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Complaints of dizziness or vertigo are common among patients visiting family doctors and emergency rooms. In recent years, methods for diagnosing dizziness or vertigo have improved and referrals for vestibular physical therapy have increased, both for dizziness accompanied by nausea and dizziness not accompanied by nausea.
Complaints of dizziness are very common in the population. About 5% of applicants to a general physician complain of dizziness, while among ear-nose and throat specialists and neurologists, the incidence of dizziness is about 20%. Dizziness ranks third among the reasons people go to the emergency room.
Problems with different body systems can cause a feeling of dizziness or vertigo, with or without nausea. Dizziness may originate from heart problems, neurological problems or tumors. It can also be cause by underlying anxiety, but the source of most dizziness is vestibular (caused by a problem with the inner ear).
painting: Einat schneider
The inner ear is located in the temporal bone of the skull. It consists of three semi-circular canals and two compartments containing crystals. Vestibular hair cells are located at the end of the canals. They are sensitive to angular acceleration and deceleration. The crystals are sensitive to vertical acceleration and deceleration and to gravity. The hair cells and the crystals work together to help us to be aware of our head movements in space. One of the functions of the inner ear is to stabilize the gaze during head movements.
Dizziness is often expressed as a feeling of heaviness in the head, a feeling of floating in the air or unsteadiness. Sometimes dizziness is accompanied by stumbling and falling. Dizziness can be accompanied by involuntary eye movements that indicate impairment in the vestibularocular reflex between the ear and the eye. Sometimes, dizziness is accompanied by mild to severe anxiety that could interfere with a person’s daily activities and could lead to avoidance behavior to the point of depression. Sometimes dizziness begins with a feeling of pressure in the neck or head , often in the form of a stabbing pain that progresses or moves from point to point. The neck and upper back may be involved in this kind of dizziness. People describe situations where the dizziness gets worse after staring at a computer, others describe the dizziness with words like “things are moving in front of my eyes” or “I have to hold my head in my hands to see in a stable way.” There are people who feel a worsening of dizziness when walking, they avoid going out alone and are afraid to look sideways in case they fall. Others say that walking helps them , but when they stop, their familiar feeling of imbalance worsens.
Vertigo is a feeling of an illusion of movement Benign Paroxysmal Positional Vertigo (BPPV) or true vertigo are common in this group. This type of dizziness is known for its relationship to the crystals in the inner ear, that fall out of their correct anatomical position. People with vertigo complain that “the room is spinning” and they feel dizzy especially when standing up or lying down, while bowing or lifting the head. The feeling of vertigo is similar to that of being on a carousel that continues to spin without stopping. People who experience vertigo once are at greater risk to experience dizziness and vertigo again. In future attacks, feelings of dizziness might be slightly different. It is important to check again that they are talking about vertigo and not another type of dizziness.
It is important to identify the specific symptoms that characterize the dizziness. First , we examine what type you have — dizziness or vertigo? Then within the types, we evaluate which type of dizziness characterizes your problem. We will examine the relationship to nausea and to anxiety and whether vestibular physical therapy may help. It is advisable to contact your family doctor, a neurologist or ENT specialist to rule out other diseases and to ensure that the problem arises from the inner ear. When someone comes to the clinic complaining of dizziness, a comprehensive examination is conducted in tandem with an evaluation of involuntary eye movements and an attempt to track the problem leading to incorrect responses in the vestibular system. The examination includes neurological evaluation tests , testing the somatosensory , visual and vestibular systems and their integration. Dizziness may be an expression of a neck problem, so examination includes palpation, examination of active and passive movement of the vertebrae, muscles and the fascia. Many of those who suffer from dizziness develop anxiety, and sometimes this remains the primary diagnosis of the problem , even if anxiety is secondary to the dizziness. Treatment with the Zur Balance Method helps eliminate dizziness in more than 90% of patients. The treatment also improves confidence and balance and reduces anxiety.
There are over a dozen types of dizziness and vertigo, and each one has a different treatment. Sometimes a person suffers from two types of dizziness, and the treatment is more complex. Several types of dizziness can be treated with medication combined with therapy in the first days, whereas with other types, drug treatment is not effective at all. In those cases, patients are treated with vestibular physical therapy, which includes specific exercises that encourage compensatory mechanisms, adaptability and coordination between the various sensory systems (vestibular, visual and somatosensory). Practice is necessary to rehabilitate the system and can enhance the brain’s ability in a relatively short time – if the exercises are adapted to the specific type of dizziness. Therefore, proper diagnosis of the dizziness from a dozen different types may help eliminate dizziness and vertigo , reduce nausea considerably , decrease anxiety, eliminate headaches that emanate from the neck to the eye or sides of the head (those that exert pressure like a helmet), improve balance and even prevent the next fall.
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