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SMSEA 2017
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 2
For some adults, and even children and adolescents, dizziness is a true concern and may
play a negative role in their lives. In other words, dizziness can be disabling and may result in
a loss of work and increased anxiety (Warren et al., 2016) Generally, dizziness is defined as a
sensation of movement most often described as rocking or spinning of the body, the
surroundings, or within the head (Mendel et al., 2010, pg. 391). This dizziness may impair the
quality of life and lead to other health issues. Numerous studies have discussed the effects of
dizziness on older adults; however, the literature surrounding dizziness and its effects on
coordination is limited for young adults or adolescents. Studies reveal that dizziness increases
with age and 39% of adults over 80 years of age are affected by dizziness (Roceanu et al., 2014;
Dros et al., 2011). Overall, dizziness is a common and most frequent symptom presented to
neurologist, ear nose and throat specialist, and other types of clinics (Chitsav et al., 2016). It is
important to include more literature to determine how dizziness affects the quality of life for
This science project aims to focus on the effects of dizziness on coordination and the
quality of life for adolescents and teens. The literature will explore and discuss several themes
found in the research concerning dizziness, which includes the types, symptoms, factors, and
prevalence of dizziness, various assessment for dizziness, and the connection between dizziness
and the brain and coordination. This study will further advance the knowledge concerning how
Review of Literature
Defining Dizziness
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 3
Dizziness can have many different meanings. In some cases dizziness can be a range of
sensations of feelings that makes a person feel strange and uneasy. The Mayo clinic describes
dizziness as faint, woozy, or unsteady, while other researchers describe dizziness to include an
intense sensation of spinning (Balance Disorders, 2017). Despite the various descriptions, the
literature reveals that the description of dizziness is imprecise and can mean different things to
different people (Starr et al., 2015). The article Feeling Dizzy(2002) from Harvards Mens
equilibrium, and vertigo. Other researchers reveal doctors use a classification system for
dizziness using 4 categories- presyncope, vertigo, disequilibrium, and atypical (Starr et al.,
2015). Presyncope is a feeling of impending loss of consciousness with weak muscles and vision
loss, vertigo is defined as spinning, disequilibrium is loss of balance, and atypical is defined as
ailment. According to the National Institute on Deafness and Other Communication Disorders,
dizziness may be the symptom of balance disorders. Other researchers agree and consider
dizziness as non specific symptom and regarded as both a syndrome and a symptom of one or
more diseases (Mendel et al., 2010, pg. 392). In several research articles, dizziness is more
likely seen as a symptom in older patients and the disease is treated and not the dizziness (Dros
Prevalence of Dizziness
Several studies have reviewed the prevalence of dizziness in adults. One study reveals
that after headache, vertigo, and dizziness are among the most frequent presenting symptoms,
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 4
not only in neurology, but also in Ear, Nose, and Throat and internal medicine clinics (Roceanu
et al., 2014, pg. 108). Other studies conclude that 25% of adults experience dizziness and
dizziness is more common in women than men (Mendel et al., 2010; Feeling Dizzy, 2002;
Warren et al., 2016). Mendel etal. (2010) concluded that the overall prevalence of women was
27% and men were 14% of 4,200 participants (pg. 392). Other studies reveal with a survey of
30,000 people that dizziness and vertigo were at 17% and rises to 39% for adults over 80 years
old (Roceanu et al., 2014). Research concerning adolescents is very limited; however,
researchers have concluded that dizziness and vertigo appears to be as common as in adults
(Langhagen et al., 2015). Despite this conclusion, this study was completed in Germany and not
in North America. Clearly, the literature supports the prevalence of dizziness in older adults, but
there is a limited review of dizziness in teens and adolescents that should be further explored.
There are many types of balance disorders that may be the cause of dizziness. The most
common are outlines in this literature review. The disorders are the most commonly found in the
literature concerning dizziness (Balance Disorder, 2017; Feeling Dizzy, 2002; Roceanu et
al., 2016; Star et al., 2015; Chitsaz, et al., 2014). Benign paroxysmal positional vertigo (BPPV)
is the brief, but intense episode of vertigo caused by a specific change in your head position. This
may occur when a person bends down to look under something or tilt the head to look up.
Labyrinthitis is an infection in the inner ear that may be caused by influenza. Menieres disease
is described as the episodes of vertigo, hearing loss, and ringing in the ear or tinnitus. Vestibular
neuronitis is the inflammation of the vestibular nerve which is the main cause of vertigo.
Perilymph fistula is the leakage of the inner ear fluid into the middle ear, which causes dizziness
bobbing that may last a few hours to a few days. Migraine-associated dizziness is common even
though is not recognized often ( (Furman et al.,, 2000). According to research, most of these
balance disorders may affect anyone at any age, but are more likely to affect older adults or
people who are ill, such as stroke victims with risk factors such as high blood pressure (Feeling
Dizzy, 2002).
Complications
Despite the inability to precisely define dizziness, it has a negative effect on adults.
According to Warren et al. (2016), dizziness can cause problems at work and increase the levels
of anxiety. Prolonged or several bouts of dizziness can cause psychological problems as well. A
study on the relationship between psychological symptoms and chronic dizziness shows that
there is a relationship and a high prevalence between anxiety and chronic dizziness (Chitsza et
al., 2016). Besides anxiety, patients are more likely to suffer from falling and injuries from
falling. Also, people who ignore their dizziness may be ignoring an existing condition that may
become worse if left untreated ( Balance Disorder, 2017). Several studies discuss
complications in light of older patients and conclude imbalance, falling, tinnitus, anxiety, and
inability to function were common complications (Ferreira et al., 2016; Stam et al., 2016).
However, another study reviewed the literature concerning questionnaires that would assess the
quality of life and complications of dizziness. This study failed to find any relevant or validated
Therefore, more research is needed to create proper assessment of the complications of dizziness
Determining the impact, severity, and extent of dizziness, vertigo, and other balance
disorders is an important aspects in the literature. According to Grill et al. (2012), there are many
measures for the assessment of the impact of vertigo, but no consensus exists on which aspects
should be measured (pg. 261). The studys objective was to determine an international standard
for patients with vertigo and dizziness called International Core Set (ICF). The ICF for vertigo
was designed for health care providers working in inpatient and ambulatory settings. Researchers
state that the ICF provides health professionals with a framework to assess patients
comprehensively and will hopefully be used to evaluate existing measures and create new
Another scale found in several studies was the Dizziness Handicap Inventory (DHI)
(Stam et al.,2016; Mi et al.,2012; Dros et al., 2011). According to Dros (2011), the DHI is a
self- report questionnaire used to assess the degree of disability associated with dizziness
regardless of its underlying causes (pg. 7). The questionnaire contains 25 items covering
functional, emotional, and physical aspects as subscales. The scores were described as mild,
moderate, and severe. This questionnaire has been translated into several languages and
therefore, accepted by researches as a reliable tool. Grill acknowledges that even though DHI
total score is well accepted, other studies have found inconsistencies in its subscales (2011).
Concerning the studies which used DHI, Dros et al. (2011) used 417 patients 65 years and
older and found that 60% of dizzy older patients experienced moderate to severe dizziness. The
inventory allowed the researcher to determine which patients suffered the most from dizziness
without knowing the exact cause or causes. Another Dutch study which used the DHI, followed
13 participants and found that the participants may have dizziness, but when reported to their
doctor may be wrongly assessed as a secondary problem ( Stam et al, 2016). The DHI should be
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 7
used to provide a better assessment and to address the dizziness instead of trying to find the
cause of the dizziness (Stam et al., 2016). Researchers using the Korean version of the DHI
examined the reliability and credibility of the questionnaire by comparing the results of 150
patients who were previously diagnosed with Menieres disease and Benign Paroxysmal
Positional Vertigo (BPPV) (Mi et al., 2012). The researchers concluded that patients with
Menieres disease scored significantly higher than patients with BPPV and females with
Menieres suffered longer symptomatic periods with higher scores than males (Mi et al., 2012).
(Mendel et al., 2010; Tomanovic and Bergenius, 2010; Langhagen et al., 2015). Studies used the
stepping in a hole, laterpulsion, walking on pillows, drop attacks, and tilt illusion (Tomanovic &
Bergenius, 2010). This study also used the questionnaire to determine the duration of vertigo
attacks among Menieres disease, benign paroxysmal positional vertigo, and unilateral peripheral
vestibular impairment (Tomonavic & Bergenius, 2010). Other studies used similar assessments
to determine dizziness and vertigo, vertigo types, duration, frequency and constraints in social
activities by dizziness or vertigo (Langhagen et al., 2015). This study used 1,661 8th-10th grade
students and concluded that adolescents suffered from vertigo at a similar rate as adults.
However, the researchers revealed a limitation of all studies on vertigo/dizziness is the lack of
complaints such as headache for children and adolescents (Langhagen et al., 2015).
Two studies included in this literature review used scales (Chitsav et al., 2016; Faag et
al., 2007). Researchers used the Vertigo Severity Scale to evaluate the severity of dizziness of
184 patients. This scale used 15 questions linked to the subscales of vertigo/balance and
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 8
autonomic/ anxiety. The study using the Vertigo Severity Scale concluded the prevalence of
dizziness with psychological disorders (Chitsav et al., 2016) Faag et al. (2007) noted that the
Vertigo Symptom Scale was used in a study to determine its effectiveness in order to describe
episodes of dizziness in a sample of patients suffering from peripheral vestibular disorders (pg.
440). Twenty patients were asked to use a diary to record feelings concerning dizziness and
vertigo and researchers compared diary entries to the scale. The researchers (Faag et al., 2007)
concluded that the scale is an adequate base, but needs to be developed for use with patients
diagnosed with peripheral vestibular symptoms to be able to evaluate care and treatment (pg.
445).
Other studies include analysis of the literature review of questionnaires assessing vertigo
and dizziness (Durancinsky et al., 2007). This study reviewed 29 articles reporting validation and
use of questionnaires using the Patient- Outcome Checklist. The questionnaires were classified as
quality of life, mixed symptoms and quality of life, and symptoms. The researchers used 4
quality of life, three mixed and one Menieres symptoms questionnaire. Researchers (Faag et al.,
2007) concluded that the literature review failed to find any relevant and validated
questionnaires assessing the impact of vertigo or dizziness on the quality of life; however,
Dizziness can be a big problem or a little problem. Dizziness most commonly originates
from the vestibular system, and the brain. When the brain or vestibular system are damaged even
a little bit, a persons coordination and balance can become harder to maintain. Some situations
can have bad outcomes depending on the severity of the damage to the brain or vestibular
system. For example, when soldiers are in the military and they get hit or thrown onto their head
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 9
by an explosion there are sometimes severe damage and other times there is not that much
The brain is a very important part of your body because it controls so much. When people
have had a TBI (traumatic brain injury) one of the problems that arises other than the injury is
dizziness. Dizziness can affect your coordination and balance but it can also cause other
problems like anxiety and severe depression. Anxiety and depression can become a part of any
major injury but to have those problems along with dizziness can be unbearable for some people.
In the whole study-population the association of the dichotomous variables anxiety and
disability was significant.... The same was the case between the association of depression and
disability (Gender differences in patients with dizziness and unsteadiness regarding self-
Injury to the brain and vestibular system cannot just cause injury but it can also cause
chronic dizziness. Patients that have chronic dizziness dont just lose their balance they also
endure very painful headaches and a feeling of fatigue. Headaches are found in patients with
peripheral, as well as central, vestibular disorder. (Gurley, J. M., Hujsak, B. D., & Kelly, J. L.,
2013). Many people who suffer from these headaches and disorders do not know when they are
going to happen. For many people with more severe cases they could wake every other day with
a horrible migraine and not have many options for how to make it go away. People with these
disorders often spend lots of time indoor and sleeping until the pain goes away.
The vestibular system is another thing dizziness can be caused by. The vestibular system
is affected by even the slightest change in your body. So when something in your body changes a
certain way then it can affect your balance and coordination and make you dizzy. Sometimes
when peoples bodys change in other ways they get dizzy spells which are caused by the
EFFECTS OF DIZZINESS ON COORDINATION AND QUALITY OF LIFE 10
vestibular system. Dizzy spells are when someone suddenly gets very dizzy and they start to feel
Sometimes dizziness that is caused from the vestibular system is not caused from an
injury. There are times that the dizziness caused by the vestibular system is because of an inner-
ear malfunction. These malfunctions can be genetic, so the person is born with it or they can be
from a disease that the person once had that left this malfunction as an effect. (Alsalaheen, B. A.,
Whitney, S. L., Mucha, A., Morris, L. O., Furman, J. M., & Sparto, P. J., 2013).
The aim of this literature review was to explore and discuss several themes found in the
research concerning dizziness and coordination. The research reveals that dizziness can have
various meaning and can be disease or disorder, such as Menieres disease, or a symptom of
other problems, such as high blood pressure or traumatic brain injury. Overall, the literature
reveals that women and the elderly are more likely to suffer from balance disorders. However,
there is limited research on the effects of dizziness on adolescents and adolescents quality of
life. The literature includes various research studies using different types of assessments and
scales to determine the severity of dizziness.The research also thoroughly examines the
connection of the vestibular system to the brain and the ability to balance.
Since there is limited information about the connection between dizziness and
coordination and its effects on adolescents daily lives, this study seeks to further advance the
knowledge concerning how dizziness affects teens and adolescents in their daily lives. The
literature supports the use of various scales and assessments and the use of adolescents instead of
adults or elderly adults.This science project aims to focus on the effects of dizziness on
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