Great Health Guide


- Dr David McIntosh

Discover the different reasons for dizziness & how they occur

The feeling of being dizzy can be related to many different body systems. To understand how things can go wrong, it is important to understand how things must first work. A health sense of balance requires the integratio­n of messages from your ears, your eyes, your neck and spine, your feet, your joints, and this all then requires a healthy brain with a good blood supply. So, with all of this in mind, let’s try and explain each part.

1. The sense of balance is one that is related to the inner ear.

In each ear there are 4 separate compartmen­ts that monitor your movement. These compartmen­ts are grouped into 2 categories – one group monitors the speed of your movement and the other monitors the angles and rotation of your movement. These little sensors send a message to the brain to let it know the position of your head. It is vital that the messages from each ear are reported to the brain equally, for example, if you turn your head to the right, the left ear will say it is moving forwards and the right ear will say it is moving backwards. Both of these messages must match for the brain to be informed appropriat­ely.

2. The next message the brain relies upon is a visual cue from your eyes.

The brain is looking for the horizon. This is its reference point for being upright and straight. So, if the horizon moves, your eyes will detect this change. At the same

time, for the horizon to have moved, your head must have likewise moved. So once again, the head movement is detected by the ears and the message of this must match entirely with the message to the brain from your eyes. If your ears are not quite working properly, the brain can use the message from the eyes to compensate, which is why some people have problems with their balance in the dark.

3. The head is attached to the neck and spine.

Within the neck in particular are sensory nerves that detect the position of the head relative to the neck and spine. So, as you nod your head, for example, the ears both note a rotation downwards and upwards, the eyes note the horizon moving in a similar manner and the sensory nerves in the neck note the head movement down and up as well.

If the message from the neck is dysfunctio­nal, then the brain starts to lose its point of reference to the body and this causes a conflict as to how everything is lining up. Likewise, the entire body has sensory nerves for the way your joints are moving and for where they are located. So, when you walk, for example, the brain is made aware of where your leg is, as it strides along. When you lift one leg up it automatica­lly knows to activate the other leg and the supporting musculatur­e to keep you upright rather than falling from side to side.

4. The final signal comes from the soles of your feet.

These detect difference­s in the ground surface, so when you walk on sand, for example and the sand moves around, the brain has to work overtime to keep up with the rush of signals coming in from your feet. All of the above informatio­n is being sent to the brain constantly. The brain has a few centres that then manage these signals and makes sure that you do not fall down. If there is a problem with the brain function, then the signals may not be processed properly. Likewise, the brain needs a good blood supply to constantly provide it with oxygen and energy. With all this in mind, it is amazing we are not dizzy more often! What is more amazing is that the brain can compensate very well if some of the informatio­n goes missing. So, if you lose your vision, it will do its best to compensate. But if you have a problem with your ears and your vision then you will be in trouble. What the brain is not so good at coping with is mixed messages. So, if one ear is working slightly less than another, then you will be in trouble. The brain is still getting a message (rather than no message) but this message does not match up with the other informatio­n. Over time it may learn to compensate, but not always. Given the many body systems involved, the important thing about experienci­ng dizziness is appreciati­ng the different types of dizziness that there are.

• if you experience a sense of rotation, we call this vertigo and this usually relates to an ear or brain problem, occasional­ly the neck.

• if you experience light headedness, this usually relates to a blood flow problem, often in turn related to low blood pressure.

• if you experience a feeling of unsteadine­ss on your feet, then this may be due to a brain problem or a problem with the sensory nerves in the feet or the joints. So, if you have a problem with being dizzy, make sure you can describe what it is that you are experienci­ng - it will make the job of your health care provider much easier.

Dr David McIntosh is a Paediatric ENT Specialist with a particular interest in airway obstructio­n, facial and dental developmen­t and its relationsh­ip to ENT airway problems and middle ear disease. He also specialise­s in sinus disease and provides opinions on the benefit of revision of previous sinus operations. Dr McIntosh can be contacted via this website.

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