by Joon Nah BScPT
Certified Vestibular Physiotherapist
updated Jan 28, 2022
It is widely acknowledged that disorders that cause dizziness and vertigo are commonly caused by viral infections. Many of these infections can inflame and damage the inner ear (the vestibular organ) or other areas of the brain that coordinate motion and position which can produce dizziness, nausea, imbalance, hearing issues and visual complaints.
The very high prevalence of the COVID-19 novel coronavirus and its variants means that millions of people are currently at risk of having issues with dizziness following infection.
At the time of this article, case reports are showing that between 12% – 20% of those infected by COVID-19 are presenting with imbalance and dizziness symptoms. Hearing loss has been approximated at 6% and tinnitus (ear ringing) at 15%.
It is important to note that due to the recent onset of COVID-19, and the rapidly changing nature of the virus and its variants, our knowledge about its side-effects (such as dizziness) is also building and changing. Particularly with respect to Post COVID Syndrome (Long Haulers).
What are Post COVID Dizziness symptoms?
The long haul symptoms associated with COVID-19 are varied and numerous. However the most common symptoms related specifically to dizziness and vestibular issues are reported as below. Note that you may only have one or a few of these symptoms.
- Generalized dizziness. Some report feeling “drunk or tipsy” but without having any alcohol.
- Lightheaded-ness or a floating feeling
- Vertigo or a spinning sensation, particularly when looking up or down, or lying on your side
- A sensation of swaying or rocking when sitting or lying, or after a quick motion
- Poor balance when standing or changing positions
- Problems walking in a straight line or in busy areas such as a shopping mall
- Nausea or vomiting
- Brain fog. (Click here to learn more about COVID Brain fog)
- Issues with vision such as blurring, doubling, trouble viewing screens or issues with fast moving or busy scenes.
Understanding general causes of dizziness and imbalance
Dizziness is usually diagnosed as either:
1) a problem WITH your vestibular system
2) a problem OUTSIDE of your vestibular system
Your vestibular system allows you to sense movement accurately and lets you react properly to motion and changes in position. It consists of the (i) vestibular organ in your inner ear, (ii) the areas of your brain that process vestibular information and (iii) the vestibular nerves that connect these two areas.
Problems WITH your vestibular system are one of the most common reasons for dizziness. Affected areas can include the inner ear, the brain, the vestibular nerves or any combination of those structures.
Problems OUTSIDE of your vestibular system involve many other areas of the body. Here dizziness can be a result of issues with your circulation, blood pressure, your heart, your brain and the nervous system, hormone regulation, your autoimmune system, the joints in your neck, spine and extremities, among other areas.
How does COVID-19 cause dizziness?
The coronavirus disease has been shown to cause organ complications due to inflammatory reactions. For example, the inflammation of the heart and lungs cause some of the classic post COVID symptoms such as breathing difficulties, coughing, and chronic fatigue. Inflammation of our inner ear and vestibular centres of the brain, can quickly create a range of dizziness related symptoms.
Decreased blood flow
The vestibular and hearing organ in your inner ear is very sensitive to changes in blood flow (ischemia). It is thought that the thrombosis (or blood clots) associated with the coronavirus damages this area as well in addition to other processes that block flow in blood vessels. This is a similar mechanism that typically causes many vestibular disorders such as vestibular neuritis/labyrinthitis, Meniere’s disease, vestibular migraine and more.
There is also potentially an side-effect of our immune system response to the virus that negatively affects our inner ear and brain. We expect to learn more about this cause in the near future.
Reactivation of an pre-existing vestibular problem
It is common for some inner ear conditions such as vestibular neuritis to have active and dormant periods. There is some evidence that COVID-19 has the ability to reactivate vestibular conditions that are in remission.
As a secondary symptom from COVID’s effects on other organs.
In some cases, the issues with dizziness and imbalance are not related to problems with the vestibular system, but rather from the health issues related to other affected body parts. Muscle weakness, poorer coordination, effects on blood pressure and extreme fatigue can certainly cause balance and dizziness symptoms.
Medications and Prolonged Bed Rest
Treatment for COVID-19 infection often means the use of medications and long periods of time in lying positions. There is some evidence that the use of some drugs to combat the effects of COVID such as hydroxychloroquine, ritonavir, interferon, and ivermectin may cause a condition called ototoxicity. This is where a chemical has a harmful or toxic effect on the inner ear organ, temporarily or permanently damaging its function. Therefore, any agent used to treat dizziness following COVID-19 infection should be carefully discussed with your physician and used with caution.
When medications are combined with prolonged bed rest, there have been reports of higher incidences of Benign Paroxysmal Positional Vertigo (BPPV) and imbalance, lightheadedness and motion-sensitivity.
When does dizziness from Long COVID start?
Dizziness is a common feature of COVID infection and in many patients, the dizziness symptoms begin at the time of initial infection. However typical spinning type of dizziness (vertigo) that is associated with sudden onset, acute attacks of the vestibular system will usually present earlier after infection, often within the first week.
Imbalance and dizziness that is non-spinning can start occurring weeks after contraction of COVID-19. In these cases the effects of the coronavirus on the vestibular system and other body systems can combine and become more apparent as your body continues its struggle, fighting the longer-term effects of the virus post COVID.
How to treat Post COVID Dizziness?
Treatment options for dizziness caused by COVID-19 is different for each person affected. It depends on what structures have been damaged and in what way. In some cases, patients infected by COVID-19 develop specific and well-known vestibular conditions. If this is the case, then recovery strategies are based on the usual approaches that are used to treat that distinct condition. Click on these common vestibular conditions below to understand what is involved with each one.
- Vestibular neuritis
- Benign Paroxysmal Positional Vertigo (BPPV)
- Meniere’s Disease
- Vestibular Migraine
- Persistent Postural Perceptual Dizziness (PPPD)
Long Haulers COVID is a complex condition that affects many different body systems. Focusing treatment on only one or two specific symptoms such as dizziness and imbalance will usually only produce partial improvement. Due to the tight-knit relationship of your vestibular system to your brain, your visual system, your circulation, your joints etc. complete recovery is much more likely when all of your post COVID impairments are addressed together.
Tips on treating Long COVID Dizziness
During a dizziness attack.
Stop moving and get to a safe sitting or lying position. Focus on one specific thing in front of you. Try to have as much contact with your hands/feet on the surfaces around you. Remain calm as anxiety will increase your symptoms.
Energy Conservation and Fatigue
Your head and body have limits to how much stimulation it can tolerate before your recovery starts moving backwards. Learn to respect these boundaries using daily activity/symptom logs and schedule in very frequent breaks regardless of how good you may think you’re feeling.
Regular movement and activity
While respecting the energy conservation advice above, head and body movement performed regularly can be significantly helpful in improving long haul COVID dizziness. Light activity such as getting up/down often, standing, turning/pivoting and walking are excellent ways to stimulate your vestibular system and body to recover faster.
A little dizziness can be good!
Avoiding things that make you dizzy may make you feel better at that moment, but can prolong your recovery and leave you with chronic, long-term dizziness and balance issues. Activities that provoke a little dizziness is often advised, as long as it disappears within a few minutes to an hour afterwards.
Reduce your anxiety
There is connection between and increase in dizziness and poor stress coping and anxiety. Recognize that this relationship exists in most people affected with Post COVID syndrome and work on removing anxiety-provoking factors and reducing anxiety through meditation, psychotherapy, or medications.
Diet and Hydration
Reduce the intake of caffeine, alcohol, high-salt and high-sugar foods and avoid smoking. Drink more water daily; at least 4 tall glasses. Eat smaller meals more often to reduce nausea and keep steady blood sugar levels.
Elevate your head while sleeping.
In the short term only, you may consider using an extra pillow or placing wood blocks under the legs at the top of your bed to produce an incline in your sleep position. This can temporarily improve your ability to sleep when dizzy, which in turn reduces fatigue, improves stability and can help kick-start faster recovery.
Structured pacing helps
Click here to learn how pacing can reduce dizziness and the overall symptoms of COVID-19 and help you avoid making your symptoms worse.
See a Vestibular Physiotherapist
As COVID-19 induced dizziness is a complex issue to understand, patients are often referred by hospitals and specialists to seek treatment from a physiotherapist who specializes in assessing and treating dizziness disorders. Treatment can involve manual head manoeuvres, education and advice on management, and a specific home exercise prescription. Click here for more details on how Vestibular Rehabilitation Therapy works.
How long does Post COVID Dizziness last?
General dizziness is a common side-effect of acute COVID infection and in many cases, will disappear as the other typical symptoms of COVID-19 resolve. However, Long Hauler / Post COVID Syndrome impairments are much more difficult to understand and to predict. At this time, research in this area is primarily presented in the form of case reports which show us that dizziness complaints do not have a standard progression and recovery pattern. Less common cases involving spinning vertigo can improve quite quickly, particularly with the help of vestibular physiotherapist. However the majority of post COVID dizziness issues appear to last for weeks to months. And due to the recent onset of this pandemic, at this time, many patients have found their symptoms are not resolving at all.
As the pool of Long Haul COVID patients continues to rapidly get larger, the collection of data is also quickly growing. We expect to have more clarity in understanding the long term effects of post COVID dizziness in the near future, and whether patients can recover completely.
Dizziness and vertigo after COVID-19 vaccination
All vaccinations (and medical interventions in general) come with some risk of adverse side-effects, including COVID-19 vaccinations such as with Pfizer/BioNTech, AstraZeneca, and Moderna. Vaccine Surveillance Reports do indicate that vertigo, tinnitus and hearing loss is a small part of the group of possible symptoms related to post-vaccination side-effects. However, more studies are need to determine the nature of this relationship and any long-term symptoms and consequences.
On a positive note, it has been observed that the majority of those who find any symptoms of dizziness after vaccination, find them mild and temporary.
Long COVID Dizziness treatment near me
Cornerstone Physiotherapy has experts in the management of both dizziness disorders and Long COVID rehabilitation. Our vestibular physiotherapists can offer assessment and treatment in-person and virtually over video telehealth for residents of the province of Ontario. We have clinic locations in Toronto, North York, Burlington and Markham. If you are unsure whether we can help you, contact us for a free 10 minute phone consult with a registered physiotherapist.
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