A brief outline of causes of dizziness, imbalance and hearing
Timothy C. Hain,
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- Vertigo (spinning or other illusion of movement such as tilting, floating, or
impulsion). Vertigo is generally caused by an inner ear disturbance, but can also be cause
by a central (brain) disturbance.
- Lightheaded sensation, impending faint. Lightheadedness is generally
caused by low blood pressure, and may be associated with orthostatic
hypotension or syncope.
- Confusion. Generally caused by metabolic (blood chemistry) disturbances.
- Spatial discomfort. This category encompasses all types of dizziness not specifically
covered by the above, and is especially applicable to dizziness caused by psychiatric
- Imbalance: Unsteadiness leading to increased risk of fall. Imbalance commonly
accompanies dizziness, but can also be independant. There are a large numberof individual causes of imbalance.
- Drop attack: unprovoked fall without loss
- Hearing disorder: Hearing disorders commonly
accompany dizziness caused by ear disorders. They are also common in individuals
over the age of 50, with any type of dizziness.
Overview: These words are often used in a general way and cover a large number of
categories of disease. One must be more specific in order to narrow down to a smaller
potential subset of disorders.
Causes of Dizziness.
- Otologic (inner ear related, about 50% of all dizziness)
- Central or Neurologic (brain related, 5% of dizziness in general)
- Medical (5%)
- Psychological (15%)
- anxiety and panic disorder
- somatization syndrome
- Unknown causes or diagnoses so vague as to be meaningless (25%)
- Multisensory disequilibrium of the elderly
- post-traumatic dizziness
- psychogenic dizziness (when diagnosis is simply one of exclusion)
Overview: The proportion of dizziness attributed to these categories varies
considerably, but roughly 50% of all dizziness is caused by inner ear disturbances, about
5% by medical and neurological problems each, about 15% by psychological disturbances, and
the remainder of patients (about 25%) the diagnosis is essentially unknown.
- Sensory disturbances (loss of position sense, vestibular sense, visual sensation, or a
combination of all three). Any source of dizziness can cause imbalance.
- Central, brain disturbances, including the same causes of central dizziness listed
- Peripheral (weakness, such as caused by muscle disease), or spinal cord
Overview: In dizzy patients, most imbalance is caused by inner ear disturbances. When
dizziness is not present, most imbalance is central. In older patients, multisensory
disturbances are the most common. In younger patients, central problems are more common.
- Conductive type (mechanical)
- ear wax
- ear drum perforation
- middle ear infection or fluid
- inner ear bone (ossicle) disturbance, such as otosclerosis
- Sensorineural type (hair cells or nerve)
- Central type (brain)
- auditory cortex
- Psychological (malingering)
Overview: The great majority of hearing disturbances are sensorineural, either
associated with aging or noise exposure. Conductive hearing losses can generally be fixed
by surgery. Central hearing losses are very rare. Psychological hearing losses are also
- Hain TC, Herdman SJ. Dizziness in the Elderly. (Ed Sage JI, Mark MH) Practical
Neurology of the Elderly. Marcel Dekker Pub, New York, NY 1996.
- Hain TC. Vertigo and Disequilibrium. In: Current Treatment in Neurologic
Disease, 5th edn, Eds. R. Johnson and J. Griffin, p 8-12, 1997, also In: Current
Therapy in Adult Medicine, 4th edn, Kassirir JP and Greene HL, Mosby, p 1358-1361,
- Hain TC. Approach to the Vertigo Patient In Practical
Neurology, Jose Biller (Editor), 1997
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