Introduction
Dennis Poe, MD

Mass Eye & Ear Infirmary
Boston, Massachusetts

Dizziness is one of the most common complaints people report to their physicians. The National Institute of Health has reported that 90 million Americans (42 percent of the population) will present to their doctors with a complaint of dizziness at least once within their lifetime. The cost of medical care for treating patients with balance disorders has been estimated at over one billion dollars per year in the United States alone. Balance disorders become increasingly common as we age. It affects 40% of Americans over the age of 75. The number of patients with dizziness increases significantly with age and it represents the leading complaint in patients over the age of 75.

How This Book Can Help You

The principal purpose of this book is to help you or someone you know who suffers from dizziness to be able to better communicate what you feel to your doctor, medical caregivers and even other non-medical people. The ability to communicate what you feel more accurately will greatly aid medical personnel in arriving at an accurate diagnosis and appropriate treatment and will also help others understand your condition and remove some of the barriers that occur when someone suffers from an illness that is not felt or seen by another person. There is no means for measuring the quality and severity of symptoms we feel such as pain or dizziness.

This book is designed to help you express what types of symptoms you have and understand what information your doctors will be looking for in trying to diagnose and treat your condition. The pattern of dizziness complaints and associations with other symptoms or illnesses are important in arriving at a diagnosis. This book will also provide a great deal of information about what to expect from your doctor and the medical system as you are evaluated for your dizziness problem.

Dizziness can be due to a staggering number of disorders that may include the cardiovascular system, the central nervous system, the vestibular or balance system (including the inner ear) and other systemic problems such as metabolic or hormonal abnormalities. Table 1-A3 lists the top fifty possible causes for dizziness (called a differential diagnosis) from a commonly used textbook of internal medicine. The list is not only long, but many of the disorders are frankly scary, such as strokes, brain tumors and multiple sclerosis. Fortunately, the most serious conditions are relatively rare.

Your doctor will try to listen carefully to the symptoms you describe and search for the type of system abnormality that most closely fits your symptoms. Most of the time your diagnosis will be apparent on the basis of your history alone. Subsequent physical examination and testing will be done on the basis of what has been discovered during the history in an effort to confirm or deny the initial impression.

This book will take you through all of the steps of the history, physical exam and the different types of examinations and balance testing available. It will give you an overview of the rationale for why we order various tests and how the results are helpful. The book will also discuss in some detail the most common balance disorders, those involving the vestibular system which includes the inner ear balance (vestibular) organ, the nerves that connect to the inner ear, and the neural centers (nuclei and connecting nerve axons) in the brain that process balance and coordination information. Medical treatments (and when appropriate surgical alternatives) for these more common conditions will be presented.

Not all vestibular system injuries are repairable and for those that are not, this book will discuss the concept of vestibular compensation for injuries and strategies designed to recover as much function as possible. If you suffer from dizziness, you may already realize the tremendous social and psychological stresses and burdens on you. Some people are often unable to perform their normal routines or may actually be disabled. Such stress may seriously detract from someone’s ability to cope chronically with a vestibular problem and managing these stresses optimally can help someone function to their best possible performance. . .

We are very pleased to have assembled a wonderful group of experts in the field of dizziness. Reading the invaluable information contained in this book might be likened to the rare opportunity of consulting with the most qualified experts in the field of vestibular disorders. They’ll provide candid insights into how they approach different aspects of their specialty and try to help you through their perspectives on problems of dizziness and its management. Listen carefully to their advice which stems from decades of experience, but foremost heed the wisdom of your physician who is managing your problem. We also hope you’ll find this book helpful to assist you in forming the right partnership with your doctor in your search for the cause and treatment of dizziness or vertigo. You may be pleasantly surprised by much of what you read and how you may be able to at last take control of your problem.