Overview

Overview

Dizziness is one of the most common reasons for a visit to a primary care doctor, but it is not a very descriptive term. It encompasses light-headedness, heavy-headedness, faintness, disorientation, distortion of position in three-dimensional space, turning sensation, spinning sensation or rocking sensation.

The most common cause of vestibular disorders is the side effect to a medication. However, whenever dizziness is followed by a complete loss of consciousness, serious concerns regarding health of the heart or cardiovascular system need prompt medical attention.

As the ears share the same blood supply as the brain, conditions that restrict blood flow to the brain can lead to dizziness. When dizziness is accompanied by other symptoms such as weakness of an arm or leg, double vision, slurred speech, clumsiness of just one arm or leg, facial numbness or facial weakness, prompt medical attention is warranted.

Vestibular Disorders Section Overview

The Section of Vestibular Disorders provides a comprehensive multi-specialty approach to the diagnosis and treatment of vestibular disorders and balance problems.

The balance system is complex and depends on the integration of visual, inner ear, and sensory information from the joints and muscles. The central nervous system integrates this input and directs the body to maintain balance in relation to the demands of the environment.

Many vestibular disorders and problems affecting the vestibular and balance system can be diagnosed with a complete history and physical exam with one of our specialized physicians. When coming for an appointment, patients are asked to bring any records of previous evaluations including physician’s notes, audiograms (hearing tests), vestibular testing, and physical therapy findings. The actual films of prior neuroimaging studies of the brain and/or neck are reviewed, as well as reports from those studies. Patients complete questionnaires about the severity of their dizziness and their overall medical history.

Patients with vestibular disorders should wear comfortable clothing, since the examination will likely involve some reclining and moving from side to side. Special glasses equipped with tiny, infrared cameras to record eye movements may be used to help measure the function of the balance system during these movements.

Additional testing may be suggested if the nature of the problem cannot be determined at the initial visit. Three Cleveland Clinic facilities allow comprehensive assessment to evaluate all aspects of the balance system. Hearing evaluation and neural imaging studies, such as magnetic resonance imaging, can be done, if needed for dizziness or vertigo treatment. Vestibular disorder treatment plans can be formulated for implementation on-site or at home, if patients come from a distance.

Our Team

The multidisciplinary team led by vestibular audiologists includes audiologists, nurses, and vestibular testing technicians and physical therapists trained in specific vestibular disorders and balance therapy techniques. Since the section is located within Cleveland Clinic, rapid access to consultation from many other specialists, such as cardiologists, rehabilitation specialists, and surgical neurotologists, is available, if needed.

Please feel free to contact our office prior to your evaluation if you have questions about what to bring or about medications, or if you are coming from a distance and would like the assistance of our medical concierge service in coordinating the details of your visit.

What We Treat

What We Treat

Symptoms that bring patients to the vestibular disorders section include vertigo (the illusion of movement), disequilibrium, staggering, and lightheadedness. Fainting or loss of consciousness is not usually related to the vestibular and balance system. Hearing loss may be an associated symptom. Some of the common disorders diagnosed and treated in the section include:

  • Benign positional vertigo or BPV, which can cause brief, intense vertigo reproducible with position change.
  • Meniere’s disease, which is an association of more prolonged episodes of vertigo with fluctuating hearing loss.
  • Labyrinthitis, which is a viral inflammation of the inner ear causing vertigo lasting for weeks with associated hearing loss.

Additional areas of expertise include migraine-associated dizziness and the cardiovascular system’s interaction with the vestibular system. Active research areas include studies and evidence-based reviews of vertigo treatment and new diagnostic options and for vestibular disorders.

Dizziness Causes & Management

Dizziness Causes & Management

Feeling dizzy?

Dizziness is a symptom, not a disease. It is a warning signal sent by the body to tell us that something is not functioning properly. Dizziness is defined as a disorientation in space, a sense of unsteadiness, a feeling of movement within the head such as giddiness or a swimming sensation, lightheadedness or a whirling sensation known as vertigo.

For the body to feel balanced, the brain requires input from the inner ear, eyes, muscles and joints. Since mechanisms for maintaining balance are so complex, finding the exact cause of dizziness is often difficult and requires input from several medical specialties. Dizziness can result from problems associated with the inner ear, brain or heart.

Dizziness continues to be one of the most common reasons to visit a primary care physician.  While dizziness may be a clinical sign of stroke, it may not have a serious or life-threatening cause. Nevertheless, this symptom can be very debilitating and lead to activity restriction and frustration.  It is very common for patients with dizziness to associate with anxiety and depression.

Symptoms that bring patients to the vestibular disorders section include vertigo (the illusion of movement), disequilibrium, staggering, and lightheadedness. Fainting or loss of consciousness is not usually related to the vestibular and balance system, however, patients may present with symptoms requiring evaluation in our facility. Hearing loss may be an associated symptom. Some of the common disorders diagnosed and treated in the section include:

  • Benign paroxysmal positional vertigo or BPPV, which can cause brief, intense vertigo reproducible with position change.
  • Meniere’s disease, which is an association of more prolonged episodes of vertigo with fluctuating hearing loss.
  • Vestibular Migraines, which is also an association of more prolonged episodes of vertigo, imbalance, or other rocking sensations without fluctuating hearing complaints and may or may not be associated with migraine headache.
  • Labyrinthitis, which is a viral inflammation of the inner ear causing vertigo lasting for weeks with associated hearing loss.

These are only a few examples of common disorders.  Our evaluation aids in further identifying the many additional causes of vestibular dysfunction.  Active research areas include studies and evidence-based reviews of vertigo treatment and new diagnostic options and for vestibular disorders.

If you are feeling dizzy

If you are feeling dizzy, you may schedule an appointment within the Head and Neck Institute for a thorough evaluation. It is important to see your physician for a thorough evaluation. Included in this evaluation should be:

  • A complete medical history
  • An audiogram (basic hearing test) and other specialized speech and hearing tests.
  • An electronystagmogram or ENG (balance test)
  • Two additional and specialized balance tests, rotating chair and posturography.

Depending on what these tests reveal, your physician may recommend a CAT scan (x-ray) or MRI (magnetic resonance imaging). Blood tests to evaluate thyroid function and the immune system also may be recommended, as well as physical therapy evaluation and rehabilitation.

This information is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient.

FAQ's

FAQ's

What is dizziness?

Dizziness is one of the most common reasons for a visit to a primary care physician. Dizziness is not a very descriptive term; it is one of the vestibular disorders that encompasses light-headedness, heavy-headedness, faintness or about to pass out, disorientation, distortion of position in three-dimensional space, turning sensation, spinning sensation or rocking sensation. To some it may seem that they are moving, to others it may seem the world is moving. Sometimes it is a sensation related to imbalance or a sense of an impending fall. Although vertigo has long been used by doctors as a more specific term to describe an inner ear condition, frequently such a distinction can be misleading.

What causes dizziness?

The most common cause of dizziness is the side effect to a medication. The chemical nature of many medications interferes with the neurotransmission in the brain or may drop the blood flow to the brain to critically low levels (hypotension). However, whenever dizziness is followed by a complete loss of consciousness, serious concerns regarding health of the heart or cardiovascular system need prompt medical attention. As the ears share the same blood supply as the brain, conditions that restrict blood flow to the brain can lead to dizziness.

Whenever dizziness is accompanied by other neurological symptoms such as weakness of an arm or leg, double vision, slurred speech, clumsiness of just one arm or leg, facial numbness or facial weakness, serious concerns regarding stroke need prompt medical attention.

These are important instances when dizziness heralds a life-threatening medical problem, and such concerns should be addressed without delay at a local Emergency Room. More commonly, dizziness is simply a sign of something wrong somewhere in the vastly complex vestibular system. Another common cause of dizziness is anxiety, usually closely coupled with other symptoms of fright or panic.

What is the vestibular system?

A complex system composed of sensors in the inner ear (vestibular labyrinth), upper neck (cervical proprioception), eyes (visual motion and tree dimensional orientation), and body (somatic proprioception) analyzed in several areas of the brain (brainstem, cerebellum, parietal and temporal cortex) affecting eyes (vestibulo-ocular reflexes), neck (vestibulo-collic reflexes), and balance (vestibulo-spinal reflexes) and at the same time keeping us apprised of where were are and how were moving through the world (visuospatial orientation). A system this complex deserves to be called a sense, like our sense of hearing, sight, etc. Its complexity befuddles doctors and patients alike.

What are vestibular tests?

A set of laboratory tests done in hospital or clinic that measure the function of various parts of the system individually. Called electronystagmography (ENG) in the past, today advanced technology allows for more comprehensive testing of vestibular disorders.

Videonystagmography (VNG) is a technique to measure the way eyes move in darkness (without the use of electrodes) using video cameras that see in the dark. Positional testing, including the Dix-Hallpike positioning test, can determine the presence of a common vestibular problem, benign paroxysmal positional vertigo (BPPV).

Caloric testing is a way to compare the response of each ear to warming or cooling stimulation. The damaged ear will respond less vigorously or not at all. Rotational chair (SVAR) testing measures the vestibulo-ocular reflex (VOR), providing information on how the brain is responding to the condition of the vestibular labyrinth, how the brain can suppress stimulation of the vestibular labyrinth, and how well the brain senses visual motion with or without stimulation of the vestibular labyrinth.

What is vestibular rehabilitation?

Physical therapy that promotes neurological adaptation required to restore the vestibular sense. A vestibular rehabilitation therapist assesses specific lost abilities and vestibular disorders, then teaches exercises to be done on a daily basis to recover those lost abilities, without the use of medications.

During six to eight weekly therapy sessions, new exercises are assigned to reach increasingly complex levels of vestibular function. A similar process is used by dancers, skaters, gymnasts, and fighter pilots to maintain a higher level of vestibular fitness necessary for their daily activities. A vestibular rehabilitation therapist is the coach necessary to complete the process in patients with vestibular disorders.

Research

Research

Selected Publications:

Hreib K, White J, Lucey M. Cranial Nerve VIII — "Vestibular." Netter’s Neurology, Ed. H. Royden Jones, Jr., MD, ICON Publishing, Teterboro New Jersey, 2005

White J. — "Meniere’s and otosclerosis." Otoneurologia 2000 18:36-7, 2004.

White J. —"Horizontal semicircular canal benign positional vertigo." Proceedings of the Barany Society XXIII International Congress, J. Vest. Res. 14(2,3):183-4, 2004.

White J. — "Benign paroxysmal positional vertigo." Cleveland Clinic Journal of Medicine, September 2004.

White J, Coale K, Catalano P, Oas J. — "Lateral semicircular canal benign positional vertigo, diagnosis and management." Otolaryngology-Head and Neck Surgery, in press.

White J, Savvides P, Cherian N, Oas J. — "Canalith repositioning for benign paroxysmal positional vertigo, an evidence based review." Otology and Neurotology, in press.

White J, Oas J. — "Diagnosis and management of lateral semicircular canal conversions during particle repositioning therapy." Laryngoscope, in press.

White J, Oas J. — "Meniere’s and migraine." Proceedings of the Fifth International Symposium on Meniere’s, Los Angeles, CA, 2005, in press.

White J. — "Benign paroxysmal positional vertigo," in Practical Management Approaches to the Dizzy Patient, Ed. P. Weber, Thieme Publishing, NY, NY. In press.

White J, Oas J. — "Apogeotropic nystagmus in lateral semicircular canal benign paroxysmal positional vertigo." Neurology (suppl.1) 64(6):A12,2005.

White J, Coale K, Beaudoin K, Catalano P, Cohen N, Oas J. — "Postural control in elderly patients with benign paroxysmal positional vertigo." Submitted to Journal of Vestibular Research.