One of the most common conditions I see in the office is vertigo. Most patients don't call it that but instead say they feel "dizzy" or "off-balance" or the "room is spinning". These symptoms can come on suddenly or be present when you wake up in the morning. They can be subtle or profound with vomiting. Most of the time this can be diagnosed as benign positional vertigo - BPV.
BPV occurs when small microscopic carbonate crystals (canaliths) get dislodged from the inner ear and disrupt the functioning of the inner ear canals. The room spins with head movement and quiets down when the head is at rest. Sometimes nausea and vomiting occur with sudden movement.
If ear pain or loss of hearing is present with severe vertigo, it could be an inner ear infection or virus causing vestibular neuritis or labyrinthitis. The symptoms are usually quite severe and neither MRI or CT scans are helpful in diagnosis. If vestibular neuritis is diagnosed, corticosteroids are often used to decrease inflammation.
Other more serious problems can also cause a feeling of being off balance or the room spinning. Any type of facial drooping, weakness of arms or legs on one side of the body or severe headache associated with balance problems could be a stroke and needs IMMEDIATE attention.
Benign positional vertigo (BPV), the most common cause of vertigo, will often be self limited and resolve after a few days. But those can be miserable days for many patients. Antihistamines like Meclizine, Benadryl, or dramamine can help with the symptoms. But they are very sedating for many people. I have been successful in resolving symptoms by using the Epley maneuver, which repositions the crystals into the utricle of the ear where they belong. This can safely be done at home and may take a couple of tries for it to work.
Other causes of dizziness can be dehydration, medications, hypoglycemia, or viruses. Vertigo is a specific symptom and can be helped once the diagnosis is made.