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Solutions for post-COVID-19 dizziness
By Alek Angeli, PT, DPT, CCVT
Sky Lakes Outpatient Rehabilitation
Most conditions related to dizziness and vertigo are commonly caused by viral infections, which can cause inflammation and impair the inner ear organ, also known as the vestibular system. The vestibular system and other areas of the brain help with coordinating balance and can produce the sensations of dizziness, nausea, hearing complications and double vision when impaired.
Current research shows that as many as 1 in 5 people diagnosed with COVID-19 demonstrate forms of imbalance and dizziness. Some even have associated ear fullness or ringing.
Post-COVID-19 dizziness symptoms
Initial onset of dizziness can vary between each person. Symptoms like "room spinning" dizziness (vertigo)—which is often associated with a spontaneous, single, sudden attack lasting several minutes to hours—typically occur within the first week of getting COVID-19.
A more common form of dizziness associated with COVID-19 includes the feeling of imbalance or the sensation of being on a boat when you move, which can begin weeks after getting COVID-19. Patients often describe the symptoms as:
- Room spinning when they change positions in bed or look up or down;
- Difficulty walking in busy environments, like grocery stores;
- Nausea or vomiting;
- Brain fog or difficulty with short-term memory recall;
- Light-headedness when they change positions; and
- Worsening motion sensitivity.
How it's caused
Inflammation. One of the primary problems associated with COVID-19 is the inflammatory response that causes complications in multiple organs. Classic examples of inflammation of the heart and lungs are difficulty with breathing and quickness to fatigue. Similarly, inflammation of the inner ear (vestibular system) includes dizziness, hearing changes and double vision.
Poor blood flow. There have been many incidents in which COVID-19 has been linked to blood clotting, which can block or slow down blood flow in blood vessels. The vestibular organ and associated structures are very sensitive to changes in blood flow and are quick to react by associated symptoms of dizziness.
Immune response. Our immune system can sometimes react negatively to a virus, like COVID-19, by causing inflammation to specific areas of the brain and vestibular organs, further causing dizziness-related symptoms.
Medications and prolonged inactivity. Typical treatment methods for COVID-19 include use of medications and prolonged periods of rest. In some cases, a side effect of certain medications to treat COVID-19 is to cause a chemical response that can damage hair cells in the inner ear organ responsible for sensing movement and maintaining balance.
Lack of movement also can weaken the inner ear organ based on the principles of "use it or lose it." The inner ear is activated by movement, and without movement it can become weak or less responsive, leading to increased dizziness.
How to treat COVID-19 dizziness
Treatments can vary depending on individual patient needs. Treatment options include personalized head position maneuvers, habituation exercises, exercises using head and eye movements, education, and symptom management advice.
Movement. Although avoiding activities that provoke dizziness feels better, it could prolong your issues and lead to long-term balance and dizziness impairments. You may want to find activities that provoke a little dizziness, so long as your symptoms resolve within minutes afterward. That way your inner ear organ is getting some form of stimulus and does not progressively get weaker.
Manage stress. In many situations, there is an association between poor stress coping or anxiety and increased dizziness. Post-COVID-19 syndrome can often provoke stress and anxiety symptoms. It is important to recognize triggers and try to remove anxiety-provoking activities or reduce stress response with mindfulness practices.
Visit a certified vestibular physical therapist
Dizziness associated with COVID-19 is a complex issue. Patients are often referred by their primary care providers to seek treatment from physical therapists who specialize in examining and treating dizziness-related conditions. Alek Angeli is a doctor of physical therapy and a certified vestibular specialist at Sky Lakes Outpatient Rehabilitation. Call 541.274.6406 for an appointment or visit SkyLakes.org/Dizzy to test your knowledge.