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The Consumer Handbook on Tinnitus

Chapter 8
Management of Dizziness

Michael D. Seidman, M.D. and Nadir Ahmad, M.D.
Henry Ford Medical Center
Department of Otolaryngology – Head and Neck Surgery
West Bloomfield, Michigan

The treatment of dizziness and balance disturbances is often challenging and can be met with frustration by both the physician and you the patient. An often cited statistic is that out of 100 patients with dizziness, a diagnosis is only made in about half despite a careful evaluation. For the other half, doctors often shrug their shoulders, apologize and tell them that we simply don’t know why they have this problem.

You must realize that even after a detailed history, examination and testing, we often cannot tell you what precisely is wrong. But do not dismay or lose hope! Over the past several years, many promising new approaches and therapies to treat dizziness have been discovered and are now used routinely in many places all over the world. Our aim is to inform you not only of the medications that have been traditionally used to treat or help with the symptoms of dizziness and vertigo, but also to highlight and consider some of the new and novel, nontraditional therapies. This discussion of various medical treatments, both conventional and alternative, will help you navigate through the complex maze of therapies that are available.

Dizziness can mean many things to many different people. The patient who suffers from dizziness can be referring to such feelings as lightheadedness, unsteadiness, confusion, giddiness or nausea. Other descriptions include a sensation of being pulled, a sensation of walking on a waterbed, a floating sensation, a feeling of being on a boat or just getting off a roller coaster. Typically, describing the sensation that they are experiencing is very difficult for most people with balance problems.
Now that you’re aware of many of the different causes of dizziness and vertigo, let’s get down to the real nitty-gritty and find out what’s out there to treat this annoying, troubling and often times debilitating problem.

Low Sodium Diet for Ménière’s Disease

Restriction of dietary salt is very often advised as a first-line therapy to alleviate symptoms of vertigo in Ménière’s disease. Because of its apparent success in many patients, a strict low salt (that is, low sodium) diet with a daily allowance of 1500-2000 mg of sodium per day is advised. Some doctors advice as low as 1000-1500 mg per day. Although this is very stringent and unpalatable for many people, it has helped many sufferers of dizziness. Perhaps a more reasonable approach but not always effective is to ask patients to avoid excessively salty foods (like highly salted popcorn or crackers) and not add table salt to foods when they’re being prepared or served. This more practical approach will result in better compliance and more enjoyable eating.

The thought behind dietary restriction is that less overall fluid will be present in the area of the ear responsible for the symptoms of Ménière’s disease. This area called the endolymphatic sac gets enlarged, a condition known as ‘hydrops’, and is because either too much fluid is getting into the sac or not enough fluid is getting out. The result is what you perceive as spinning or turning, or just plain dizziness.

Restriction in the intake of caffeine, chocolate and alcohol is also recommended for patients with Ménière’s disease. In addition, there have been reports that yeast-free and sugar-free diets also help alleviate the symptoms of vertigo. Some patients report that by limiting these substances their attacks occur less frequently. But there is no scientific data to support these claims. The most important thing we advise is that with any form of dietary restriction make sure you determine what is appropriate for you.

. . .Your cause of dizziness may not necessarily just respond to diet. A better approach is an objective one. [Here’s what to do] . . .