From the Guidelines
Dizziness in the elderly following a post-viral infection is most likely caused by benign paroxysmal positional vertigo (BPPV) or long COVID, which can affect the vestibular system and cause inflammation or fluid buildup, disrupting balance signals to the brain. The exact cause of dizziness can be determined through a thorough neurologic examination and a simple Dix-Hallpike test, which can reliably identify BPPV and rule out other neurologic problems 1. According to a recent study, long COVID can also cause neurological and cognitive symptoms, including dizziness and balance issues, which can be debilitating and impact daily living 1.
Some key factors that contribute to dizziness in the elderly after a viral infection include:
- Age-related changes in the vestibular system, making them more susceptible to prolonged symptoms
- Inflammation or fluid buildup in the inner ear, disrupting balance signals to the brain
- Neuroinflammation, damage to blood vessels, and injury to neurons, which can occur in long COVID
- Activation of the kynurenine pathway, associated with cognitive impairment and dizziness
For immediate relief, I recommend starting with non-medication approaches such as:
- Adequate hydration
- Gradual position changes when standing up
- Avoiding sudden head movements Over-the-counter medications like meclizine (Antivert) 12.5-25mg every 4-6 hours as needed can help manage symptoms, but should be used for only 3-5 days to prevent dependence. For persistent dizziness, vestibular rehabilitation exercises performed daily for 10-15 minutes can be beneficial, including eye movement exercises, head rotations, and balance training 1. If dizziness is accompanied by severe headache, hearing loss, high fever, or difficulty walking, immediate medical attention is necessary.
From the Research
Causes of Dizziness in the Elderly Following a Post-Viral Infection
- Dizziness in the elderly can be caused by various factors, including vestibular disorders, which may be exacerbated by post-viral infections such as COVID-19 2, 3.
- Vestibular suppressants, commonly prescribed for dizziness, may not be effective in the long term and can even increase the risk of falls in older adults 4.
- Post-viral infections, such as COVID-19, can cause inner ear damage and lead to vestibular dysfunction, resulting in dizziness and vertigo 2, 3.
- Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness in the elderly and can be triggered by viral infections, including COVID-19 3, 5.
- Age-related degenerative processes, such as presbystasis, can also contribute to dizziness and vertigo in the elderly 6.
Vestibular Disorders and Post-Viral Infections
- COVID-19 infection can cause vestibular damage and lead to persistent dizziness and vertigo 2.
- The pathophysiology of post-COVID-19 BPPV is thought to be similar to that of other viral infections, with possible hypercoagulation and microthrombus formation affecting the inner ear 3.
- Comprehensive studies are needed to investigate the long-term effects of COVID-19 on the vestibular system and the development of dizziness and vertigo in the elderly 2.
Diagnosis and Management of Dizziness in the Elderly
- Accurate diagnosis and management of dizziness in the elderly require a comprehensive approach, including otoneurological assessment and consideration of age-related degenerative processes 6.
- Vestibular suppressants should be used with caution in older adults, and alternative treatments, such as particle-repositioning maneuvers or habituation exercises, may be more effective for BPPV 4, 5.