Dizziness — More Than Just A Feeling

By Dr. Ernesto Fernandez

A broad spectrum

Dizziness is what is known as a vestibular disorder. A vestibular disorder is a condition that affects your body systems that control your sense of balance and sense of awareness of the environment. Epidemiological studies have reported that dizziness including vertigo affects over 20% of adults yearly and has reached up to 40% in those older than 40.

Different individuals can experience various forms of dizziness. You know, like the feeling after spinning one too many times on the merry-go-round, or after having one too many cocktails and then lying down. Unfortunately, many suffer from dizziness on a regular basis, without having done either of those things. In certain people being dizzy may feel like the world is spinning or rocking. In others it may feel like an inability to concentrate or even light headedness. In more severe cases of vertigo one may experience nausea and vomiting.

Due to the complexity of causes and effects of dizziness, it is important for doctors to not give the same cookie cutter diagnosis to all. Dizziness is not just some insignificant feeling. It can hinder the level of independence in an individual. Something as routine as driving their car becomes a difficult and dangerous task. It can take a toll on the overall quality of life, affecting time with family or favorite hobbies. Imagine trying to return a serve in tennis while the court is spinning around you! More important, it may dramatically increase the risk of falling and becoming seriously injured.

It’s all about the brain

Dizziness can be more accurately diagnosed and treated with a better understanding of the sensory integration between three vital aspects of the body and the brain.

1. The inner ear (vestibular apparatus)
2. The eyes
3. The proprioceptive system (muscle, joint, skin)

Dizziness can manifest as a primary condition such as positional vertigo or Meniere’s disease, or as a secondary condition due to head injuries, medications, and stroke.

The most common form of dizziness diagnosed is caused by problems in the inner ear also known as Benign Paroxysmal Positional Vertigo (BPPV). In brief; this type is caused by a disruption in the sensory organs in the inner ear and its ability to tell the brain where you are in the environment. This is normally due to a trauma, abnormal positional change, or viral infection. This piece of anatomy in the inner ear is called the vestibular apparatus and communicates with the brain through the vestibulocochlear nerve. Who knew the ears were responsible for much more than just hearing. Although, our spouses may believe our anatomy can’t even get that part right.

Other conditions, like a head injury or concussion for example, may affect the way your eyes move, fixate, and track targets in the environment. If your eyes are unable to register the appropriate and accurate information from the environment, your brain receives faulty signals and interprets it as a loss of balance. This creates a sensory mismatch between the eyes and the brain and can result in dizziness.

Furthermore, the proprioceptive system plays a critical role in the diagnosis and treatment of dizziness. The proprioceptive system includes receptors within the joints, muscles, tendons, and skin that communicate with the central nervous system to tell it where it is in space. Areas of the body with the highest concentration of these receptors include the hands, feet, and upper neck. A study done on the density of these receptors in specific muscles found a range of 190–242 muscle spindles per gram of tissue in the suboccipital muscles. These are tiny muscles of the upper neck that attach to the spine and skull. That is a whole lot of information coming from just your neck to tell your brain what position you’re in! Acquired or degenerative conditions of the neck like trauma, muscle spasms, and chronic postural abnormalities can cause structural shifts of the head and neck as well as tension in those joints, ligaments, and muscles. These shifts manifest as postural distortions away from the center of gravity and interferes with the important job those receptors carry. This creates another sensory mismatch between the proprioceptive tissues and the brain.

A thorough investigation of each of these body symptoms should be done by doctors before making an accurate diagnosis of dizziness or vertigo. From there, different treatment strategies can be implemented to address the specific anatomy wreaking havoc in these patients’ lives. In Part II of this dizziness series we will discuss specific treatment strategies that may offer hope to those who continue to suffer from dizziness and can’t seem to find answers.

Sources:

[1]https://www.ncbi.nlm.nih.gov/pubmed/27638063

[1]https://emedicine.medscape.com/article/2149881-overview

[2]https://www.ncbi.nlm.nih.gov/pubmed/22999306

[3]https://pdfs.semanticscholar.org/64bb/b1b73041418d1caefcd9b9a0273501743242.pdf

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