Recent discoveries give doctors more tools to properly diagnose and treat this complex disorder

If you go to a doctor complaining of dizziness, chances are one in five that your condition will be misdiagnosed.

Even though dizziness is one of the most common medical problems — affecting up to 15 million Americans each year — it is also one of the most complex.

Problem: Many people downplay the significance of dizziness and end up suffering unnecessarily for months or even years. But when dizziness is chronic (occurring for more than three weeks), it could indicate a serious health problem, such as heart failure, a brain tumor, diabetes or a thyroid disorder.

If dizziness develops suddenly, it could be due to an inner-ear disorder or even signal an emergency such as a transient ischemic attack (TIA) — also known as a “ministroke” — or a full-blown, life-threatening stroke. (Dizziness that is due to a stroke typically is accompanied by other neurological symptoms, such as double vision, slurred speech or weakness or numbness in the face or limbs.)

Solution: Fairly simple, noninvasive therapies are now available for most forms of chronic dizziness, including some that were previously thought to be incurable or correctable only through surgery.

What you need to know…


Dizziness is a general term used to describe vertigo (a spinning sensation), light-headedness and/or imbalance. This wide variety of symptoms is due, in part, to the fact that dizziness can have many possible causes.

What your symptoms may mean…

  • Vertigo can be caused by inner-ear disorders such as Ménière’s disease, in which fluid buildup (due to an unknown cause) affects the inner-ear function and often is accompanied by tinnitus (ringing in the ears) and/or hearing loss in one or both ears… a viral or bacterial infection… allergies…or head trauma. Vertigo also can be caused by migraine… a TIA or stroke… a brain tumor… or certain medications.
  • If one of the underlying conditions mentioned above is causing the vertigo, it will generally go away when the condition is treated. If dizziness is caused by medication, such as aspirin or antihistamines, it usually stops when the drug is discontinued. However, the damage may be permanent if the dizziness is caused by medications, such as the cancer drug cisplatin (Platinol), that have a toxic effect on the inner ear.

    Improved therapy: The antibiotic gentamicin sulfate (Garamycin) can effectively treat Ménière’s disease, not through its antibacterial effects, but rather by destroying the nerves causing the vertigo while leaving other nerve cells intact. The drug is administered to the inner ear over several days while the patient’s hearing and balance are carefully monitored. In about half of cases, tinnitus symptoms are improved.

    Gentamicin therapy for Ménière’s disease has revolutionized treatment for this condition, which formerly required surgery that involved removal of the inner-ear system or the balance nerve. Caution: Gentamicin therapy has about a 20% risk for some hearing loss.

    Another common cause of vertigo is an inner-ear disorder known as benign paroxysmal positional vertigo (BPPV).

    What happens: Calcium carbonate crystals break loose from the part of the inner ear that senses gravity and move into the area that senses movement, sending the brain a distorted signal when a person changes the position of his/her head — such as while looking up, bending over, lying down or turning over in bed.

    This harmless condition usually can be alleviated by avoiding the head movements that trigger BPPV or by receiving a treatment known as the Epley maneuver, in which a doctor gently moves the patient’s head into specific positions that can dislodge the calcium crystals and move them back to where they belong.

    The Epley maneuver has an 85% success rate. Before this technique was adopted, the only cure for BPPV was open-ear surgery. Now such operations are rare.

  • Light-headedness (without vertigo) can be caused by a circulatory problem, such as high or low blood pressure… hardening of the carotid arteries leading to the brain… cardiac arrhythmia (heart rhythm disturbance) or heart failure… a metabolic problem such as hormonal imbalances (including those due to menopause) or low blood sugar (glucose)… diabetes… or a thyroid disorder such as hypothyroidism (underactive thyroid). Treating the underlying condition usually eliminates the feeling of light-headedness.
  • Exciting new discovery: A newly identified cause of dizziness, called a superior canal fistula, results from a hole in the superior semicircular canal (a balance receptor in the inner ear). The condition causes a vague feeling of light-headedness, imbalance and muffled hearing — especially after coughing or blowing one’s nose.

    Previously it was written off as being untreatable, but this disorder can now be identified via a magnetic resonance imaging (MRI) or computed tomography (CT) scan and cured by placing a tiny patch made of bone dust and soft tissue over the hole — an operation that often can be performed without an overnight stay in a hospital.

  • Imbalance may be severe enough to make a person stumble or even fall. It can be caused by an inner-ear disorder, such as vestibular neuritis (inflammation due to an infection in the inner ear)… a TIA or stroke… diabetic neuropathy (in which sensation is lost in the legs and feet)… acoustic neuroma (a tumor that can affect the balance nerve)… multiple sclerosis… or Parkinson’s disease.
  • When the condition that is causing imbalance is treated, the dizziness usually goes away. In other cases, imbalance can be due to age-related degeneration of the nervous system.

    Best therapy: Vestibular rehabilitation therapy to treat imbalance or non-vertigo dizziness. This technique involves working with a specially trained physical therapist to enhance neurological connections between the inner ear, the visual system and the legs. For example, the patient might practice walking down a hallway while looking right and left at pictures on the walls.

    Prior to the development of this technique, the only therapy for these disorders were drugs prescribed for dizziness, such as meclizine (Antivert), which often cause unpleasant side effects, including drowsiness and dry mouth.


    Many primary care doctors can start the diagnostic process by taking your medical history and referring you to the right specialist.

    Don’t forget to tell your doctor about: All the medications you take. Also be sure to mention any allergies you have and note exactly when symptoms occur.

    Depending on your symptoms, your physician may refer you to…

  • A cardiologist if circulatory problems are suspected.
  • A neurologist if the dizziness seems linked to a neurological problem, such as multiple sclerosis or Parkinson’s disease.
  • An otolaryngologist (ear, nose and throat, or ENT, specialist) if the inner ear is involved.
  • Best option: If your dizziness persists for 10 days or more, I recommend seeing a neurotologist (an ENT doctor specializing in inner-ear disorders) for a complete exam, including audiological and balance testing. An MRI or CT scan also may be performed.

    Because neurotologists are trained to understand all forms of balance disorders, these specialists are well-equipped to identify the underlying cause and treat you or refer you to a cardiologist or neurologist. To find a neurotologist near you, contact the American Academy of Otolaryngology — Head and Neck Surgery (703-836-4444,