Allergy symptoms are usually recognized as a stuffy nose, a familiar congested feeling, sneezing, or itching. However, a less common but significant reaction to allergies is dizziness. Although the dizziness frequently feels like it is in your brain, it’s actually your ears! In this case, your eustachian tube, the tube that makes your ear “pop” when you climb in elevation, will make you feel dizzy if you’re having severe allergies. Your Eustachian tube gets filled with mucus when you have a reaction to an allergen as a result of histamine buildup. Histamine is produced when the body is having an allergic reaction, usually causing inflammation and congestion. If this response blocks your Eustachian tube, your ear can’t equalize the pressure, and you end up feeling dizzy.
Allergies are also an underlying cause of Secondary Endolymphatic Hydrops (SEH). SEH is a fluid imbalance in the endolymph located inside your vestibular system. Symptoms of SEH include fullness in your ears, tinnitus, and dizziness. Learn more about SEH here!
If you feel like your dizziness fluctuates as allergy season ebbs and flows, this may be the cause of your dizziness. Luckily, you have options for treatment!
Symptoms & Diagnosis
Allergies can be distinguished by multiple different feelings, most of which we are familiar with. These include:
- Itchy eyes
- Sneezing
- Postnasal drip
- Congestion
- Sore throat
Additionally, a symptom of allergies can be dizziness. Dizziness has multiple definitions, but most commonly with allergies they include:
- Feeling like your brain is spinning
- Lightheadedness
These two kinds of dizziness, lightheadedness and spinning, are common symptoms of many inner ear disorders, so differentiating them from another cause of vertigo or vestibular disorder is important. Typically, when you have allergy-related-dizziness, your symptoms will be related to the environment, seasons, or foods. You might start to notice that every time you are around a certain kind of tree, or when it is “allergy season” you start to feel dizzy. I also find people telling me that they’ve never had allergies, but moved to a new city and aren’t sure why they developed them all of the sudden (1). Keeping track of your symptoms with a journal or log to find triggers can be an important step in finding what it is you’re allergic to in order to seek treatment. Despite this feeling being very disruptive and frustrating, it is usually treatable!
Treatment
Treatment for allergy-induced-dizziness is treated a lot like other allergies. A physical therapist is not the practitioner most qualified to treat your allergies, if allergies are the only cause of your dizziness, you should seek help from an allergist or your primary care provider. When you find out what is causing your allergies, there are a few ways to treat the symptoms.
- Diet
- Allergy shots
- Allergy Medications
Diet
Often we are allergic to something in our diets when we don’t realize it. Even in adulthood and as we age, we can develop allergies, so something that you may have been eating your whole life can suddenly cause an allergic reaction. The most common culprits are nuts, corn, soy, dairy, citrus fruits, nightshade vegetables, wheat, foods containing gluten, pork, eggs and seafood (2). If you suspect your dizziness is related to your diet, you can try an elimination diet. To do this, first determine which food or foods you suspect may be causing your symptoms. Next remove those foods from your diet for 2-3 weeks. If your symptoms decrease, you may be allergic to one or multiple of them. Then, reintroduce the foods one at a time. If your symptoms increase, you are now aware of what is causing your dizziness and can eliminate it for good. Don’t forget to always consult your qualified healthcare provider prior to changing your diet!
Allergy Shots
For more severe allergies, an allergist, or other qualified healthcare provider, can provide allergy shots to slowly desensitize your body to the allergen causing your symptoms. You may have a multiple-injection course of treatment. Gradually, your body will build a defense to the allergen, treating the root cause, therefore reducing your dizziness. There are usually two phases to receiving allergy shots. Phase 1 is the build-up phase, where you receive shots one to three times a week, gradually increasing the dosage at each appointment. Then, when you enter Phase 2, you will receive monthly shots for three to five years depending on your specific case (3).
Allergy Medications
There are many brands and forms of allergy medications, but they are all focused on treating the same factor — histamine (4). Allergy medications, or antihistamines, treat allergy symptoms by reducing the reaction to histamine. Many antihistamines cause drowsiness, so be careful about operating or driving machinery after taking the medication, always pay close attention to the directions, and be sure to contact your doctor before taking a new or different medication. Ultimately, when taking an antihistamine, you are looking to treat the allergies to reduce the symptoms of dizziness.
Physical Therapy
If allergies are the underlying cause of your dizziness, a physician will help you treat these symptoms, but if you have continual dizziness and imbalance, physical therapy is likely right for you. Physical therapy for SEH is in the form of vestibular rehabilitation. Your therapist will help you with your balance, mobility, activity tolerance, and energy levels. Your PT should also be able to assist you with dietary recommendations for SEH and other ways to manage your symptoms!
Sources:
(1) Jewell, T. (2020, March 30). Can You Develop Allergies in Adulthood? What Science Says. Retrieved August 20, 2020, from https://www.healthline.com/health/allergies/can-you-develop-allergies
(2) Raman, R. (2017, July 2). How to Do an Elimination Diet and Why. Retrieved August 20, 2020, from https://www.healthline.com/nutrition/elimination-diet
(3) Mayo Clinic Staff. (2020, February 08). Allergy shots. Retrieved August 20, 2020, from https://www.mayoclinic.org/tests-procedures/allergy-shots/about/pac-2039287
(4) Cafasso, J. (2020, June 30). Allergies and Dizziness. Retrieved August 20, 2020, from https://www.healthline.com/health/allergies/dizziness
An acoustic neuroma is a slow growing, benign tumor that typically develops on your vestibular nerve. Your vestibular nerve carries signals from your inner ear and vestibular system to your brain, controlling balance and dizziness. Sometimes acoustic neuromas grow on your cochlear nerve, which transmits information about sound from your inner ear to your brain. An acoustic neuroma grows from Schwann cells, which is the cell that creates myelin, a material that protects and insulates nerves throughout your body. Most typically, acoustic neuromas occur in women aged 30-60, and arise from unknown cause.
Symptoms & Diagnosis
Because of the slow growing nature of an acoustic neuroma, it can often be difficult to diagnose. Symptoms often build up slowly and begin with hearing loss and dizziness. If it grows large enough, it may press on other nerves or your brainstem and worsen symptoms. These are also difficult to diagnose because the typical symptoms are common in other types of vestibular disorders. Symptoms include some, or all, of the following:
- tinnitus (ringing in your ear)
- hearing loss
- aural fullness (feeling stuffed up or like you have water in your ear)
- loss of balance
- vertigo (dizziness, lightheadedness, or like your brain is spinning)
- double vision
- nausea and/or vomiting
- headaches
- numbness/tingling in your face
Any, or all, of these symptoms can occur with an acoustic neuroma as well as other vestibular or central nervous system disorders. It is important that you and your healthcare provider rule out all other diagnoses before getting to acoustic neuroma. The first tests that will likely be done are a hearing test and an ear exam. Then, if an acoustic neuroma is still suspected you will receive an MRI and/or a CT scan.
For an MRI, you will likely be injected with contrast dye prior to your scan. This will help show your physician a 3D image of the soft tissues in your brain, and help the tumor be differentiated from the rest of your brain tissue.
The CT scan will provide a 3D image of your brain as well, and is used if you have metal in your body, or any other reason you can’t have an MRI. You may be given an injection of contrast dye to help enhance the image as well. If you have a positive CT or MRI scan, your healthcare provider will provide you with a few treatment options depending on your specific needs.
Treatment
There are a few ways your healthcare team may choose to handle your acoustic neuroma once you receive your diagnosis. The best choice is always the one that you make with the assistance of your treatment team. You and your team should always make sure to consider all options before coming to a decision. The three most common forms of treatment are observation, surgical removal, or radiation. These three choices are incredibly different, so let’s break them down together to help with your decision
Observation
Observation is usually the choice best suited for people who have very small or slow growing tumors, or those without symptoms. Acoustic neuromas do not always require immediate treatment, so if your providers make this recommendation don’t be worried that you aren’t taking a more significant action — you’re likely making the best decision for yourself!
You may need surgery or radiation therapy in the future if the tumor grows or you develop symptoms, but in this case that can be reserved for the future!
Surgical Removal
Surgical removal of an acoustic neuroma is a procedure done under a microscope, a microsurgery, for partial or full removal of the mass. You and your surgeon can decide on if a partial or total removal of the neuroma is right for you. A partial removal indicates only removing a portion of the tumor in order to decrease the complication rate and decrease risk of facial paralysis or hearing loss. However, with a partial removal you may have to undergo another surgery in the future if the tumor returns. The other option is a total removal of the tumor. In a total removal, your surgeon will remove the entire neuroma while also trying to preserve hearing and avoid facial paralysis.
Radiation Therapy
The final option, radiation therapy, has increased in accuracy and dependency with recent technology. People can now use radiation therapy to reduce the size of the neuroma and slow or even stop growth. Depending on your case, it can take one or many treatments before results are seen, but this treatment can be done in an out-patient setting like a regular trip to the doctor. The concept is the direct radiation specifically at the tumor, sparing the tissue around it, to stop growth and decrease the tumor’s size.
Physical Therapy
Physical therapy is a vital part of your treatment once you are diagnosed with an acoustic neuroma. Your physical therapist should have a background and understanding of vestibular care, and will help treat your symptoms! You can start before, during, or after your other medical treatments depending on what you decide with your healthcare team. Vestibular Rehabilitation Therapy will help to increase your balance, decrease dizziness, and improve your overall vestibular function. In patients who underwent surgery, those who received direct instruction to improve their vestibular system post-operation had significantly improved balance compared to the group who received general instruction about vestibular rehabilitation (2). Your physical therapist should understand your personal goals, and work with you to determine the best course of treatment with you!
Sources:
(1) National Organization for Rare Disorders (NORD). (2016). Acoustic Neuroma. Retrieved August 18, 2020, from https://rarediseases.org/rare-diseases/acoustic-neuroma.
(2) Vereeck L, Wuyts FL, Truijen S, De Valck C, Van de Heyning PH. The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection. Clin Rehabil. 2008;22(8):698-713. doi:10.1177/0269215508089066. https://pubmed.ncbi.nlm.nih.gov/18678570/.