Dizziness and Vertigo in the ER
Dizziness is one of the more common complaints in the emergency department. Patients will usually come in with a chief complain of lightheadedness or a sensation of the room spinning (vertigo). Dizziness is quite disconcerting to the patient because there is always associated nausea, a feeling of unsteadiness while standing and can sometimes lead to a fall and broken bones.
A CT scan of the head, ECG and blood work are usually ordered because we don’t want to miss other dangerous diseases that can also present as dizziness like a small brain bleed, tumor, cardiac irregularities, and electrolyte problems, and anemia to mention a few.
Most of the time, nothing significant will be found. If the symptoms resolve after the intravenous fluid and other medications, then they get to go home. If there is no improvement, they get admitted for more tests and observation. Often a one or two days stay in the hospital will reveal nothing significant in spite of the hospital stay and added analysis. The patient is later discharged, and the dizziness is labeled “idiopathic.” A fancy term for “I don’t know.” So, Idiopathic Vertigo may be the best diagnosis you can get after spending time, money, and probably a lot of anxiety, hoping that nothing serious will be discovered.
But something terrible may be undiagnosed and hiding behind that dizziness. Something as deadly as a future heart attack.
I was reading an article about hyperinsulinemia, and the author described an association between metabolic syndrome and tinnitus. I searched for metabolic syndrome+tinnitus+vertigo. The results surprised me because I must admit that I am one of the doctors who also diagnosed idiopathic vertigo in the past.
The studies to be mentioned do not specify metabolic syndrome (MetS) per se, but the associations were made with the components of MetS which are obesity, hypertension, dyslipidemia (high triglycerides, low HDL), and diabetes.
Vertigo
This study from Japan, The Prevalence and Characteristics of Metabolic Syndrome in Patients with Vertigo, found that the group with vertigo has a higher incidence of metabolic syndrome than those who did not.
This article in Otolaryngology: Head and Neck Surgery, Metabolic disorders of the vestibular system, recommended that the metabolic evaluations to be done for unexplained dizziness should include a lipoprotein profile, glucose tolerance test, and thyroid hormone measurements.
This study, done in Brazil, Vertigo and metabolic disorders., published in the International Tinnitus Journal, showed the association between abnormal thyroid functions, High LDL and diabetes among patients with vertigo.
Tinnitus
Tinnitus is an incessant ringing in the ears. It is quite bothersome.
Another study from Brazil, Tinnitus sensation pre and post nutritional intervention in metabolic disorders. In this study, all subjects have metabolic syndrome, and tinnitus and dietary intervention were done for seven months. In the end, 71.5% reported an improvement in their tinnitus.
This article, Tinnitus, and Diabetes explains how the inner ear can be affected by abnormal glucose metabolism.
The inner ear, like the brain, is totally lacking in energy reserves. Its metabolism depends directly on the supply of oxygen and glucose from the blood supply. Alterations in glucose metabolism therefore have great potential for disturbing the workings of the inner ear.
Hearing Loss
In this study from Poland, published in the International Tinnitus Journal, Metabolic disorders in vertigo, tinnitus, and hearing loss, the authors concluded that hyperinsulinemia, hyperglycemia, and diabetes mellitus but not hyperlipoproteinemia is associated with inner ear diseases.
From Taiwan, a case-control study published in Otolaryngology: Head and Neck Surgery, Metabolic Syndrome Increases the Risk of Sudden Sensorineural Hearing Loss in Taiwan: A Case-Control Study. Results showed that:
Subjects with metabolic syndrome had a 3.54-fold increased risk (95% confidence interval [CI] = 2.00-6.43, P
A large study that looked at 3,474 patients using Taiwan’s National Health Insurance Research Database entitled, The association between tinnitus and the risk of ischemic cerebrovascular disease in young and middle-aged patients: A secondary case-control analysis of a nationwide, population-based health claims database.
Found that tinnitus was significantly associated with a higher risk of incident ischemic heart disease for both men and women and even as young as the 20 -29.9 and 30 to 39.9 age group but not in the 40 to 45 age group.
Take-Away Message
If you know somebody complaining of dizziness, ringing in the ears or sudden deafness, there may be more to it than just accumulated ear wax. Measure your waist circumference, check your blood pressure, and ask your doctor about getting a fasting blood glucose and a lipid panel.
Early detection of metabolic syndrome is half the battle. You might prevent a heart attack and stroke in the future. Keep in mind that intermittent fasting works very well for metabolic syndrome.
Related Readings
- Eye Problems and Metabolic Syndrome
- Diseases Associated with the Metabolic Syndrome
- The 80/20 Rule Applied to Diseases
- Cancers Associated with Metabolic Syndrome
- Lung Diseases Associated with Metabolic Syndrome
- The Deadliest Diseases Associated with Metabolic Syndrome
- Abnormal Blood Clots and Metabolic Syndrome
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