| 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] . . .
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