"Apart from strokes, which occasionally can present with dizziness, most of the time, the reasons for dizziness are relatively mild," Fattal said. "Migraine headaches are a common cause of dizziness. Other common causes are viral infections, Mèniére's disease, which affects the inner ear, and a relatively common condition primarily in the elderly, known as benign paroxysmal positional vertigo, often referred to as loose crystals."

In this condition, tiny crystals normally located in the inner ear, break loose on their own and wind up in the ear canal fluid, causing dizziness and imbalance. Other conditions that lead to loose crystals are trauma, ear infection, or prolonged putting of head way back such as when in a beauty salon or in dentistry chair. Treatment consists of placing the patient in bed and turning them in a certain way that puts the stones back into their proper place, according to Fattal.

"Usually dizziness will disappear with proper treatment," she said. "Some people go for years with a dizziness problem because they weren't treated properly or were diagnosed incorrectly. The main milestone for treatment of most causes of dizziness and imbalance is balance therapy, which includes exercises to improve balance."

Fattal explained that a person's balance system is located in the ears, which send signals to an integrating center in the brain.

"If there is an imbalance in the signals because one of the ears is malfunctioning, dizziness will result. In time, however, the brain will compensate for the disorder and the dizziness will usually go away."

Sometimes, however, the dizziness does persist. "One reason for this is a recurrent cause such as a migraine headache. another reason is medications, such as meclizine. If patients take a medication to decrease the dizziness, this often deters the ability of the brain to compensate. Also, if patients become inactive because of their dizziness, they also tend to lose the ability to compensate," she said.

That's why balance therapy is a very important treatment. Fattal compared balance therapy to physical therapy, using a broken arm as an example. She explained, "If you break an arm and put it in a cast for six weeks it comes out shrunken. The only way you can get it back to work is to exercise it. It's the same thing with the signals from the ear. Your balance and dizziness will become worse and worse if you don't exercise them."

Fattal says the risk for dizziness increases with age because of three factors: a higher tendency for loose crystals; deteriorating hearing, vision, and foot sensations; and a less stable vestibular system, which involves the inner ear and its connection to the brain. She recommends that patients visit with their health care provider any time they become dizzy without apparent cause.

For more information:

Balance Disorders Clinic

Deema Fattal, M.D.

Department of Otolaryngology

Department of Neurology