into another part of the inner ear where they do not cause balance problems. Ménière s disease Ménière s disease is caused by changes in the pressure of the fluid in the inner ear, which lead to sudden attacks of severe dizziness. An attack lasts between 30 minutes and several hours and is usually accompanied by nausea and vomiting, as well as hearing loss and tinnitus. Ménière s disease develops differently over time from person to person. There are many different treatments for Ménière s disease and most people can find one that works for them. For more information, see our factsheet Ménière s disease. Infections The most common cause of a sudden episode of dizziness is a simple viral infection in your inner ear or in the nerve taking information from your ear to your brain. Although your immune system removes the virus quite quickly, your balance organs may have been damaged while you had the infection. You may feel dizzy until your brain can compensate for the damage. This sort of balance problem is usually helped by vestibular rehabilitation physiotherapy, which includes head and balance exercises. Serious infections such as meningitis can lead to balance problems, as can the antibiotics used to treat life-threatening infections (see Prescription drugs on page 5). Bifocal glasses Some older people find that wearing bifocal glasses often makes them feel unsteady and unstable. If this happens to you, see your optician, who may be able to suggest different glasses. Any person with a balance disorder will find changing glasses disorientating. Dizziness and balance problems, Action on Hearing Loss Information, May 2011 4

Chronic middle ear disease If you have chronic middle ear disease, this may affect your balance. This is fairly rare, but if you become dizzy and notice a discharge (liquid) from your ear, you must see your GP or specialist immediately. Glue ear Children with glue ear (also known as otitis media with effusion ) may feel dizzy. For more information, see our factsheet Glue ear. Head injury or whiplash Injuries, including mild bangs to the head, can cause balance problems. The type of problem and how severe it is depends on the severity of the head injury. Neck-related dizziness Whiplash injuries or neck manipulations performed by health professionals, such as in physiotherapy, can make you dizzy, especially if you already have an inner ear upset. This kind of dizziness is not usually severe but may continue for a long time. Neurological causes Very rarely, a problem in the brain can cause balance problems. This usually affects people who have already been diagnosed as suffering from a neurological brain or nerve disease. It is extremely unusual for a balance problem to be the only symptom of a neurological disease. Operations If you have an operation on your ear, it may affect your balance, either temporarily or permanently. Prescription drugs Occasionally, certain antibiotics used for the treatment of life-threatening infections can damage your balance organs. This type of damage can be quite severe. A particular type of physiotherapy balance retraining rehabilitation physiotherapy can help if you have this sort of balance problem. If these life-saving antibiotics have caused your loss of balance, you should avoid situations where your balance is under stress. Never swim alone or underwater, and do not stand at the edge of train platforms or cliffs. Dizziness and balance problems, Action on Hearing Loss Information, May 2011 5

Other prescribed drugs may also cause balance problems, such as drugs that you take for high or low blood pressure, or drugs with an effect on the central nervous system, such as antidepressants, sedatives, tranquillisers and anticonvulsants. How do I know if I have a problem with my balance? You might feel dizzy, light-headed or unsteady. You may notice that your vision is slightly blurred or out of focus. When you walk, you may feel as though the world is bobbing up and down. You may also feel pulled to one side, or, in extreme cases, actually fall over. Some of these symptoms can be very severe if there is a sudden loss of balance function in the inner ear. You may feel you are spinning around as if on a roundabout. You might be sick, and find you can t walk across a room. You may also develop symptoms such as: anxiety, panic attacks, depression, difficulty concentrating fatigue (tiredness) headaches and neck pain. In this section, we look at the symptoms that are often associated with balance problems. Anxiety, panic attacks and depression You may find that your balance problems make you anxious, depressed, or give you panic attacks. This happens because of connections in the brain to the centres controlling emotion and thought processes. It may be that you are afraid that you will feel dizzy away from home and you may worry about not being able to cope. Or you may be concerned about what is causing the dizziness. These symptoms can be more difficult to cope with than the dizziness or unsteadiness itself and can slow down your recovery. Fatigue If you have balance problems, you have to concentrate a lot to keep your balance and carry on as normal. This can make you feel more tired. Headaches and neck pain When some people get dizzy, they hold their heads very still because they find that moving them around makes them dizzier. However, holding your head very still can cause tension in your neck muscles, which begin to ache, and the pain may then go on up into your Dizziness and balance problems, Action on Hearing Loss Information, May 2011 6

head. Headaches and neck pain can make people wrongly think their dizziness is caused by a neck problem. If you keep your head still, you will also slow down your recovery. What treatment is there for balance problems? Drugs Simple treatments can help with sudden, severe dizziness problems. You might be prescribed a short course of an anti-sickness drug to help your nausea and a drug to ease your dizziness, known as a vestibular sedative. If you re being sick and can t keep pills down, you may be prescribed drugs that can be absorbed in your mouth without swallowing, or you may be given suppositories (medicine you put up your bottom). You should only take the drugs prescribed for dizziness and sickness for a few days. If they are used for longer periods they may slow down your natural recovery. Getting better naturally Fortunately, the brain is very good at readjusting to balance problems and after a few days or several weeks most people feel better. This happens despite the fact that the balance information sent to your brain is still upset in some way. This recovery process is known as cerebral compensation. In the early stages of recovery, compensation is not always 100 per cent efficient. You may feel better on some days than on others. This does not mean that the original condition is coming back or that the problem is getting worse. If you are feeling extremely dizzy and sick, it can take from a few hours to two or three days to settle. Unsteady and slight dizzy feelings may take weeks to go away and eventually disappear. You will help your recovery if you carry out normal movements. This means that your brain will receive the important information it needs to adapt and make up for the balance upset. If your symptoms are still affecting you after a period of about six weeks, or you do not get better naturally, your doctor may refer you to a specialist. Specialist help and treatment for balance problems The specialist will examine your eye movements, inner ears and joint sensors. Special balance tests will find out how well you are using the information from your eyes, ears and joints to keep your balance. If you have joint problems, such as arthritis, your specialist will discuss treatment options. They will also recommend that you have any sight problems corrected. For example, you may need new glasses. Dizziness and balance problems, Action on Hearing Loss Information, May 2011 7

Balance retraining exercises If your balance problem is caused by damage to the inner ear, for example, from an infection or a head injury, balance retraining exercises may help you get better. These might be from a set list such as the Cawthorne-Cooksey exercises or you might be given exercises specifically for your problems. Exercises are usually taught by a physiotherapist or other professional with experience of helping people with balance problems. They will help you work out which movements you need to practise and you will be able to do them at your own pace. These exercises are designed to make you slightly dizzy, so that they help your brain to adapt and you will gradually find you don t feel so dizzy any more. You will need to do the exercises a couple of times each day for several weeks before they start to help. You should continue with your exercise programme until you can perform each exercise without feeling any balance symptoms. This may take six to nine months or even longer. Remember that everyone is different and there is no correct time that it will take to get better. These exercises are not suitable for some kinds of balance problems. If you have balance problems, you should always speak to your doctor before starting any kind of exercise. General exercise General exercise is important in helping people with balance problems get better. You should concentrate on whatever exercise you particularly enjoy. Cognitive behavioural therapy If you have had balance symptoms for a long time, you may well feel anxious, depressed or have panic attacks (see page 6). These symptoms need to be treated at the same time as the underlying cause of your balance problem. You may be offered cognitive behavioural therapy (CBT) as part of your therapy. CBT helps you take more control of your symptoms, especially in situations that make you anxious. Therapy is very effective in helping people develop a more normal lifestyle and tackle everyday tasks, which they may have come to avoid. This can help you recover more quickly. If you are depressed, you may need specific anti-depressant treatment and you should discuss this with your doctor. Surgery If you have severe dizziness that does not improve with drugs or other forms of treatment, you may be offered an operation. This is rarely necessary and is not a suitable option for most people. Your specialist will discuss surgery with you. Dizziness and balance problems, Action on Hearing Loss Information, May 2011 8

How long does it take to recover? Recovery takes time and there are many different factors that may slow down your recovery from balance problems. These include: being unable to move around a lot other illnesses, including a simple cold drugs that you might have been prescribed to deal with the severe symptoms, including anti-sickness and anti-dizziness drugs drugs that affect the central nervous system stressful situations sight problems joint problems. Your doctor will look at all these factors to make sure that you have the most effective recovery plan for your needs. Even when a balance problem is taking a very long time to improve there is almost always a rehabilitation programme that will help if you can stick with the exercises and the psychological support provided. If you stay positive, you will help your recovery. Balance symptoms can come back. This can happen even when you have totally recovered from previous balance problems. Be reassured, however, that you will be able to recover naturally again, usually much more rapidly than the first time. Again, keeping positive will help. Where can I get further information? Our helpline offers a wide range of information on many aspects of hearing loss. You can contact us for further copies of this factsheet and our full range of factsheets and leaflets see the cover page for contact details. Action on Hearing Loss Information, May 2011 The Royal National Institute for Deaf People. Registered Office: 19-23 Featherstone Street, London EC1Y 8SL. A company limited by guarantee registered in England and Wales No. 454169, Registered Charity Numbers 207720 (England and Wales) and SC038926 (Scotland). Dizziness and balance problems, Action on Hearing Loss Information, May 2011 9