Vestibular Disorders

What are vestibular disorders?

Vestibular disorders involve problems with your vestibular system. This body system includes structures in your inner ear and brain that help you maintain your sense of balance.

A problem with the vestibular structures within your inner ear or the parts of your central nervous system (CNS) that process this information can lead to balance problems (vestibular dysfunction). Typically, vestibular issues cause symptoms like dizziness and vertigo.

Types of vestibular disorders

Experts classify vestibular disorders based on where the breakdown is within your vestibular system:

• Peripheral vestibular disorders (PVD): Conditions that impact your inner ear or the nerve that carries balance signals to your brain (vestibular nerve).
• Central vestibular disorders (CVD): Conditions that impact parts of your brain that process balance signals from your peripheral vestibular system.

The most common vestibular disorders are:

• Benign paroxysmal positional vertigo (BPPV).
• Ménière’s disease.
• Vestibular neuritis.
• Labyrinthitis.

Other vestibular conditions include:

• Acoustic neuroma.
• Autoimmune inner ear disease.
• Enlarged vestibular aqueducts (EVA).
• Mal de débarquement syndrome (MdDS).
• Otosclerosis.
• Perilymphatic fistula (PLF).
• Persistent postural-perceptual dizziness (PPPD).
• Presbyvestibulopathy (PVP).
• Secondary endolymphatic hydrops.
• Superior semicircular canal dehiscence syndrome.
• Vascular vertigo.
• Vertebrobasilar insufficiency.
• Vestibular ataxia.
• Vestibular migraines.
• Vestibular hypofunction.
• Vestibular paroxysmia.

What are the symptoms of vestibular disorders?

The most common symptoms of a vestibular issue are:

• Dizziness (feeling disoriented or “woozy”).
• Vertigo (feeling as if you’re spinning or the room is spinning around you).

Other symptoms depend on the specific condition or balance issues you’re having. They include:

• Trouble standing or sitting upright.
• Trouble walking in a steady pattern.
• Hearing loss or ringing in your ears (tinnitus).
• Uncontrollable, irregular eye movements (nystagmus).
• Blurred vision.
• Nausea and vomiting.
• Difficulty concentrating.

What causes vestibular disorders?

Causes of vestibular dysfunction include:

• Aging: The structures within your inner ear that receive and send balance signals to your brain can deteriorate as you age.
• Head injuries: Trauma from a head injury can damage your inner ear or parts of your brain involved in your vestibular system.
• Exposure to toxins: Ototoxicity is when a medicine you’re taking damages your inner ear. It’s one of the most common causes of vestibular dysfunction. Chemicals in the environment (like lead) can also damage your inner ear.
• Inflammation: Inflammation can damage the organs and nerves in your inner ear involved in balance. Sometimes, the inflammation results from a viral or bacterial infection.
• Problems with inner ear fluid (endolymph): Fluid inside your inner ear shifts in response to your head movements. The shifting activates nerves that communicate information about your position to your brain. Problems with the fluid can disrupt the signal, causing vestibular system problems.
• Tumors: Growths, including tumors, can impact the nerves that help you maintain your balance.
• Autoimmune diseases: Although it’s rare, an autoimmune disease can cause your immune system to attack your inner ear.
• Neurological conditions: Conditions that impact your nerves and CNS can disrupt your balance. Stroke is a common cause of central vestibular dysfunction. Other causes include conditions that damage the protective covering of your nerves (demyelinating diseases).

Triggers of vestibular disorders

Some vestibular disorders involve episodes where you experience symptoms like dizziness and vertigo, followed by periods where you don’t experience symptoms at all. In these instances, “triggers” may start or worsen an episode. Triggers may include:

• Changes in your environment (like entering a “busy,” visually stimulating place).
• Sudden head movements or changes in position (like lying back in bed).
• Certain foods and drinks.
• Lack of sleep.
• Stress.

Your healthcare provider can help you identify factors that trigger or intensify symptoms.

What are the complications of vestibular disorders?

Vestibular dysfunction doesn’t just impact your balance. Untreated vestibular conditions can lead to other things, too, like:

• Falls: Trouble balancing can lead to dangerous falls. According to the World Health Organization, about 20% to 30% of older people in the U.S. who fall experience serious head injuries, bruises or hip fractures. The risk of life-threatening falls is greatest in people over 60 years old.
• Long-term hearing loss: Some vestibular disorders are also associated with long-term hearing loss. Early diagnosis and treatment can often prevent this from happening.
• Mental health conditions: Symptoms of vestibular dysfunction can keep you from doing everyday activities like driving or even walking. Vestibular issues can cause you to avoid social interactions if you’re concerned something might trigger dizziness or a vertigo episode. The effects can lead to anxiety and depression.

It’s important to get checked and treated so you don’t increase your risk of additional health issues.

How are vestibular disorders diagnosed?

Your healthcare provider will perform a physical exam and a neurological exam to diagnose your condition. They’ll also ask about your symptoms. Understanding your symptoms is key to determining whether the problem is in your inner ear or CNS.

What kind of doctor do you see for vestibular disorders?

Healthcare providers that diagnose and treat vestibular disorders include:

• Otolaryngologists (ENTs).
• Vestibular audiologists.
• Neurologists.
• Physical therapists.

What tests will be done to diagnose vestibular disorders?

Tests may include:

• Vestibular tests: Vestibular testing involves several tests that can check how the vestibular organs within your inner ear are working. Many check how your eyes and inner ear are working together to help you maintain balance.
• Hearing tests: These check for signs of hearing loss or symptoms like ringing in your ear that may be related to a vestibular disorder.
• Imaging tests: You may need imaging procedures like an MRI (magnetic resonance imaging) or CT scan (computed tomography scan) to check for structural problems in your inner ear or brain.
• Blood tests: These can check for infections that may be causing inner ear issues.

How are vestibular disorders treated?

Your treatment depends on the specific condition. Vestibular disorder treatments may include:

• Lifestyle changes: Conservative treatments, like lifestyle changes, go a long way in managing several vestibular disorders. For example, if fluid buildup in your ear is an issue, reducing salty foods (which cause you to retain water) may help. So can learning to identify and manage triggers that may cause a vertigo episode.
• Medications: You may need medicines to treat what’s causing your condition or to manage symptoms. For example, you may need antibiotics to clear bacterial infections or diuretics to reduce fluid buildup in your ear. You may need anti-nausea medications or antihistamines to manage feelings of motion sickness.
• Canalith repositioning procedure: If you have BPPV, you may work with a physical therapist to help reposition misplaced structures called canaliths in your inner ear with this procedure.
• Vestibular rehabilitation: Vestibular rehabilitation therapy involves exercise sessions that can help you manage dizziness and vertigo.
• Surgery: Surgery on your inner ear is usually a last resort for treating vestibular disorders. But you may need it to manage severe vertigo symptoms if other treatments don’t help.

Can vestibular disorders be prevented?

It depends on the cause of the vestibular disorder, but typically, vestibular disorders aren’t preventable.

But there are things you can do to care for yourself. For example, you can get treated as early as possible to prevent long-term damage from causes like infections. If you’re living with a chronic (long-lasting) condition, you can take steps to reduce your risk of falls.

What can I expect if I have a vestibular disorder?

Your situation depends on the specific vestibular disorder. In some cases, vestibular issues go away. For example, vestibular problems related to infections usually improve once the virus or bacteria are gone. Still, it’s important to get treated as soon as possible to prevent long-term inner ear damage.

Other vestibular disorders require lifelong management. Symptoms may come and go unpredictably or in response to triggers that you learn to identify. If this sounds like you, you’ll work with a healthcare provider (or care team) to manage your condition.

How do I take care of myself?

Often, it takes a combination of lifestyle adjustments, medications and vestibular rehabilitation to treat or manage a vestibular disorder. But most people find a treatment plan that works for them. In the meantime, you can care for yourself by:

• Always having your medications handy.
• Taking time out to rest if you’re starting to experience symptoms.
• Avoiding high-risk activities unless you’re sure they’re safe.
• Avoiding (or quitting) smoking, which can cause symptom flare-ups.
• Reducing caffeine and alcohol, which are common symptom flare-up triggers.

What questions should I ask my healthcare provider?

Questions to ask include:

• What caused my vestibular disorder?
• What tests will I need to diagnose my condition?
• What treatments will I need?
• How can I manage triggers?
• What changes can I make to reduce my risk of a fall?

A note from Cleveland Clinic

Most of us don’t notice how important maintaining a sense of balance is to our everyday lives until a problem arises — and suddenly it feels as if the room is spinning. Sometimes, the feeling is fleeting. But if you have a vestibular disorder, it’s important to see a healthcare provider to get treated before an episode of vertigo becomes something more dangerous, like a fall. Your healthcare provider will help you find the right combination of treatments to fix your balance issue or help you manage symptoms.