Dizziness and Vertigo in Long COVID

Dizziness. What is it?

Please go to our hearing and balance page to learn more about how our bodies regularly handle these senses, this will help you to understand how we are affected when the normal function goes wrong.

Dizziness is a vague term that can imply different things to different people. It is one of the most common complaints reported to a family doctor, and it can be difficult to diagnose and treat. Please see our page on the 10 Causes of Dizziness.

More precisely, dizziness can be characterized in the following ways:

Vertigo² – Vertigo is a sensation of feeling off balance or unsteady or that the room is spinning. It can be caused by inner ear issues, brain problems or the use of certain medications.
Lightheadedness – This is a vague sense that’s sometimes characterized as feeling unanchored or like one’s head is floating. It is typically ongoing and frequently accompanied by anxiety, a feeling of being too hot, or a feeling that you are going to pass out.
Loss of Balance – This is the lack of stability that occurs when you switch positions fast or when walking.

Dizziness is usually diagnosed as either:

A problem WITHIN your vestibular (balance)system

A problem EXTERNAL TO your vestibular system.

Your vestibular system allows you to detect movement accurately and respond appropriately to motion and position changes. It is made up of three parts: the vestibular organ in your inner ear, the sections of your brain that interpret vestibular information, and the vestibularcochlear nerve that connect these two parts.

Problems WITHIN the vestibular system are processes that affect the inner ear, vestibularcochlear nerve, the brain or a combination of all three.

Problems EXTERNAL to the vestibular system that cause dizziness involve other areas of the body and can be due to circulation, blood pressure, heart, hormones, immune system, joints etc.- see our page on the 10 causes of dizziness.

Typical Symptoms –

The most common dizziness symptoms experienced with Long COVID are as follows³:

Generalized dizziness. Some people describe feeling “drunk or tipsy” despite not having any alcohol.
Swaying or rocking when sitting or lying or after moving quickly.
Off balance when changing position – such as going from sitting to standing.
Inability to walk in a straight line.
Spinning sensation particularly when looking down or lying on one’s side.
Headiness or a floating sensation.
Vomiting and/or nausea.
Cognitive impairment (brain fog).
Visual disturbance – seeing double, blurring of vision, difficulty with viewing screens particularly with fast moving or busy scenes.

Who gets dizziness? Adult population

Anyone with Long COVID can experience dizziness, but women are significantly more likely to suffer from it than men, their symptoms tend to be more severe and more likely to persist 9-12 months after infection with SARS-CoV-2(occasionally referred to as the coronavirus in this article) ⁴.

People who get infected with the coronavirus are 2-3 times more likely to develop symptoms of vestibular dysfunction on average, namely dizziness and some other auditory symptoms⁵. Research has shown that this is the case no matter the variant of SARS-CoV-2 circulating, though some variants can increase the risk of developing a vestibular disorder up to 8 times more for those infected than those not infected⁵.

The number of people worldwide thought to be suffering from vestibular disorders out of

700 million people infected with SARS-CoV-2, from the Lee.L et al study is calculated to be approximately 3 million people⁵. Long Haulers with dizziness tend to recover more slowly⁶.

Who gets dizziness? Children with Long COVID Dizziness and Vertigo

In a retrospective study of 272 of children, aged between 5-11years conducted between January 1^st 2022-July 31^st 2022 in Italy looking at audio vestibular symptoms of tinnitus, hyperacusis(heightened sensitivity to some sounds); aural fullness, otalgia(earache), otorrhea (fluid discharge from the ear), vertigo and dizziness, following COVID-19 vaccination and coronavirus infection found that the most common audio vestibular symptoms were aural fullness and dizziness.

Compared to children who received the COVID-19 vaccine, those infected with SARS-COV-2 were more likely to develop tinnitus, hyperacusis, aural fullness, otalgia, otorrhea and vertigo. Audio-vestibular symptoms (except for vertigo which tended to occur 2-4 weeks after infection), tended to start within 2 weeks of a coronavirus infection.

All audio-vestibular symptoms following COVID-19 vaccination resolved within 24hrs whereas those due to SARS-CoV-2 infection persisted for at least 5 days.

New onset unilateral sensorineural hearing loss(loss of hearing in one ear) was found in

2 girls following SARS-CoV-2 infection, no cases of hearing loss were seen following COVID-19 vaccination.

Children with pre-existing one sided hearing loss did not have higher prevalence of audio-vestibular symptoms than children with normal hearing after coronavirus infection or COVID-19 vaccination⁷.

Several small studies have been performed to ascertain the likelihood of children developing audio-vestibular symptoms following SARS-CoV-2 infection with contradictory results. More research is needed to fully understand the exact occurrence of this condition in the pediatric (child) population.

POSSIBLE MECHANISMS

The cause of dizziness and vertigo in Long Haulers is unknown, several theories have been postulated:

WITHIN THE VESTIBULAR SYSTEM

An acute coronavirus infection leading to inflammation of the vestibular-cochlear nerve, inner ear or vestibular regions of the brain.

Reactivation of latent(dormant) herpes viruses such as herpes simplex type 1 or 2 (cause of cold sores) or varicella zoster virus (from a past chickenpox infection) that causes inflammation of the vestibular-cochlear nerve⁵.

Autoimmune disease – SARS-CoV-2 could trigger the release of antibodies that attack the vestibular system.

The presence of SARS-CoV-2 in the body is thought to cause a pro-thrombotic state which means blood clots form in the blood vessels. In this situation the blood supply to the vestibular system would be reduced due to a clot or microclot resulting in ischaemia (reduced blood flow) and therefore damage³.

Some conditions such as vestibular neuritis can be present then lay dormant. Infection with the coronavirus is thought to reactivate something like this.

Medications are used to treat COVID-19, some are directly toxic to the vestibular system, resulting in damage. See our page on the 10 causes of dizziness.

EXTERNAL TO THE VESTIBULAR SYSTEM

COVID-19 is a multisystem disease – many organs are affected or infected with the coronavirus. This can lead to dysfunction in a number of the body’s systems leading to situations such as autoimmune dysfunction (dysautonomia); heart arrhythmias, respiratory disorders leading to breathing difficulty, psychological disorders such as anxiety – all of these examples can cause dizziness or vertigo.

In the quiet aftermath of COVID-19, unseen spirals disrupt stability. Dizziness and vertigo become silent challenges, emphasizing the need for empathy, awareness, and tailored support in the journey towards equilibrium in Long COVID..
Long Covid The Answers

Relief:

As you have learned, there are many causes of dizziness in general and also in Long COVID in particular, so the best way of managing this is to have a Physician familiar or willing to work with a Long Hauler take a careful history and examination with a view to narrowing down exactly what is causing the dizziness. Then the approach would be to treat or manage the cause of it by tried and tested methods. Different Long Haulers will have different causes of their dizziness or vertigo unique to them.

Below are listed some common vestibular disorders and a brief explanation of relief.

Benign Paroxysmal Positional Vertigo (BPPV) – You can read more about BPPV here. Prolonged bed rest such as with fatigue or long hospital stays can increase the risk of BPPV in Long Haulers⁹. BPPV is treated with the Epley Manoeuvre and other targeted manoeuvres and exercises¹⁰by your Physician or a Vestibular Physiotherapist.
Ménière’s Disease or Ménière’s Syndrome – This consists of a trio of vertigo, hearing loss and tinnitus (ringing in the ears). You can read about Ménière’s here. There is no cure for this illness, symptoms are treated with physiotherapy, lifestyle changes and occasionally surgery.
Vestibular Migraine⁸ – The features of this are episodes of vertigo followed by migraine. Treatment can be non-medical – avoiding triggers, getting good sleep, prioritizing a good diet, vestibular rehabilitation therapy via a vestibular physiotherapist or medication administered by your Physician.

GENERAL TIPS³

Stay calm and keep still during an acute attack
Reduce your anxiety – remove stress from your life and incorporate strategies that will relax you such as yoga, meditation, music, art.
Maintain a balanced and healthy diet, avoid excess caffeine, alcohol, sugary and salty foods.
Drink plenty of water, eat small meals little and often rather than big meals.
Post Exertional Malaise(PEM) can worsen dizziness. Avoid PEM by learning how to pace.
Vestibular Physiotherapist – if you can source these valuable healthcare professionals, they will help you to assess and manage your dizziness, with manoeuvres, education and advice.