What is Dizziness?

Dizziness is not a disease itself but a symptom that can occur due to various reasons. Patients may describe it as imbalance, lightheadedness, blurred vision, or mild to severe spinning sensations. Depending on many different factors, complaints can range from slight imbalance to very intense spinning sensations. Dizziness can occur as the only complaint or alongside hearing loss and/or tinnitus.

The ear has three sections: the outer, middle, and inner ear. The structures of the outer and middle ear are responsible for collecting sound waves, amplifying them, and transmitting them to the fluid of the inner ear. The hearing and balance centers in the inner ear are located within the cochlea and are filled with inner ear fluids (endolymph and perilymph).

The sensitive nerve endings and nerve cells of the hearing and balance nerves are in constant contact with these fluids. Sound waves reaching the inner ear are transmitted here through the inner ear fluids, stimulating the nerve endings and causing the formation of electrical impulses. This impulse is transmitted to the brain via the auditory nerve, resulting in hearing.

Maintaining Balance

The balance system consists of one center and three different sensory systems. The brain acts as a center that collects and processes information related to body position continuously transmitted from the eyes, balance centers in the inner ear, and muscles, joints, and tendons, and is responsible for maintaining balance. These three systems work independently of each other and function together to preserve the body’s balance.

The eyes provide the brain with information about the body’s position relative to the environment by transmitting images from the surroundings, while signals from muscles, tendons, and joints provide information about the position of the head relative to the body.

The balance system of the inner ear consists of semicircular canals that detect rotational movements and structures called vestibules that detect linear movements. Together, these two fluid-filled sections are referred to as the „labyrinth.” When the head moves, the fluids in the inner ear also move, and different nerve endings send signals to the brain indicating the movement of the head based on the shape and direction of this movement.

Balance organs located in the labyrinths on both sides continuously produce perfectly symmetrical signals to each other. Signals related to head rotation originate from the semicircular canals, while linear movements up and down create signals in the vestibule. Calcium carbonate crystals attached to the cells in the balance centers of the vestibule change their position based on gravity, allowing the detection of the direction and intensity of head movement.

When a balance center in one inner ear malfunctions, the symmetry of signals sent to the brain is disrupted, creating a sensation of imbalance while signals sent from the brain to the eye muscles cause involuntary eye movements (nystagmus). These eye movements create the perception in the patient that their surroundings or themselves are spinning.

Information from all balance centers is combined with corrective reflexes in the cerebellum and voluntary responses in the brain to send signals to the body muscles to perform movements aimed at maintaining balance.

The balance centers located in the brain, cerebellum, and brainstem adapt over time to asymmetrical signals from the inner ear, making them imperceptible. Due to this property, it is possible to eliminate or prevent imbalance through appropriate exercises in some diseases that cause dizziness or in normal conditions that might create imbalance during certain sports activities.

Types of Dizziness

Problems in any of the centers involved in maintaining balance can lead to symptoms such as dizziness, imbalance, and lightheadedness.

Inner Ear Diseases:

Balance disorders originating from the inner ear occur due to changes in the pressure of inner ear fluids or directly affecting the balance centers and/or balance nerves.

The sensitive ends of the hearing and balance nerves terminate in different parts of the balance and hearing centers within the inner ear that contain the same fluid (endolymph). Circulation, pressure, or changes in the content of this fluid stimulate the nerve endings, causing acute, chronic, or recurrent dizziness, with or without accompanying hearing complaints.

Similar complaints also occur in other problems that disrupt blood circulation in the inner ear or affect the balance nerves.

Brain-Related Diseases:

These occur as a result of impaired ability of the brain to interpret signals from the balance organs and generate appropriate responses. Hearing loss and/or tinnitus may also be observed. These problems can result from advanced age, vascular blockages or spasms, allergic or metabolic diseases, and both benign and malignant tumors.

Excessive stress, panic attacks, depression, and tension can also cause similar complaints. In such cases, along with imbalance, patients may also feel fullness and pressure in the head and ears.

Neck Diseases:

Imbalance can result from disruptions in position information signals sent from neck muscles to the balance centers in the brainstem, playing a crucial role in maintaining balance. Traumas, joint diseases in the cervical vertebrae, or pressure on neck nerves can cause spasms in the neck muscles, leading to abnormalities in position signals sent from the neck to the brain and resulting in balance disorders.

Vision Disorders:

Involuntary eye movements caused by vision defects or diseases of the eye muscles lead to disrupted signals from the eyes to the balance centers. When these signals are not in sync with signals from other balance-detecting structures, signal discrepancies cause dizziness. During this time, other inappropriate stimuli in the nervous system can lead to symptoms such as sweating, nausea, and vomiting.

Findings in Inner Ear-Related Dizziness

Diseases affecting the functions of the inner ear or its connections with the central nervous system cause symptoms such as dizziness, hearing loss, and tinnitus. These symptoms can occur alone or together, depending on the affected functions.

Dizziness can manifest as a very intense spinning sensation, imbalance, or lightheadedness. Complaints can be continuous or intermittent and are usually aggravated by head movements. Nausea and vomiting are often observed, but loss of consciousness does not occur in inner ear-related dizziness.

The main causes of inner ear dysfunction include infections, disrupted blood circulation, changes in inner ear fluid pressure, nerve inflammations, traumas, medications, or tumors. The most important elements in diagnosis are a detailed history and physical examination.

Most patients need to undergo hearing and balance tests. In cases where a diagnosis cannot be made at this stage, radiological evaluations, hormonal and metabolic disease tests, allergy tests, and neurological evaluations may also be necessary.

These evaluations primarily determine whether there is an underlying serious or life-threatening pathology. The results of these tests assist in selecting appropriate medical or surgical treatments following the diagnosis.

Diseases Related to Blood Circulation

Vascular spasms, blockages, ruptures, and bleeding affecting the balance organs of the inner ear can cause dizziness, hearing loss, and tinnitus. Dizziness caused by vascular spasms usually begins suddenly and is recurrent in nature. Nerve fatigue, emotional stress, certain medications, nicotine, and caffeine can cause vascular spasms.

When vascular blockages develop slowly along with aging and arterial stiffness, the structures of the inner ear can gradually adapt to the reduced blood circulation. Sometimes, patients may feel a constant sense of imbalance, and sudden standing up or rapid movements can exacerbate the symptoms.

In cases of sudden complete blockages, severe dizziness is usually accompanied by nausea and vomiting.

Severe complaints decrease within a few days and disappear within a few weeks as the healthy ear functions take over. In cases of vascular ruptures caused by high blood pressure or trauma, sudden complete blockage-like symptoms are observed.
**Treatment:** In cases of dizziness caused by vascular diseases, vasodilators are used along with medications that alleviate the spinning sensation in the early stages of treatment.

Additionally, calming medications that suppress the balance centers can be used in the early stages to reduce complaints. Substances with vasoconstrictive properties, such as nicotine and caffeine, should be avoided. Calming medications that suppress the functions of the inner ear should not be used long-term to avoid delaying the functions of the healthy ear.

Positional Dizziness

The most common cause of dizziness in young and middle-aged individuals is benign positional vertigo (Benign Paroxysmal Positional Vertigo – BPPV). Information about this disease is provided under the heading „Positional Dizziness.”

Age-Related Balance Loss

The most important factor in balance problems associated with aging is the disruption of circulation in the capillary blood vessels that supply the balance centers and balance nerves. This issue rarely causes severe complaints. Reduced blood circulation in the vestibule and impaired function of balance organs can lead to the displacement of crystals in the inner ear, resulting in positional dizziness.

Balance exercises are generally beneficial for this group of patients. With aging, vascular reflexes slow down, especially in patients treated for high blood pressure, which can cause balance loss during sudden movements from bed.

For these individuals, this often means dependence on the bed. Therefore, posturography is used as the „gold standard” in overcoming balance-related problems. People suffering from dizziness and balance disorders around the world have started establishing recreational clubs and non-governmental organizations. The main reason for this need is that this group of diseases isolates the person from social life and leads to professional failures.

Especially in elderly patients, traumas caused by balance disorders can lead to life-threatening situations. In this context, the posturography technique developed over the past 10 years has revolutionized the diagnosis of balance disorders (identifying which system is affected) and the balance rehabilitation of these patients.

Treatment of Meniere’s Disease:

Treatment can involve medical and surgical methods. The basic principle is to ensure the circulation of inner ear fluids and prevent an increase in pressure. If these results cannot be achieved, destructive methods such as eliminating the balance centers of the inner ear through medical or surgical means, or cutting the balance nerve, may be applied.

Most patients can alleviate their symptoms through medical treatment.

Treatment Content;

  • Probable cause of the disease
  • Frequency of symptoms
  • Severity of symptoms
  • Determined based on the degree to which the patient is affected by the disease.

Basic Principles;

  • Regulation of inner ear fluid circulation
  • Reduction of inner ear fluid pressure
  • Suppression of immunological and/or allergic reactions in the inner ear
  • Medications used in treatment include:
  • Vasodilators
  • Diuretics
  • Steroids
  • Calming medications

In special cases, medications that suppress the immune system or medications that destroy the functions of the balance centers can be used. When desired results are not achieved with medical (pharmaceutical) treatments, surgical treatment options come into play. There are two groups of surgical approaches: those that preserve and those that do not preserve hearing and balance functions. Surgeries that preserve hearing are preferred as long as hearing is effective in patients.

In recent years, intra-aural steroid injections have become increasingly common, providing good results while avoiding the serious side effects of steroids affecting the entire body.

Despite using methods to preserve hearing, if complaints cannot be controlled, methods aimed at completely eliminating the balance centers of the inner ear are used. As a result, the healthy balance center on the opposite side can quickly take over all functions nearly to normal.

Low-Level Laser Therapies (LLLT)

LLLT is successfully applied in all pathologies affecting the sensitive hearing and balance organs of the inner ear, causing damage to nerve cells, including in Meniere’s disease.

The basic principle of this method is to increase the regenerative and healing potential of damaged cells and tissues by irradiating them with lasers of specific wavelengths. Detailed information about this treatment method is provided under the heading „Low-Level Laser Therapies.”

Although this method can yield very good results in treatment-resistant cases, it is not considered a definitive treatment method for all types of dizziness.