Dizziness

Treatment and Management

The prognosis for most cases of dizziness is good, often with no treatment. In up to 50% of cases, dizziness goes away on its own or improves substantially within about 2 weeks. For example, many common causes of vertigo (eg, inner ear inflammation or BPV) typically resolve within days or weeks.

If BPV is disabling, comes back frequently, or just hangs on too long, it is important to know that there is safe and effective treatment. Because BPV is caused by crystals floating freely in the inner ear, those crystals can be coaxed to land and stay put using head positioning. Generally, this is done by an audiologist, although some primary healthcare providers may do this as well. One treatment is usually sufficient.

Orthostatic hypotension may occur because the older adult is taking medications that affect blood pressure, and these will need to be adjusted or discontinued. Other people have disorders of blood pressure control that cause orthostasis, and they may need medicine to increase blood pressure, to increase blood return to the heart (eg, specially-fit support stockings).

If symptoms occur with position change and there is little or no drop in blood pressure, people can be reassured that it isn’t something more serious, and they can usually learn to make position changes more slowly.

Unsteadiness while walking (eg, related to vision problems, arthritis, etc) usually improves immediately when the person holds onto the arm of and walks with a companion. These people can be greatly helped by using a properly fit cane (see Canes in Chapter on Rehabilition). Also, physical therapy for strengthening and balance will reduce symptoms of unsteadiness. Treatments for this type of unsteadiness may include proper glasses or hearing aids. Keeping the lights on at night can also help unsteadiness and help prevent falls. If unsteadiness is caused by arthritis or other problems that make moving difficult, treatment for pain is needed (see Pain Management).

In some older adults with severe episodes of vertigo with vomiting, a short hospital stay may be needed to replace lost fluids. This is most likely to occur in Ménière’s disease. Once the vomiting has stopped, recurrence of Ménière’s can usually be prevented with a very low-sodium diet. Usually, counseling from a dietician is necessary to learn how to maintain such a diet. Surgery is reserved for only the most severe cases of Ménière’s disease, because it involves destruction of the nerve of hearing on the affected side.