University of Iowa Health Science Relations and
Bruce Gantz, MD, MS
Professor of Otolaryngology-Head & Neck Surgery
First Published: 2000
Last Revised: November 2004
Peer Review Status: Internally Peer Reviewed

Jimmy Stewart races up the belltower stairs of the old mission church in pursuit of Kim Novak. He stops to grab the railing and looks down the stairwell only to see the bottom appear to zoom far away and back again quickly, making him dizzy.

The scene is from Alfred Hitchcock's movie Vertigo and the sensation experienced by Jimmy Stewart's character might well have been vertigo. But a University of Iowa otolaryngologist explains that feelings of dizziness may or may not be vertigo, a sensation involved in a number of medical conditions.

When a patient comes to a physician with a complaint of "dizziness," the physician is faced with what can be a dizzying problem in diagnosis, says Dr. Bruce Gantz, a professor of otolaryngology in the Ul Carver College of Medicine.

"Dizziness is a vague symptom interpreted in a variety of ways," says Gantz, also a staff physician at Ul Hospitals and Clinics. "Diagnosing problems of dizziness depends greatly on the patient's medical history."

Vertigo is a sensation of movement or a feeling of turning, spinning, or falling, Gantz says. Vertigo, however, is not the same thing as disequilibrium. Patients with disequilibrium report feelings of lightheadedness, faintness, or wooziness, sometimes involving blackouts.

Many diseases or medical conditions have vertigo as an associated complaint, Gantz notes. Most of these have to do with problems of the inner ear or of the brain stem or cerebellum.

Disorders of the inner ear area tend to produce more dramatic or severe episodes of vertigo, Gantz explains. They can produce a severe whirling sensation accompanied by nausea and vomiting. Spells of vertigo associated with neurological or circulatory problems in the brain are usually less intense and produce a more subdued sensation of movement, which can continue for a month or longer, Gantz says.

The most common cause of vertigo, Gantz says, is motion sickness, such as that experienced in cars or in boats and ships in rough waters. Antimotion sickness drugs such as Dramamine can help prevent motion sickness but are usually ineffective after the symptoms begin. Reducing head movements can help fight motion sickness, as can finding a fixed, outside visual reference once the motion begins.

Benign paroxysmal positional vertigo (BPPV) is characterized by a brief spell of vertigo triggered by a change in position. The whirling sensation begins from one to five seconds after the position change, builds in intensity for several seconds and then decreases until it is gone. The treatment for BPPV is for the patient to repeat the offending position, Gantz says, until the spells of vertigo become less intense and finally go away. "You reprogram your nervous system so that it gets used to a different definition of normal," he says. Another strategy is called an Eppley maneuver. The objective of the maneuver is to reposition inner ear particles that are thought to induce the vertigo, he adds.

Meniere's disease is an inner ear disorder that produces spontaneous, intermittent spells of vertigo, ringing in one ear, hearing loss, and a feeling of fullness in the affected ear. The spells last between 20 minutes and 24 hours, with long periods in between. The cause of Meniere's disease is not known, but it can be controlled with medication and a low-salt diet. A small number of patients may require surgical internvention if medicine does not control the vertigo spells.

If you experience dizziness, your physician may refer you to an otolaryngologist or neurologist who can help pinpoint the type and origin of the dizziness.