Feeling dizzy or "off balance" is a common complaint of people seeking the help of an ENT surgeon.  Symptoms can vary from a mild sensation unsteadiness to severe "room spinning" vertigo.  Regardless of severity, if your sense of balance is off, you should seek immidiate help from a physician as there may be a significant problem that would benefit from fast diagnosis and treatment.

One of the most helpful things in determining the cause of dizziness is trying to figure out what the person is actually experiencing.  People's definition of "dizziness" varies, so complaints will range from feeling weak or lightheaded to symptoms of inadequate equilibrium such as, motion sickness, vertigo, and unsteadiness. 

This variability in sensation is understandable when you consider all of the different organ systems involved in maintaining an appropriate sense of balance and equilibrium.  The brain, spine, sensors in the skin, eyes, cardiovascular system, and inner ear all play some role in this regard.  Therefore, a detailed description of what you are feeling is very important in figuring out which organ system (or systems) are involved in causing your symptoms.

Since this site is dedicated to ear, nose and throat pathology, we will focus this section on inner ear causes of dizziness.  Below are some questions that can help you determine if the inner ear balance system (the vestibular system) is not functioning appropriately.  It is a very brief guide intended to help you better describe the problem when you see your doctor. 

Vertigo or lightheadedness?  A good way to start describing what you experience when you are dizzy is to determine whether you notice any change in your surroundings such as spinning or abnormal shifting of the environment.  This helps determing whether your symptoms should be classified as vertigo, raising the suspicion for an inner ear problem.  Since vertigo is caused by an abnormal reflex between the brain and eyes, when there is malfunction of this extremely fine reflex, the eyes may move back and forth or rotate rapidly giving the impression that your surroindings are moving.  This abnormal back and forth movement of the eyes is called nystagmus, and is one of the common physical exam findings in people with vertigo.  It can be brief or prolonged, depending on the disease process, and can lead to severe nausea and vomiting.

Association with movement?  Another helpful clue comes from knowing if the symptoms are assiciated with motion.  Some conditions, such as benign paroxysmal positional vertigo, occur only with specific head positions.  Other times, dizziness and vertigo can be spontaneous, even waking people up at night.

Duration of episode?  Whether you always feel dizzy or not is always important.  If there are discrete episodes, its important to know what (if anything) brings them on.  Its also very important to know how long the dizziness lasts.  Conditions such as benign paroxysmal positional vertigo will cause dizziness for 20 to 30 seconds.  Other conditions such as Meniere's disease can lead to episodes of vertigo lasting hours or even days.

Associated symptoms?  Are there are other symptoms affecting the ear such as hearing loss, tinnitus (a continuous noise in the ear), ear pain, or drainage from the ear?  If so, there is a higher likelyhood that the primary problem involves the inner ear.

As you can see, determining the exace problem with the dizzy patient is very difficult.  Remember to seek help early and be as specific as possible when describing your symptoms to your doctor.