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As the World Turns: Dizziness Explained by a JFK Specialist

JFK Dr. Kramer

When something unbelievable happens, it may make your head spin. But if that spinning is happening more often than not, Phillip Kramer, MD, director of the Vestibular Laboratory at the JFK Neuroscience Institute, suggests it may be time to investigate the true cause.

Dr. Kramer, one of few physicians in the nation to be trained in Otoneurology, recently discussed with NJ.com the causes of dizziness, and when someone should seek medical intervention. 

Q. What is an Otoneurologist?
A. An Otoneurologist is a physician who concentrates on the ear/brain relationship with respect to dizziness. The ear and brain work together to produce and process information we interpret as sound, as well as our sense of position and balance. When that interface is disrupted, a delicate balance becomes compromised, resulting in conditions like dizziness.

Q. What is dizziness?
A. Dizziness actually falls into four categories. The first, vertigo, is a feeling of spinning or that the environment around you is spinning. This can be caused by activities like standing still after spinning in circles for a short period of time, which is normal. But when vertigo occurs when you are perfectly still or after movements like rolling over in bed, that’s not normal. Vertigo is often the result of an inner ear problem, like Meniere's disease, or vestibular neuritis (a virus that results in inflammation of the nerves of the inner ear). Vertigo will sometimes go away on its own as the body adapts to changes in the inner ear. Or other treatments may be prescribed that focus on eliminating underlying conditions. 

The second type of dizziness is known as lightheadedness. This is the sensation you get when you stand up too quickly from a seated position. It is caused by decreased blood flow to the brain that results from sudden and abrupt movement. Having a cold or flu, altitude sickness, and even some medications can cause lightheadedness.

Imbalance is the third type of dizziness, and is very much what it sounds like – an unsteadiness or loss of balance. Individuals may stumble or even fall at times. 

And the fourth type of dizziness falls into the “other” category. These are the symptoms that mimic many of those in the first three categories, but are very hard to diagnose because the patient isn’t able to accurately describe their dizziness. This presents a greater challenge in determining the root cause of the condition.

Q. Are there other conditions associated with dizziness?
A. Less common causes of dizziness include head or neck injuries, ear damage from certain medications, migraine headaches, or brain problems including tumor and stroke. Individuals may experience ringing in the ears, changes in hearing or vision or even an inability to concentrate.

Q. How are dizziness and underlying causes diagnosed?
A. The first source is obviously listening to the patient’s own words. We begin with a discussion about what kind of symptoms are occurring. Then we discuss duration. How long does the dizziness last? It is important to understand exactly how often someone is dizzy. Saying “I am constantly dizzy” implies that you are dizzy all the time. And in extreme cases, this may be true. But dizziness usually has a regular, measurable interval -- it may be seconds, minutes, hours, or even days.

Next is a physical exam, which primarily focuses on the eyes and their movements. Eye movement influences our balance system, so we will look for unusual eye movements while performing a series of tests. These tests stimulate the balance system, allowing us to see eye movement reactions. We can do this using a rotating chair that spins the patient or by introducing warm and cold temperatures into the ear, which causes fluid in the ear to move.

Q. What are some treatments for dizziness?
A. Depending on the underlying cause, there are a variety of ways to control or eliminate dizziness. For someone with Meniere's disease, it may be introducing the use of a diuretic or switching to a low-salt dietary. Migraines can be controlled with diet changes as well, in addition to the use of supplements or medications. For imbalance, physical therapy is often used to retrain the patient’s balance system.

Q. When should you seek medical advice for dizziness?
A. Because there are a variety of causes, it is best to consult a physician at the onset of recurring symptoms. If you have a short wait before seeing the doctor, keep a journal of when you are experiencing symptoms. Be sure to note particular triggers, including foods and activities you may be participating in. And be sure to bring previous tests related to the condition, including hearing tests and Magnetic Resonance Imaging (MRI) reports.