There are many causes of dizziness that make the patient dizzy and also tend to make the doctor dizzy because it is relatively complex with multiple causes present. However, we can determine the cause by simply ranking the symptoms, and later perform the appropriate tests to confirm the diagnosis. What exactly is dizziness? Let’s look at it specifically, its characteristics and scope. Most of them are actually benign and not serious, but there are a few of them that may be accompanied by adverse consequences. According to statistics, the prevalence of vertigo in the population is about 5%, accounting for 15% of ENT outpatients, 30% of neurology outpatients, 5% of neurosurgery outpatients, and is more common in elderly outpatient clinics, reaching 81-91%, and the first reason for hospital visits for people over 75 years old is vertigo. The number one reason for hospital visits for people over 75 years old is vertigo, and 50-60% of elderly people living at home have also experienced varying degrees of vertigo. In fact, dizziness is only a symptom with a complex cause, like coughing, sneezing, or headache, rather than a specific disease, but there must be some underlying disease behind it. There are many causes of dizziness, and it is still a difficult clinical condition to find the cause of dizziness, which is sometimes very difficult and often makes doctors feel “dizzy”. Some dizziness is not serious, such as dizziness when hungry, when riding in a car or when overexerted, these mild, physiological dizziness, there is no need to fear, after a period of rest and replenishment, will naturally recover, but some dizziness can not be ignored. What is dizziness? There are two similar concepts about dizziness, one is dizziness and the other is vertigo, both of which sound similar, but in fact their manifestations and causes are very different. Vertigo is an illusion or hallucination of a change in the spatial position of oneself and surrounding objects, including a sense of rotation, bumps, oscillation, floating or drifting, and can be accompanied by significant nausea and vomiting, fear of opening the eyes, and panic and sweating. Vertigo is often a symptom of peripheral or central vestibular system lesions. Dizziness (dizziness), on the other hand, is only a persistent feeling of mental dizziness and lack of clarity, and may be accompanied by a feeling of head heaviness, dullness, and swelling. Dizziness is often not a problem of the vestibular system, but can be caused by low cranial pressure syndrome, anemia, hypertension, postural hypotension, heart disease, cardiac arrhythmias, ophthalmology, psychiatric disorders (depression, anxiety), insomnia, and other causes. Why do people feel dizzy? Why don’t people hit a wall or a tree? How do you know that reaching for an object will be so accurate that you won’t reach farther or closer and not get it? How do you know that when someone pushes you, your body just tilts a little and then quickly corrects itself? This is all due to the role of the balance triad. The synergy of the visual, proprioceptive and vestibular systems allows the body to maintain homeostasis and proper functioning of the orienting function, collectively known as the “balance triad”. The vestibular system is the most important in maintaining the balance of the body’s posture and position. It is also the most closely related to vertigo. Under normal conditions, the activity of the vestibular system in coordinating the body’s balance is rarely felt by people, but when the vestibular system is strongly stimulated or pathologically damaged, the stimulation of vestibular sensation is inconsistent with the impulses from muscles, joints and visual receptors in spatial orientation, and vertigo is produced. The vestibular system is composed of the inner ear, vestibular nerve, vestibular nucleus and vestibular center. Vertigo caused by lesions of the inner ear or vestibular nerve is called peripheral vertigo, while vertigo caused by lesions of the vestibular nucleus or vestibular center is called central vertigo. Peripheral vertigo 1. Benign paroxysmal positional vertigo is the most common type of peripheral vertigo (50%), also known as otolithiasis, and is characterized by brief episodes of vertigo when the head position changes, lasting only a few seconds to 20 seconds, rarely >40 seconds; vertigo is easily fatigable and self-resolving. Otolithiasis is a very typical form of vertigo. The scientific name for this disorder is benign paroxysmal positional vertigo, or BPPV, and otoliths are usually not associated with tinnitus or deafness. Otolithiasis is a postural induced vertigo, which can be triggered when the patient is in a particular position. For example, getting up in the morning, lying down to sleep at night or suddenly turning over to a certain side while sleeping, or tilting the head down or tilting the head up to dry clothes may cause vertigo. This kind of vertigo usually occurs in a fixed position or head position, and can be relieved by changing the position or head position immediately; but when the position that triggered the vertigo is repeated again, the symptoms may appear again, so it is also called positional vertigo. Benign paroxysmal positional vertigo means that the disease is self-healing, and most people have vertigo that disappears spontaneously within two weeks to a month after the onset of the disease, and the vertigo comes in bursts and does not come continuously. The most critical test for otolaryngitis is the position-evoked test. There are two main types of position-evoked tests, one is the varus nystagmus-evoked test and the other is the tumble test. The diagnosis of this disease is based mainly on the typical medical history and positional nystagmus. Otolith repositioning therapy is the most effective treatment for benign paroxysmal positional vertigo. Medication is mainly anti-emetic and can be applied with Minkozyme or Ondansetron. You should pay attention to your diet and living. You should not be too bumpy when riding in a car or motorcycle, and you can do some exercises such as slow walking, brisk walking and tai chi. Lie down or get up slowly. In daily life, we should pay attention to the prevention and control of cardiovascular diseases, such as atherosclerosis, three high, diet appropriate control of fat, cholesterol, etc. Pay attention to general life care, diet and living, is also beneficial to prevent the recurrence of otoliths. The treatment of this disease mainly includes manipulation to reset the otolith. Symptomatic treatment includes betahistine medication, etc. Meniere’s disease (Meniere’s disease), first reported by French physician Meniere in 1861, is an idiopathic inner ear disease characterized by fluid accumulation in the vagus of the inner ear, with the typical triad of symptoms of episodic vertigo, sensorineural hearing loss and tinnitus. The majority of cases develop in middle age, with a slight increase in men. It occurs in the 30s and 40s and has a genetic predisposition. The basic pathological change is fluid in the membranous vagus, so some people call it “inner ear fluid” or “inner ear glaucoma”. The vertigo lasts for more than 20 minutes and usually resolves within 24 hours, but the hearing becomes progressively worse with repeated attacks. During acute attacks, bed rest and a semi-liquid diet are recommended. Those with significant nausea and vomiting should maintain nutrition and water and electrolyte balance. For patients with prolonged seizures and severe symptoms, appropriate medication should be given. Sedatives (vestibular depressants), commonly used drugs include tranquilizers and barbiturates. Vasodilators, vasodilators are mostly used in the acute and remission phases of vertigo attacks. Anticholinergics, scopolamine, antimuscarinic receptor inhibitors, increase tolerance to exercise. Antihistamines, which act mainly in the vestibular center, prevent motion sickness and reduce its symptoms. All antihistamines used to combat vertigo have anticholinergic effects. The typical drug is multiplying dizziness, also known as diphenhydramine. Representative calcium channel inhibitors, mainly Cipro, also known as flunarizine, are commonly used as anti-vertigo medications to help prevent motion sickness. Another option is nimodipine. Asymptomatic patients do not need to be treated, but for patients with more frequent attacks, medication can be continued to reduce or mitigate the attacks, such as antivertigo, glutamate, and yogurt. Some people believe that a low salt diet can prevent attacks. For the treatment of Meniere’s disease, dietary salt restriction and diuretic therapy can reduce the symptoms of attacks, decrease the frequency of attacks, and delay the progressive damage of hearing. 3. Vestibular neuritis is a common disease of the vestibular system, second only to benign paroxysmal positional vertigo and Ménière’s disease in terms of incidence. It is common in adults but rare in children, and its cause may be related to viral infection. It presents as sudden onset vertigo, usually without tinnitus or hearing impairment. It has a tendency to heal on its own. Vestibular neuritis is very common in otologic vertigo and ranks third in treatment. The principle of treatment remains to use as little medication as possible and to encourage the patient to be active, usually on the third day of the course of the disease, vestibular suppressants should be discontinued and daily activities increased. Vestibular neuritis is usually treated with vestibular depressants for 1 or 2 days, and on the third day there is often no more vomiting, although there are still significant symptoms of vertigo and unstable balance, requiring the patient to move frequently and to stop being bedridden. Methylprednisolone significantly improves the results of the hot and cold test after one year. For this vestibular neuritis patients with hormones is sufficient, if vestibular compensation is considered, some other sexual drugs can be given for intravenous treatment, other unnecessary. 4, vestibular drug toxicity The adverse effects of many drugs can be vertigo, the most studied are aminoglycosides and diuretics, and some other drugs, such as anticonvulsant drugs, morphine derivatives, anti-fear of Kinison’s disease and narcotic drugs, all have different degrees of inhibitory effects on the vestibule. 5.Sudden deafness Sudden deafness is a kind of sudden sensorineural deafness of unknown cause, also called violent deafness. 10 people out of 10,000 have the disease, the incidence increases gradually with age, and 3/4 of people aged 40 or above are affected. The onset of vertigo is rapid and progresses quickly, and the treatment effect is directly related to the time of consultation, so it should be regarded as an emergency after occurrence and immediately go to the hospital. 6. Other diseases in peripheral vertigo Foreign body or cerumen embolism in the external auditory canal, otitis media, tympanic pneumatic injury, middle ear and mastoid tumor, otosclerosis, recurrent vestibular disease, autoimmune inner ear disease, delayed membranous vagal effusion, vagal trauma, vagal hemorrhage, temporal bone fracture, etc. Central vertigo Central vertigo is vertigo caused by lesions in the vestibular center, which accounts for about 5 to 10 of all vertigo. Although the percentage is not high, its severity has to be alarming. In addition to dizziness, it is often accompanied by double vision, slurred speech, dysphagia and ataxia. The causes of central vertigo include cerebrovascular disease, cerebellar tumors, IV ventricular tumors, intracranial infections and other diseases, among which the symptoms caused by cerebrovascular disease are the most common and deserve the most attention, such as vertebrobasilar stenosis or cerebellar and brainstem infarction, mainly because it occurs and deteriorates quickly; if left untreated, it is likely to further aggravate and endanger life, therefore When vertigo and the above symptoms appear, it is necessary to go to a regular hospital with a neurological specialist for medical examination as soon as possible. Myths about vertigo 1.Vertigo = Meniere’s syndrome? 2.Dizziness = insufficient blood supply to the brain? 3. The legendary cervical vertigo? What should I do when I get dizzy? When dizziness occurs suddenly, you should take a safe position immediately to prevent falls. Since dizziness is only a symptom and there are many causes of vertigo, it can be a “minor problem” or a manifestation of a serious disease, so you should not take it lightly. The cause of dizziness should be clearly identified. Avoid misdiagnosis and mistreatment. Before finding out the cause, you should not purchase drugs, blindly infuse fluids or traction/massage the neck to avoid misdiagnosis.