Dizziness and balance issues are common and often persistent symptoms associated with COVID-19 infection. The term “dizziness” describes two distinct sensations. True vertigo is the feeling that you or your surroundings are spinning, typically linked to a problem within the inner ear or brain’s balance centers. Lightheadedness is a feeling of faintness or unsteadiness, often related to issues with blood flow or systemic illness. Dizziness is reported by up to 20% of people during the acute phase of the illness and can continue for months during recovery.
Systemic Effects That Trigger Dizziness
During the acute phase, dizziness frequently stems from the body’s overall response to the viral invasion. The intense inflammatory state triggers the release of signaling molecules called cytokines, which can temporarily disrupt normal brain function and alertness. This systemic inflammation contributes to a general feeling of being unwell, often described as brain fog or unsteadiness.
Fevers and reduced fluid intake, common with severe viral infections, can lead to dehydration and a temporary drop in blood pressure, known as hypovolemia. Low blood volume causes the body to struggle to maintain adequate blood flow to the brain, resulting in lightheadedness or a near-fainting sensation. Severe fatigue, a hallmark of COVID-19, also contributes to balance disturbance by limiting the energy needed for stable movement and coordination.
Direct Viral Impact on the Vestibular System
A more specific cause of the spinning sensation, or vertigo, involves the vestibular system. This sensory apparatus in the inner ear maintains balance and includes the semicircular canals and the vestibulocochlear nerve. The SARS-CoV-2 virus can affect this delicate system through direct invasion and immune-mediated damage.
The virus may trigger an inflammatory response targeting the inner ear structures or the vestibulocochlear nerve, a condition known as vestibular neuritis or labyrinthitis. Nerve damage causes conflicting signals to be sent to the brain, leading to the sudden, severe onset of vertigo. Additionally, the virus can cause inflammation and micro-clotting in the small blood vessels supplying oxygen to the inner ear. Because the vestibular organ is highly sensitive to blood flow changes, reduced circulation impairs its function and results in balance disorders.
Research suggests the virus may utilize the ACE-2 receptor, present in inner ear tissues, to gain entry and cause damage. This localized inflammation disrupts the communication pathway between the inner ear and the brain’s balance centers. This involvement often produces true rotational vertigo, sometimes accompanied by hearing loss or ringing in the ears (tinnitus).
Autonomic Dysfunction and Blood Pressure Changes
One complex and long-lasting cause of post-COVID dizziness relates to the body’s control systems, specifically the Autonomic Nervous System (ANS). The ANS regulates involuntary functions like heart rate, breathing, and blood pressure. When the virus or inflammation causes this system to malfunction, the condition is called dysautonomia.
A primary manifestation of post-COVID dysautonomia is Orthostatic Intolerance, meaning the body cannot tolerate the upright position. Normally, when a person stands up, the ANS triggers blood vessels to constrict and the heart rate to increase slightly, preventing blood from pooling in the lower body. In dysautonomia, this regulatory reflex fails, leading to a temporary reduction of blood flow to the brain. This failure results in dizziness, lightheadedness, or near-fainting specifically upon transitioning to standing.
Postural Orthostatic Tachycardia Syndrome (POTS) is a specific type of dysautonomia frequently reported after COVID-19 infection. A person with POTS experiences an abnormal increase in heart rate—often more than 30 beats per minute—within ten minutes of standing. This rapid heart rate is the body’s attempt to compensate for the blood pressure drop and insufficient blood return to the heart. The resulting cerebral hypoperfusion, or lack of blood flow to the brain, directly causes the dizziness, brain fog, and fatigue seen in this syndrome.
When Dizziness Becomes a Long-Term Symptom
When dizziness persists for weeks or months after the initial infection, it is categorized as a symptom of Long COVID, also known as Post-Acute Sequelae of COVID-19 (PASC). This prolonged dizziness is often the continuation of underlying mechanisms that began during the acute illness, particularly unresolved autonomic dysfunction and orthostatic intolerance.
The persistent inflammation from the acute phase can continue to affect the nervous system and the inner ear. Ongoing neuroinflammation or unresolved damage to the vestibular nerve can lead to chronic unsteadiness and imbalance. If the dizziness is primarily lightheadedness that worsens with standing, it suggests that dysautonomia, possibly POTS, has become chronic. Persistent dizziness can significantly interfere with daily life, and any chronic or worsening balance issue, especially if accompanied by fainting or chest pain, warrants a medical evaluation.