Dizziness is a common symptom that nearly anyone can experience. Approximately 30% of Korea's population is known to experience dizziness at least once in their lifetime. Lightheadedness from fatigue or sleep deprivation, or temporary symptoms such as motion sickness, are closer to transient, physiological dizziness. By contrast, the sensation that the world is spinning even while still, the feeling of being about to fall to one side, or staggering when unable to walk properly may indicate pathological dizziness.
Pathological dizziness has a wide range of causes. It can stem from problems in the balance organs of the inner ear, signal a brain disorder, or manifest as chronic dizziness driven by anxiety and stress. That is why identifying the cause is the first gateway to treatment.
On Seoul Economic TV's "Now, Master Doctor" at 9 p.m. on the 16th, Professor Seo Jae-hyun of the Tinnitus, Hearing Loss and Dizziness Center at Catholic University of Korea Seoul St. Mary's Hospital appears to explain the major causes of dizziness, treatment methods, and warning signs that require an immediate hospital visit.
◇More Than Half of Dizziness Cases Stem from 'Ear' Problems, with BPPV Most Common
The causes of pathological dizziness fall into three broad categories. The first is a problem with the balance organ in the inner ear, the second is dysfunction in the brain's balance control, and the third is dizziness caused by psychological factors and stress. Among these, the most common cause is the "ear." Five to six out of every 10 patients with pathological dizziness suffer from problems with the vestibular organ in the inner ear. Dizziness caused by brain disease accounts for about 10%, while the remainder is explained as psychogenic dizziness related to anxiety, depression, and stress. Representative ear-related conditions include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease.
The most common dizziness disorder is BPPV. Otoliths play a role in detecting the body's position and the direction of gravity. The problem arises when some otoliths become dislodged from their normal location and enter the semicircular canals. The semicircular canals are organs that detect the rotation of the head, and when otoliths enter them, the rotation is perceived as a much stronger stimulus than the actual movement, triggering severe dizziness.
A defining feature of BPPV is that severe spinning dizziness occurs suddenly in specific postures. "Patients feel severely dizzy when turning their head or getting up from a lying position, but feel relatively fine when staying still," Professor Seo said. "Dizziness usually appears briefly, within five minutes, and is characterized by recurring with the same posture."
About 90% of BPPV cases occur without any specific reason. However, calcium deficiency, vitamin D deficiency, osteoporosis, aging, and head trauma can influence the dislodging of otoliths. The reason it is more common in women, particularly postmenopausal women, is also related to bone health.
Treatment is performed through canalith repositioning maneuvers, which return the dislodged otoliths to their original location. The treatment posture varies depending on which ear and which semicircular canal the otoliths have entered. The success rate is generally known to be 80% to 90%. However, the recurrence rate is around 20% to 30%, meaning it can recur even after treatment. "Some health functional foods have recently been advertised as 'attaching otoliths,' but there is no medication that directly treats BPPV," Professor Seo said. "Calcium or vitamin D supplementation may help prevent some recurrence, but it should not be understood as a treatment."
◇Vestibular Neuritis: Dizziness Even at Rest
Vestibular neuritis is a condition in which inflammation occurs in the balance nerve inside the ear. The cause is known to be related to viral infection. "If BPPV is dizziness like 'guerrilla warfare' that recurs briefly when changing posture, vestibular neuritis is closer to a 'storm of dizziness' that lasts for several days," Professor Seo said. "Many patients complain that the ceiling spins even while lying still, and that their head feels like it is spinning even with their eyes closed."
In the acute phase, drug treatment such as nerve sedatives that reduce dizziness is helpful. However, after the severe dizziness has passed, vestibular rehabilitation exercises are important. This treatment restores diminished vestibular function by repeatedly moving the eyes, head, and posture. Without sufficient rehabilitation, it can lead to chronic dizziness or psychogenic dizziness.
◇Meniere's Disease: Dizziness Accompanied by Hearing Loss, Tinnitus, and Ear Fullness
Meniere's disease is characterized by the recurrence of dizziness along with hearing loss, tinnitus, and ear fullness. Inside the ear are the cochlea, responsible for hearing, and the vestibular organ, responsible for balance. Meniere's disease is explained as a condition in which a problem with the regulation of lymph fluid inside causes it to swell like a water balloon and stimulate the nerves. As a result, hearing declines, the ear feels stuffy, ringing tinnitus develops, and dizziness recurs.
The first step in treatment is improving lifestyle habits. It is important to reduce salt intake, get enough sleep, and avoid stress, excessive alcohol, and caffeine. If necessary, drug treatment such as diuretics or blood circulation enhancers is administered. With lifestyle improvements and drug treatment, a significant number of patients are stably managed. However, when dizziness attacks recur and hearing continues to deteriorate even after more than six months of treatment, injection therapy or surgery may be considered.
◇Brain Problems Suspected When Dizziness Is Accompanied by Paralysis, Double Vision, or Speech Disorders
The most dangerous case of dizziness is when it is a signal of brain disease. Dizziness caused by brain problems can also appear as a spinning sensation or a feeling of tilting to one side, similar to dizziness from the ear. It is not easy to distinguish based on the dizziness pattern alone. "When it is a brain problem, accompanying symptoms appear along with the dizziness," Professor Seo said. "If speech becomes slurred, sensation declines or paralysis occurs in one arm or leg, double vision develops, or severe headache accompanies the dizziness, the possibility of brain disease such as cerebral infarction should be suspected."
In such cases, dizziness should not be dismissed as simple dizziness. Patients should immediately go to the emergency room for neurological examinations and imaging tests such as MRI. Missing the treatment window for brain problems can lead to lasting aftereffects or even endanger life.
◇When Tests Are Normal but Dizziness Persists, the Problem May Be Psychological
Recently, psychogenic dizziness has also been treated as an important category. This does not mean that it simply arises from stress without any underlying problem. After experiencing severe dizziness such as BPPV or vestibular neuritis, the lingering fear and anxiety often lead to chronic dizziness. While tests show no major abnormalities, patients continue to feel dizzy. In such cases, it is important to explain the test results to patients and help them understand that it is not a dangerous condition. Vestibular rehabilitation exercises, cognitive behavioral therapy, and, if necessary, drug treatment such as anti-anxiety medications can be helpful. With accurate diagnosis and treatment, many patients with psychogenic dizziness can also recover significantly.
◇Managing Sleep, Hydration, and Bone Health to Prevent Dizziness
Reducing the recurrence of dizziness requires disease-specific management. Since BPPV is related to bone health, calcium and vitamin D deficiencies should be checked, and outdoor activities such as walking in the sunlight are helpful. It is also good to avoid the habit of lying on only one side for long periods.
For Meniere's disease, salt intake should be reduced, and excessive drinking and caffeine consumption should be avoided. Sleep deprivation and stress can also be aggravating factors. As vestibular neuritis is related to immunity, sufficient sleep, hydration, and appropriate activity are important. In particular, the habit of drinking enough water helps maintain the electrolyte balance inside the ear.
"Dizziness is not just a simple discomfort but can be an SOS signal sent by the body," Professor Seo said. "It can be an abnormality in the ear's balance organ, an early signal of brain disease, or the result of mental tension manifesting in the body, so it is important not to take dizziness lightly and to find the exact cause."
Dizziness Is Not Just Anemia? Warning Signals from the Ear and Brain [Professor Seo Jae-hyun, Department of Otolaryngology, Seoul St. Mary's Hospital]
