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Vertigo caused by inner ear infection: Vertigo: Causes, Symptoms, and Treatment


Vertigo: Causes, Symptoms, and Treatment

Vertigo is a sensation of feeling off balance. If you have these dizzy spells, you might feel like you are spinning or that the world around you is spinning.

Causes of Vertigo

Vertigo is often caused by an inner ear problem. Some of the most common causes include:

BPPV. These initials stand for benign paroxysmal positional vertigo. BPPV occurs when tiny calcium particles (canaliths) are dislodged from their normal location and collect in the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. It helps you keep your balance.

BPPV can occur for no known reason and may be associated with age.

Meniere’s disease. This is an inner ear disorder thought to be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss.

Vestibular neuritis or labyrinthitis. This is an inner ear problem usually related to infection (usually viral). The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance

Less often vertigo may be associated with:

  • Head or neck injury
  • Brain problems such as stroke or tumor
  • Certain medications that cause ear damage
  • Migraine headaches

Symptoms of Vertigo

Vertigo is often triggered by a change in the position of your head.

People with vertigo typically describe it as feeling like they are:

  • Spinning
  • Tilting
  • Swaying
  • Unbalanced
  • Pulled to one direction

Other symptoms that may accompany vertigo include:

Symptoms can last a few minutes to a few hours or more and may come and go.

Treatment for Vertigo

Treatment for vertigo depends on what’s causing it. In many cases, vertigo goes away without any treatment. This is because your brain is able to adapt, at least in part, to the inner ear changes, relying on other mechanisms to maintain balance.

For some, treatment is needed and may include:

Vestibular rehabilitation. This is a type of physical therapy aimed at helping strengthen the vestibular system. The function of the vestibular system is to send signals to the brain about head and body movements relative to gravity.


Vestibular rehab may be recommended if you have recurrent bouts of vertigo. It helps train your other senses to compensate for vertigo.

Canalith repositioning maneuvers. Guidelines from the American Academy of Neurology recommend a series of specific head and body movements for BPPV. The movements are done to move the calcium deposits out of the canal into an inner ear chamber so they can be absorbed by the body. You will likely have vertigo symptoms during the procedure as the canaliths move.

A doctor or physical therapist can guide you through the movements. The movements are safe and often effective.

Medicine. In some cases, medication may be given to relieve symptoms such as nausea or motion sickness associated with vertigo.

If vertigo is caused by an infection or inflammation, antibiotics or steroids may reduce swelling and cure infection.

For Meniere’s disease, diuretics (water pills) may be prescribed to reduce pressure from fluid buildup.

Surgery. In a few cases, surgery may be needed for vertigo.

If vertigo is caused by a more serious underlying problem, such as a tumor or injury to the brain or neck, treatment for those problems may help to alleviate the vertigo.

Vertigo causes & treatment – Illnesses & conditions

Treatment for vertigo depends on the cause and severity of your symptoms.

During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea and reduce the sensation of spinning. You may be advised to take medication.

You should also try to avoid stressful situations, as anxiety can make the symptoms of vertigo worse.

Read more about what to do if you’re struggling with stress


Labyrinthitis is an inner ear infection that causes the labyrinth (a delicate structure deep inside your ear) to become inflamed. It’s usually caused by a viral infection and clears up on its own without treatment. In rare cases, where labyrinthitis is caused by a bacterial infection, antibiotics may be prescribed.

If you’ve experienced any hearing loss, your GP may refer you to an ear, nose and throat (ENT) specialist or an audiovestibular physician. This is a doctor who specialises in hearing and balance disorders. You may need emergency treatment to restore your hearing.

Labyrinthitis may also be treated with vestibular rehabilitation – also called vestibular rehabilitation training or VRT (see below).

See treating labyrinthitis for more information

Vestibular neuronitis

Vestibular neuronitis, also known as vestibular neuritis, is inflammation of the vestibular nerve (one of the nerves in your ear that’s used for balance). It’s usually caused by a viral infection.

The symptoms of vestibular neuronitis often get better without treatment over several weeks. However, you may need to rest in bed if your symptoms are severe. See your GP if your symptoms get worse or don’t start to improve after a week.

You may find your balance is particularly affected if you:

  • drink alcohol
  • are tired
  • have another illness

Avoiding these can help to improve your condition.

Vestibular neuronitis can also be treated with vestibular rehabilitation and medication.

Benign paroxysmal positional vertigo (BPPV)

Like vestibular neuronitis, benign paroxysmal positional vertigo (BPPV) often clears up without treatment after several weeks or months. It’s thought that the small fragments of debris in the ear canal that cause vertigo either dissolve or become lodged in a place where they no longer cause symptoms.  BPPV can sometimes return.

Until the symptoms disappear or the condition is treated, you should:

  • get out of bed slowly
  • avoid activities that involve looking upwards, such as painting and decorating or looking for something on a high shelf

BPPV can be treated using a procedure called the Epley manoeuvre.

The Epley manoeuvre

The Epley manoeuvre involves performing four separate head movements to move the fragments that cause vertigo to a place where they no longer cause symptoms. Each head position is held for at least 30 seconds. You may experience some vertigo during the movements.

Your symptoms should improve shortly after the Epley manoeuvre is performed, although it may take up to two weeks for a complete recovery. Return to your GP if your symptoms haven’t improved after four weeks. The Epley manoeuvre isn’t usually a long-term cure and may need to be repeated.

Brandt-Daroff exercises

If the Epley manoeuvre doesn’t work, or if it’s not suitable – for example, because you have neck or back problems – you can also try Brandt-Daroff exercises. These are a series of movements you can do unsupervised at home.

Your GP will need to teach you how to do the exercises. You repeat them three or four times a day for two days in a row. Your symptoms may improve for up to two weeks.

Referral to a specialist

Your GP may refer you to a specialist, such as an ear, nose and throat (ENT) specialist if:

  • the Epley manoeuvre doesn’t work or can’t be performed
  • you still have symptoms after four weeks
  • you have unusual signs or symptoms

In rare cases, where the symptoms of vertigo last for months or years, surgery may be recommended. This may involve blocking one of the fluid-filled canals in your ear. Your ENT specialist can give more advice on this.

Ménière’s disease

If your vertigo is caused by Ménière’s disease, there are a number of treatment options for both the vertigo and other symptoms caused by the condition.

Possible treatments for Ménière’s disease include:

  • dietary advice – particularly a low-salt diet
  • medication to treat attacks of Ménière’s disease
  • medication to prevent attacks of Ménière’s disease
  • treatment for tinnitus (ringing in your ears) – such as sound therapy, which works by reducing the difference between tinnitus sounds and background sounds, to make the tinnitus sounds less intrusive
  • treatment for hearing loss – such as using hearing aids
  • physiotherapy to deal with balance problems
  • treatment for the secondary symptoms of Ménière’s disease – such as stress, anxiety and depression

See treating Ménière’s disease for more information

Central vertigo

Central vertigo is caused by problems in part of your brain, such as the cerebellum (which is located at the bottom of the brain) or the brainstem (the lower part of the brain that’s connected to the spinal cord).

Causes of central vertigo include migraines and, less commonly, brain tumours.

If your GP suspects you have central vertigo, they may organise a scan or refer you to a hospital specialist, such as a neurologist or an ENT (ear, nose and throat specialist) or audiovestibular physician.

Treating your migraine should relieve your vertigo if it’s caused by a migraine.

Vertigo with an unknown cause

If the cause of your vertigo is unknown, you may be admitted to hospital if:

  • you have severe nausea and vomiting, and can’t keep fluids down
  • your vertigo comes on suddenly and wasn’t caused by you changing position
  • you possibly have central vertigo
  • you have sudden hearing loss, but it’s not thought to be Ménière’s disease

Alternatively, you may be referred to a specialist, such as:

  • a neurologist – a specialist in treating conditions that affect the nervous system
  • an ENT specialist – a specialist in conditions that affect the ear, nose or throat
  • an audiovestibular physician – a specialist in hearing and balance disorders

While waiting to see a specialist, you may be treated with medication.  

Vestibular rehabilitation

Vestibular rehabilitation, also called vestibular rehabilitation training or VRT, is a form of “brain retraining”. It involves carrying out a special programme of exercises that encourage your brain to adapt to the abnormal messages sent from your ears.

During VRT, you keep moving despite feelings of dizziness and vertigo. Your brain should eventually learn to rely on the signals coming from the rest of your body, such as your eyes and legs, rather than the confusing signals coming from your inner ear. By relying on other signals, your brain minimises any dizziness and helps you to maintain your balance.

An audiologist (hearing specialist) or a physiotherapist may provide VRT. Your GP may be able to refer you for VRT, although it depends on availability in your area.

In some cases, it may be possible to use VRT without specialist help. Research has shown that people with some types of vertigo can improve their symptoms using a self-help VRT booklet. However, you should discuss this with your doctor first.


Medication can be used to treat episodes of vertigo caused by vestibular neuronitis or Ménière’s disease. It may also be used for central vertigo or vertigo with an unknown cause.

The medicines are usually prescribed for 3 to 14 days, depending on which condition they’re for. The two medicines that are usually prescribed are:

  • prochlorperazine
  • antihistamines

If these medicines are successful in treating your symptoms, you may be given a supply to keep at home, so you can take them the next time you have an episode of vertigo.

In some cases you may be advised to take long-term medication, such as betahistine, for conditions like Ménière’s disease.


Prochlorperazine can help relieve severe nausea and vomiting associated with vertigo. It works by blocking the effect of a chemical in the brain called dopamine.

Prochlorperazine can cause side effects, including tremors (shaking) and abnormal or involuntary body and facial movements.

It can also make some people feel sleepy. For the full list of possible side effects, check the patient information leaflet that comes with your medicine.


Antihistamines can be used to help relieve less severe nausea, vomiting and vertigo symptoms. They work by blocking the effects of a chemical called histamine.

Possible antihistamines that may be prescribed include:

  • cinnarizine
  • cyclizine
  • promethazine teoclate

Like prochlorperazine, antihistamines can also make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects.

A medication called betahistine works in a similar way to antihistamines. It has been used to treat Ménière’s disease and may also be used for other balance problems. It may have to be taken for a long period of time. The beneficial effects vary from person to person.


If you have vertigo, there are some safety issues to consider. For example:

  • you should inform your employer if your job involves operating machinery or climbing ladders
  • you may be at increased risk of falls – see preventing falls for advice on making your home safer and reducing your risk

Vertigo could also affect your ability to drive. You should avoid driving if you’ve recently had episodes of vertigo and there’s a chance you may have another episode while you’re driving.

It’s your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could affect your driving ability. Visit the GOV.UK website for more information on driving with a disability.

labyrinthitis and vestibular neuritis – NHS

Labyrinthitis is an inner ear infection which affects your balance. It’s sometimes called vestibular neuritis. It usually gets better by itself within a few weeks.

Check if you have labyrinthitis

The most common symptoms of labyrinthitis are:

  • dizziness or feeling that everything around you is spinning (vertigo)
  • feeling unsteady and off balance – you might find it difficult to stay upright or walk in a straight line
  • feeling or being sick
  • hearing loss
  • ringing in your ears (tinnitus)

Symptoms can start suddenly. They may be there when you wake up and get worse as the day goes on.

The symptoms often ease after a few days.

You’ll usually get your balance back over 2 to 6 weeks, although it can take longer.

Things you can do to help

Labyrinthitis usually gets better on its own. But there are things you can do to ease the symptoms:


  • lie still in a dark room if you feel very dizzy

  • drink plenty of water if you’re being sick – it’s best to drink little and often

  • try to avoid noise and bright lights

  • get enough sleep – tiredness can make symptoms worse

  • start to go for walks outside as soon as possible – it may help to have someone with you to steady you until you become confident

  • when you’re out and about, keep your eyes focused on a fixed object, rather than looking around all the time


  • do not drive, cycle or use tools or machinery if you feel dizzy

  • do not drink alcohol – it can make symptoms worse

Non-urgent advice: See a GP if you have:

  • symptoms of labyrinthitis that do not get better after a few days
  • symptoms of labyrinthitis that are getting worse
  • been diagnosed with labyrinthitis and your symptoms have not improved after another week

The GP may refer you to a hospital specialist.


Coronavirus update: how to contact a GP

It’s still important to get help from a GP if you need it. To contact your GP surgery:

  • visit their website
  • use the NHS App
  • call them

Find out about using the NHS during coronavirus

Urgent advice: Ask for an urgent GP appointment or call 111:

  • if you have sudden hearing loss in 1 ear

You may need to be referred to a specialist for tests, and possibly treatment.


Labyrinthitis and vestibular neuritis – what’s the difference?

Labyrinthitis and vestibular neuritis are problems with different parts of the inner ear, which are needed for balance:

  • Labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear
  • Vestibular neuritis is inflammation of the vestibular nerve – the nerve in the inner ear that sends messages to the brain

The symptoms of vestibular neuritis and labyrinthitis are very similar.

However, if your hearing is affected, then labyrinthitis is the cause. This is because inflammation of the labyrinth affects hearing, while inflammation of the vestibular nerve does not.

Treatment from a GP for labyrinthitis

A GP may prescribe antihistamines or motion-sickness tablets for up to 3 days. Do not take them for any longer, as they can slow down your recovery.

Labyrinthitis is usually caused by a viral infection, such as a cold or flu, so antibiotics will not help. But a GP may prescribe antibiotics if they think your infection is bacterial.

Exercises for long-term balance problems

Sometimes, balance problems can last for much longer – for many months even years.

Vestibular rehabilitation is a series of exercises that can help to restore balance. You should only do the exercises under the supervision of a physiotherapist.

The Brain & Spine Foundation charity has a factsheet about vestibular rehabilitation exercises.

Ask a GP to refer you to a physiotherapist, or it may be possible to refer yourself directly.

Waiting lists for NHS physiotherapy can be long and you may prefer to pay for private treatment. Most private physiotherapists accept direct self-referrals.

Read more about accessing physiotherapy.

Video: labyrinthitis and vertigo (BPPV) – Hazel’s story

In this video, Hazel talks about how labyrinthitis affected her balance and perception and how she found help.

Media last reviewed: 1 July 2020
Media review due: 1 July 2023

Page last reviewed: 11 February 2020
Next review due: 11 February 2023

Symptoms, Causes, Diagnosis & Treatment


What is vestibular neuritis?

Vestibular neuritis is a disorder that affects the nerve of the inner ear called the vestibulocochlear nerve. This nerve sends balance and head position information from the inner ear to the brain. When this nerve becomes swollen (inflamed), it disrupts the way the information would normally be interpreted by the brain.

Vestibular neuritis can occur in people of all ages, but is rarely reported in children.

The vestibulocochlear nerve sends balance and head position information from the inner ear (see left box) to the brain. When the nerve becomes swollen (right box), the brain can’t interpret the information correctly. This results in a person experiencing such symptoms as dizziness and vertigo.

Symptoms and Causes

What are the symptoms of vestibular neuritis?

Symptoms include:

Vestibular neuritis and labyrinthitis are closely related disorders. Vestibular neuritis involves swelling of a branch of the vestibulocochlear nerve (the vestibular portion) that affects balance. Labyrinthitis involves the swelling of both branches of the vestibulocochlear nerve (the vestibular portion and the cochlear portion) that affects balance and hearing. The symptoms of labyrinthitis are the same as vestibular neuritis plus the additional symptoms of tinnitus (ringing in the ears) and/or hearing loss.

Generally, the most severe symptoms (severe vertigo and dizziness) only last a couple of days, but while present, make it extremely difficult to perform routine activities of daily living. After the severe symptoms lessen, most patients make a slow, but full recovery over the next several weeks (approximately three weeks). However, some patients can experience balance and dizziness problems that can last for several months.

What causes vestibular neuritis?

Researchers think the most likely cause is a viral infection of the inner ear, swelling around the vestibulocochlear nerve (caused by a virus), or a viral infection that has occurred somewhere else in the body. Some examples of viral infections in other areas of the body include herpes virus (causes cold sores, shingles, chickenpox), measles, flu, mumps, hepatitis and polio. (Genital herpes is not a cause of vestibular neuritis.)

Diagnosis and Tests

How is vestibular neuritis diagnosed?

In most patients, a diagnosis of vestibular neuritis can be made with an office visit to a vestibular specialist. These specialists include an otologist (ear doctor) or neurotologist (doctor who specializes in the nervous system related to the ear). Referral to an audiologist (hearing and vestibular [balance] clinician) may be made to perform tests to further evaluate hearing and vestibular damage. Tests to help determine if symptoms might be caused by vestibular neuritis include hearing tests, vestibular (balance) tests and a test to determine if a portion of the vestibulocochlear nerve has been damaged. Another specific test, called a head impulse test, examines how difficult it is to maintain focus on objects during rapid head movements. The presence of nystagmus, which is uncontrollable rapid eye movement, is a sign of vestibular neuritis.

If symptoms continue beyond a few weeks or become worse, other tests are performed to determine if other illnesses or diseases are causing the same symptoms. Some of these other possible health conditions include stroke, head injury, brain tumor, and migraine headache. To rule out some of the disorders of the brain, an MRI with dye (called a contrast agent) may be ordered.

Management and Treatment

What is the treatment for vestibular neuritis?

Treatment consists of managing the symptoms of vestibular neuritis, treating a virus (if suspected), and participating in a balance rehabilitation program.

Managing symptoms. When vestibular neuritis first develops, the focus of treatment is to reduce symptoms. Drugs to reduce nausea include ondansetron (Zofran®) and metoclopramide (Reglan®). If nausea and vomiting are severe and not able to be controlled with drugs, patients may be admitted to the hospital and given IV fluids to treat dehydration.

To reduce dizziness, drugs such as meclizine (Antivert®), diazepam (valium), compazine and lorazepam (Ativan®) are prescribed. The different types of drugs used to reduce dizziness are group together and called by the general name, vestibular suppressants. Vestibular suppressants should be used no longer than three days. They are not recommended for long-term use and may make recovery more difficult.

Sometimes steroids are also used.

Treating a virus. If a herpes virus is thought to be the cause of the vestibular neuritis, antiviral medicine such as acyclovir is used. (Antibiotics are not used to treat vestibular neuritis because this disorder is not caused by bacteria.)

What is a balance rehabilitation program?

If balance and dizziness problems last longer than a few weeks, a vestibular physical therapy program may be recommended. The goal of this program is to retrain the brain to adapt to the changes in balance that a patient experiences.

As the first step in this program, a vestibular physical therapist evaluates the parts of the body that affect balance. These areas include:

  • The legs (how well the legs “sense” balance – when attempting to stand or walk)
  • The eyes (how well the sense of vision interprets the body’s position in relation to its surroundings)
  • The ears (how well the inner ear functions to maintain balance)
  • The body as a whole (how well the body interprets its center of gravity – does the body sway or have unsteady posture)

Based on the results of the evaluation, an exercise program is designed specifically for the patient. Some examples of balance exercises:

Overall body posture balance exercises:

  • Exercises that shift body weight forward and backward and from side-to-side while standing

Eye/ear head-turn exercises:

  • Focusing eyes on an object while turning head from side to side
  • Keeping vision steady while making rapid side-to-center head turns
  • Focusing eyes on a distant object, with brief glances at floor, while continuing to walk toward the object

The key to a successful balance rehabilitation program is to repeat the set of personalized exercises 2 to 3 times a day. By repeating these exercises, the brain learns how to adjust to the movements that cause dizziness and imbalance. Many of the exercises can be done at home, which will speed recovery. Vestibular rehabilitation specialists provide specific instructions on how to perform the exercises, identify which exercises can be done at home, and provide other home safety tips to prevent falls.

Can vestibular neuritis recur?

In most patients (95 percent and greater) vestibular neuritis is a one-time experience. Most patients fully recover.

Labyrinthitis and Vestibular Neuritis | Michigan Medicine

Topic Overview

What are labyrinthitis and vestibular neuritis?

Labyrinthitis (say “lab-uh-rin-THY-tus”) is a problem inside the inner ear. It happens when the labyrinth, a part of the inner ear that helps control your balance, gets swollen and inflamed.

Vestibular neuritis is an inflammation of the vestibular nerve. The nerve is located in the inner ear. It carries signals that help with your balance from the inner ear to the brain.

The inflammation of either condition may cause sudden vertigo. This makes you feel like you’re spinning or whirling. Labyrinthitis may also cause temporary hearing loss or a ringing sound in your ears.

The two problems have similar symptoms and treatment. However, if you have both sudden vertigo and hearing loss, you need urgent care to rule out a stroke.

See pictures of the inner ear showing the labyrinth and an inflamed vestibular nerve.

What causes labyrinthitis and vestibular neuritis?

The causes of labyrinthitis and vestibular neuritis are not clear. They can happen after a viral infection or, more rarely, after an infection caused by bacteria. The trigger may be an upper respiratory infection, such as the flu or a cold. Less often, it may start after a middle ear infection.

The infection inflames the vestibular nerve. This causes the nerve to send incorrect signals to the brain that the body is moving. But your other senses (such as vision) don’t detect the same movement. The confusion in signals can make you feel that the room is spinning or that you have lost your balance (vertigo).

What are the symptoms?

The main symptom of both labyrinthitis and vestibular neuritis is vertigo. Vertigo is not the same as feeling dizzy. Dizziness means that you feel unsteady or lightheaded. But vertigo makes you feel like you’re spinning or whirling. It may make it hard for you to walk. Symptoms of vertigo and dizziness may be caused by many problems other than labyrinthitis and vestibular neuritis.

Vertigo begins without warning. It often starts 1 to 2 weeks after you’ve had the flu or a cold. It may be severe enough to make you vomit or make you feel sick to your stomach. Vertigo slowly goes away over a few days to weeks. But for a month or longer, you may still get vertigo symptoms if you suddenly move your head a certain way.

Labyrinthitis may also cause hearing loss and a ringing sound in your ears (tinnitus). Most often, these symptoms don’t last for more than a few weeks.

How are labyrinthitis and vestibular neuritis diagnosed?

Your doctor can tell if you have labyrinthitis or vestibular neuritis by doing a physical exam and asking about your symptoms and past health. Your doctor will look for signs of viral infections that can trigger labyrinthitis.

If the cause of your vertigo is not clear, your doctor may do other tests, such as electronystagmography or an MRI to rule out other problems.

How are labyrinthitis and vestibular neuritis treated?

Most of the time, labyrinthitis and vestibular neuritis go away on their own. This normally takes several weeks. If the cause is a bacterial infection, your doctor will give you antibiotics. But most cases are caused by viral infections, which can’t be cured with antibiotics.

Your doctor may prescribe steroid medicines, which may help you get better sooner. He or she may also give you other medicines, such as antiemetics, antihistamines, and sedatives, to help control the nausea and vomiting caused by vertigo.

Vertigo usually gets better as your body adjusts (compensation). Medicines like antihistamines can help your symptoms, but they may make it take longer for vertigo to go away. It’s best to only use medicines when they are needed and for as little time as possible.

Staying active can help you get better. Check with your doctor about trying balance exercises at home. These include simple head movements and keeping your balance while standing and sitting. They may reduce symptoms of vertigo.

Feeling Off-Balance? The Problem Might Be in Your Ears

If you’re feeling a little unsteady on your feet, it’s not just in your head. It might actually be in your ears.

We’ve all experienced dizziness after a boat trip, an amusement park ride or spinning in a circle as a kid. But if you feel like you’ve just gotten off a roller coaster even if you’ve hardly moved, you could have a balance problem related to your inner ear. Here’s how it happens.

Your inner ear has three canals that sense different types of movement: up and down, side to side, turning in any direction and tilting. These canals are filled with fluid; within that fluid are floating membranes with tiny cells that send signals to your brain. That special sensory information, combined with what you see and feel, helps you navigate the physical world. The brain ultimately interprets all of this incoming sensory information and translates it into coordination, balance and movement. If those incoming signals are thrown off, you can experience dizziness, nausea or a feeling that the world is spinning. You may even feel like you’re about to fall down. Several different conditions can cause your inner ear–balance system to become off-kilter, but thankfully they can be managed with help from a doctor.


Vertigo is really the name of the symptom describing this dizzy, off-balance feeling, but something called benign paroxysmal positional vertigo (BPPV) is a diagnosis in itself. With BPPV, small calcium crystals in your inner ear become dislodged, causing your brain to receive the wrong signals about your movements. So when you turn your head or change positions, you might experience a sudden spinning spell. It usually occurs in older people, but head injuries, an inner ear infection called labyrinthitis or having a family member with BPPV can also increase your risk. BPPV is usually easily treated with a special series of movements your health care provider can perform to help get the crystals back in place.


Everyone has earwax, but some people have more than others. If it builds up, it can block the ear and cause hearing problems as well as balance issues. Older people tend to be more at risk for earwax buildup, but it can also happen if you stick anything, like a cotton swab, in your ear; this can impact the wax instead of removing it. Your primary care doctor may use irrigation or give you drops to moisten earwax buildup so it will dislodge. If it is severe or if you have other ear issues, you may need a specialist to remove it under a microscope, which can be done in the office.

Meniere’s disease

Named after the physician who first described it, Meniere’s disease occurs when fluid builds up in the inner ear, causing sudden attacks of vertigo as well as ringing in the ear (tinnitus), hearing loss or a feeling of fullness in the ear. Doctors aren’t sure what causes it, but some proposed theories include problems with circulation, allergy or autoimmune reactions, infection or genetics. While there’s no cure for Meniere’s disease, treatments can be effective at controlling the symptoms. Medications, diet and lifestyle changes and, in severe cases, surgery, can help.

Acoustic neuroma

Technically called vestibular schwannoma, acoustic neuroma is a benign tumor that causes balance problems, along with vertigo, tinnitus, hearing loss on the affected side or ear fullness or pressure.

“Acoustic neuromas cause balance disturbance in many cases because the tumor grows around the vestibular, or balance, portion of the eighth cranial nerve, which carries sensory information from the inner ear,” says Joni Doherty, MD, PhD, an otolaryngologist and neurotologist at Keck Medicine of USC and assistant professor of clinical otolaryngology–head and neck surgery at the Keck School of Medicine of USC.

Although uncommon, the incidence of acoustic neuroma is on the rise, most likely due to early detection via magnetic resonance imaging, Doherty adds. Some experts estimate that one in 1,000 people per year develop an acoustic neuroma. Microsurgery can remove the tumor; radiation therapy or a wait-and-watch approach are also options.

Vestibular neuritis

If the inner ear becomes infected, usually from a virus, it can cause this inner ear condition. When the vestibular nerve swells from the infection, the signals to the brain are thrown off and result in vertigo, dizziness, balance problems, nausea and even difficulty concentrating. There are medications to control symptoms; often a steroid will also be given. Physical therapy to “retrain” the brain may be recommended if symptoms persist.

by Tina Donvito

If you’re experiencing balance or hearing problems, the expert otolaryngologists at the Hearing and Balance Center at Keck Medicine of USC can help. If you’re in the Los Angeles area, schedule an appointment or call (800) USC-CARE (800-872-2273).

Balance, Dizziness and Vertigo * Michigan Ear Institute Farmington Hills, Dearborn, Royal Oak, Novi MI

Download Dizziness and Balance Brochure

The Dizziness, Balance, and Falls Center at the Michigan Ear Institute has been recognized internationally as an outstanding clinical program for the diagnosis and treatment of balance disorders. After diagnosing the balance problem various treatment modalities including medical, surgical, and vestibular rehabilitation can improve overall balance function. Common balance disorders we see include Meniere’s disease, benign positional vertigo, vestibular neuritis, post traumatic dizziness, among other processes.

Dizziness is a general term for many different symptoms. While it generally means an abnormal sensation of motion, it can also mean imbalance, lightheadedness, blacking out, staggering, disorientation, weakness and other sensations. Symptoms can range from mild and brief to severe spinning sensations accompanied by nausea also known as vertigo. For clarity the definitions we use to talk about dizziness are used.

Dizziness – A general term for all abnormal symptoms of balance and stability.

Imbalance – Inability to keep one’s balance especially when standing.

Lightheadedness – The feeling of nearly passing out, similar to the feeling you might have if you hold your breath for a long time.

Vertigo – The sensation that you or your surroundings are moving or spinning or whirling.

Balance requires the interaction between many different organs and systems in the body. The brain is the central processing center for all balance information coming from the senses and for all information going out to the muscles of balance. Input comes from three main areas: vision, the balance portion of the inner ear, and the touch (from the feet and joints). Vision is an important cue to the brain which tells us if we are moving relative to our surroundings.


There are two parts of hearing: mechanical and nerve (or electric). The mechanical part of hearing picks up sound from the outer ear canal and then vibrates the ear drum and the three tiny hearing bones in the middle ear. The inner ear looks a bit like a snail. It has two halves which are connected and are filled with fluid. The coil or cochlea takes care of the nerve part of hearing. Like a telephone it takes the vibration and turns it into an electric signal that is then relayed to the brain.

The other half of the inner ear is the balance or vestibular system. There are three balance canals, each set in different directions that respond to rotational movement of the head. Depending on which way you turn fluid, called end lymph, move within the canals and send the direction to the brain by way of the vestibular nerve.

There are also 2 small compartments that have sensory cells that are covered with small calcium crystals in a gelatin matrix. These compartments are responsible for sensing linear movement, such as swaying, rocking or bouncing movements. When the crystals of this compartment are dislodged, they may cause BPPV (benign paroxysmal vertigo).

The inner ear fluid undergoes a natural recycling every day. It is made from the brain’s spinal fluid and is absorbed by the endolymphatic sac. In Meniere’s syndrome the sac fails to absorb enough fluid. This increases inner ear pressure resulting in dizziness and hearing loss.

Also in close association with the ear is the facial nerve. It helps move the face and also provides for some of the taste to the tip of the tongue.

Maintenance of Balance

Balance is maintained by the interactions in the brain of nerve impulses from the inner ear, the eye, the neck muscles, and the muscles and joints of the limbs. A disturbance in any of these areas may result in the subjective sensation of dizziness or unsteadiness. General disturbances of body function may lead to dizziness by interfering with coordination of the impulses of the brain.

Causes of Dizziness

Dizziness can be grouped into types by the portion of the entire balance system that is not working properly. The different portions include the inner ear, the brain, the eyes and the limbs (neck, back, and leg muscles and joints which react to keep us upright).

Inner Ear Dizziness

Half of the inner ear is used for hearing (the cochlea) and the other half is used for balance (the labyrinth). If the labyrinth or the nerve that connects it to the brain is malfunctioning, dizziness can result. Many types of maladies occur in the inner ear to cause dizziness, including Meniere’s syndrome, labyrinthitis, positional vertigo, and vestibular neuritis, migraine and tumors of the inner ear nerves. These usually cause imbalance, vertigo (spinning), and nausea. It can also be accompanied by tinnitus and hearing loss, if the nearby cochlea is also affected. These diseases will be further explained.

Central Dizziness

Central dizziness is caused by problems in the balance portion of the brain. Anytime this portion of the brain is not working properly, dizziness can occur. Symptoms usually include lightheadedness, disorientation, imbalance, and sometimes even blacking out. Causes of central dizziness include low blood sugar, low blood pressure to the brain, strokes, multiple sclerosis, migraine headaches, head injury, tumors, and the aging process, among others. Treating these types of dizziness usual involves treating the problem which is causing the brain to not work properly.

Muscle-Joint Dizziness

This type of dizziness is uncommon. If the muscles, joints or touch sensors of the limbs are not working well, it becomes difficult for the body to react to motion, and makes it difficult to remain upright. Causes of muscle-joint dizziness include muscular dystrophy; sever diabetes, arthritis, joint replacements, and injuries. Symptoms are usually imbalance and unsteadiness.

Visual Dizziness

Eye muscle imbalance and poor vision can make one’s balance worse. The brain relies on information from the eyes to help with balance. Car sickness or sea sickness are types of visual dizziness because the eyes are constantly adjusting to a moving visual field and confuses the balance part of the brain. This can lead to dizziness, nausea and vomiting.

Diagnostic Tests

Dizziness can be caused by numerous disturbances to any of many different parts of the body. Based upon your history and physical findings your physician may require further tests to complete a full evaluation. The tests necessary are determined at the time of examination and may include hearing and balance tests, imaging (CT or MRI scans), blood tests, and ultrasound tests. A general physical exam and neurological tests may also be needed.

The most common test for dizziness is the electronystagmogram (ENG) or videonystagmogram (VNG). In these tests the strength of the inner ear is tested as well as the coordination of eye movements. They involve watching the eye movements after placing warm or cool air into the ear canal. This usually causes a normal sensation of brief dizziness. It is important not to be taking any medications which can affect the test such as Valium, Antivert, alcohol and others. When scheduling this test make sure to ask if your medications will impact the outcome of the tests.

Other tests that are done for dizziness are the electrocochleography (ECoG) and Vestibular evoked myogenic potentials (VEMP). These painless tests may be useful in determining the cause of dizziness in complex cases.

The object of this evaluation is to be certain that there is no serious or life threatening disease and to pinpoint the exact site of the problem. This lays the groundwork for effective medical or surgical treatment.

Diagnosis can often be difficult. Frequently multiple tests must be conducted. Patience and understanding is necessary on the part of the doctor and patient alike.

90,000 Why am I dizzy?


Various organs such as our eyes, brain, inner ear and leg, and vertebral nerves are responsible for the ability to maintain balance. When these systems malfunction, dizziness and imbalances can occur. This can be a serious and dangerous sign if it causes imbalance and falls, or dizziness makes it difficult to walk or navigate the environment. Let us deal with the problem immediately and see a doctor immediately.The specialists will assess your complaints, your general health and find out what is happening and how to treat them.
Seek medical attention if dizziness or lack of balance are accompanied by:

  • Chest pain
  • Severe headaches
  • Head injury
  • fever
  • Irregular heart rate
  • seizures
  • Shortness of breath
  • “Cuff” neck
  • Sudden change in speech, vision or hearing
  • emetic
  • Numbness of the face
  • Leg or arm weakness

Is it dizziness?

Do you feel that the room is moving or revolving around you? This is a classic symptom of vertigo called vertigo.It’s more than talent, and it usually gets worse when you move your head. It is a symptom of an imbalance problem in the inner ear or brain stem. The most common type is benign paroxysmal postural head rotation. Your inner ear is a complex fluid-filled channel system. This lets your brain know how your head is moving. Small pieces of the calcium crystal in your inner ear loosen and move to places where they shouldn’t be.The system is not working properly and is sending the wrong signals to your brain. It is often caused by the natural breakdown of cells that occurs with age. It can also be caused by a head injury. You will feel it for a short time when you tilt or turn your head, especially when you roll over or sit down. Benign paroxysmal positional vertigo is not serious and usually resolves spontaneously. If not – or if you want to help together – it can be treated with special head exercises (“particle remodeling exercises”) called the “Epley” maneuvers to get the calcium chips back in place.Most people feel better after one or three treatments.
There are other causes of vertigo, both inside and outside the brain. You may have Meniere’s disease (described below), labyrinthitis (described below), a tumor called an acoustic neuroma, or side effects caused by certain antibiotics. It can be caused in the brain by vestibular migraines, multiple sclerosis, birth defects of the brain, or stroke due to inadequate blood flow or bleeding in the cerebellum.

Is it an infection?

Inflammation of a nerve in the ear can also cause dizziness. This is called vestibular neuritis or labyrinthitis and it is caused by an infection. The virus is usually to blame. Middle ear infections or meningitis bacteria can also enter your inner ear. In this case, dizziness usually occurs suddenly. Your ears may ring and it may be difficult to hear. You may also feel nausea, fever, and ear pain. Symptoms can last for several weeks.If it is caused by a virus and cannot be treated with antibiotics. Supplementary foods can help you feel better when the infection clears up.

Is this Meniere’s disease?

This condition causes intense periods of dizziness that can last for hours. You may feel fullness or pressure in one ear. Other symptoms include ringing in the ears, hearing loss, nausea, and anxiety. You may feel drained after an attack.People with Meniere’s disease have too much fluid in their inner ear. Doctors do not know what caused this, and there is no cure for it. This is usually treated with dietary changes (a low-salt diet) and medication to control vertigo.

Is it a circulatory disorder?

Dizziness may be a symptom of your circulatory problem. Your brain needs constant oxygen-rich blood. Otherwise, you can be sleepy and even weak.Some of the causes of decreased blood flow to the brain include blood clots, clogged arteries, heart failure, and irregular heartbeat. For many older people, standing up suddenly can cause a sudden drop in blood pressure. It is important to see a doctor immediately if you feel dizzy, faint, or pass out.

Is this your medicine?

Some medications prescribe dizziness as a possible side effect. Talk to your doctor if you are taking any of the following medicines:

  • Antibiotics, including gentamicin and streptomycin
  • antidepressants
  • Anticonvulsants
  • Medicines for blood pressure
  • sedatives

Is it dehydration (lack of fluid in the body)?

Many people do not drink enough fluids to replace the fluids they lose every day by sweating, breathing and urinating.This is a particularly pressing problem for the elderly and people with diabetes. When you’re dehydrated, your blood pressure drops, your brain doesn’t get enough oxygen, and you start to feel dizzy. Other symptoms of dehydration include thirst, fatigue, and dark urine. To rehydrate, drink plenty of water or diluted fruit juice and limit your intake of coffee, tea, and soda.

Is your blood sugar too low?

People with diabetes should have their blood sugar checked frequently.You may feel dizzy if it falls too low. It can also cause hunger, tremors, sweating, and confusion. The quick fix is ​​to eat or drink something with sugar, such as juice or candy.

Is that something else?

Dizziness can be a symptom of many other medical conditions, including:

  • Migraine, even if you don’t feel pain
  • Stress or Anxiety
  • Nervous system problems such as peripheral neuropathy and multiple sclerosis
  • Tumor in the brain or inner ear

In addition to dizziness, any of these conditions can have other symptoms.If your dizziness is not interfering with your ability to function normally, be sure to discuss it with your doctor to determine the cause and correct it.

90,000 Dizziness: cause, diagnosis, treatment

Vestibular Rehabilitation Therapy

Fortunately, most of us lead our daily lives without regard for the complexity of our body systems that keep us upright and balanced. But this only happens until, for some reason, our coordination and balance are not disturbed, reminding us how vital simple daily tasks are.

Vestibular Rehabilitation Therapy (VRT) consists of a set of exercises that induce the brain and spinal cord to restore imbalance arising from diseases or abnormalities of the vestibular apparatus or lesions of the central nervous system.

This guide will help you understand:

  • anatomy of the vestibular system
  • why do you need VRT
  • What disorders ART is usually treated with


The anatomy and physiology underlying the sense of balance in the human body are complex.Many systems are involved, including the brain, spinal cord, eyes, ears, and receptors in the skin, joints, and muscles. Disruption of any of these areas due to injury or illness can negatively affect your sense of balance.

The inner ear, also called the labyrinth, is made up of semicircular canals along with a sac and a uterus. Collectively, this inner ear system is called the vestibular system or vestibular apparatus.

The inner ear also contains the cochlea, which is the main structure involved in hearing perception.

The three semicircular canals also respond to rotational movements of the head. The canals are located at a 90-degree angle to each other and are filled with a fluid called endolymph. Hair cells are located at the base of each semicircular canal and protrude into the endolymph. The movement of the head causes the movement of the endolymph in the canals, which in turn causes the hair follicles to move accordingly and emit impulses of balance that are sent to the brain.The hair cells in the sac and uterus respond to linear acceleration of the head, for example, when riding in an elevator or moving forward.

Sensory information from the inner ear is transmitted to the brain through the vestibular portion of the eighth cranial nerve, also called the vestibulocochlear nerve. The cochlear nerve transmits information about hearing. Certain areas of the brain, notably the cerebellum and brainstem, as well as parts of the cerebral cortex, process sensory information from the inner ear.When both the right and left inner ear send the same information to the brain, the body is balanced. When the body or head moves, the sensory information from the ears is not identical, so the brain senses the movement and the body adjusts accordingly.

The ears work closely with the eyes to maintain balance. This is based on

vestibulo-ocular reflex (VOR). This is an automatic eye function that stabilizes images on the retina in response to head movements.This reflex causes the eyes to move in the opposite direction to the movement of the head so that the eyes remain stationary on the observed target. Thus, accurate information from the vestibular apparatus influences the sense of balance.

If one inner ear is affected by disease or injury, then sensory information sent to the brain will falsely indicate movement from that vestibular system. In this case, the eyes will adjust accordingly and move in the opposite direction to the perceived movement, even though the head is actually motionless.The result is involuntary back and forth eye movements. This eye movement is called nystagmus and, if present, makes any healthcare professional suspect a vestibular problem.

There are two other reflexes, the vestibulo-cervical reflex and the vestibulo-spinal reflex, which also help the body maintain a sense of balance.

Vestibulo-Cervical Reflex works in conjunction with incoming vestibular information and neck muscles to stabilize the head.And the vestibulo-spinal reflex works to create compensatory body movements in response to vestibular input in order to maintain balance and avoid falling.

Disruption along any part of the anatomical pathway described above can affect the perception of balance or equilibrium. A problem with a portion of the inner ear or sensory information being transmitted to the brain via the vestibulochochlear nerve is called peripheral vestibular disorder.

If a problem affecting balance is due to damage to a structure within the brain itself, which then affects the reception and integration of balance information, this is called central vestibular disorder.

General disorders treated with ART

The most common peripheral vestibular disorders treated with ART are benign paroxysmal positional vertigo (BPPV) and any injury or disease that results in decreased inner ear function.This decreased function may be associated with disorders such as Meniere’s disease, vestibular neuritis or labyrinthitis, or acoustic neuroma. The term unilateral or bilateral vestibular hypofunction can be used to describe decreased function of the vestibular system in one (unilateral) or both (bilateral) ears due to illness or injury.

Clinically, any peripheral dysfunction in the vestibular system that affects balance can potentially be treated with ART, but the effectiveness of treatment will depend on the exact cause of the vestibular problem.

Central vestibular disorders, such as multiple sclerosis or stroke, can also respond to ART, although peripheral vestibular disorders generally tend to respond better.

Benign paroxysmal positional vertigo (BPPV)

BPPV is a common clinical imbalance that is characterized by recurrent episodes of dizziness that are brief in nature (usually 10-60 seconds) and are most often caused by certain head positions.Medically benign means it is not life threatening. Paroxysmal means that it occurs with rapid and sudden onset or worsening of symptoms.

BPPV is the most common cause of recurrent vertigo. It is believed that BPPV is caused by calcium carbonate crystals (called otoconia, otoliths, or “ear calculi”) in the semicircular canals of the inner ear. Under normal circumstances, these crystals are located within the ear sac, but in BPPV these crystals are thought to shift and migrate into the semicircular canals of the ear. A number of possible causes are thought to be responsible for this displacement, such as ear or head trauma, ear infection or surgery, or natural degeneration of the inner ear structures. Often, however, the direct cause cannot be identified.

Otoconia settle in one place of the canal when the head is motionless. The most common lesion canal is the posterior semicircular canal. A sudden change in head position, often caused by actions such as rolling over in bed, getting out of bed, tilting the head, or looking up, causes the crystals to shift.This shift, in turn, sends false signals to the brain about balance and causes dizziness.

Vertigo due to BPPV can be very severe and accompanied by nausea. Attacks can occur for seemingly no reason and then disappear for weeks or months before returning again. BPPV usually affects only one ear, and although it can occur at any age, it is often seen in patients over 60 years of age and more commonly in women. Nystagmus is usually present.

Meniere’s disease

Meniere’s disease is a chronic, incurable vestibular disorder characterized by symptoms of episodic severe dizziness, fluctuating hearing loss, bloating in the ear and / or ringing in the ear (tinnitus) and nystagmus.

The disease got its name from the French physician Prosper A.Meniere, who in the late 1800s put forward a theory about the cause of these symptoms, which he noted in many of his patients.

The exact cause of Meniere’s disease has not yet been determined, but it is speculated that it is due to an abnormal amount of endolymphatic fluid accumulating in the inner ear and / or an abnormal accumulation of potassium in the inner ear.

The early stages of acute attacks of Meniere’s disease range in length from 20 minutes to 24 hours. Attacks can occur regularly throughout the week, or they can occur weeks or months later. Other symptoms may coincide with the attack, such as anxiety, diarrhea, tremors, blurred vision, nausea and vomiting, cold sweats and a fast heart rate or heartbeat. After seizures, patients often experience extreme fatigue that requires hours of rest to recover. For some patients, the time between attacks may be asymptomatic, but other patients report persistent associated symptoms even between attacks.

Vestibular neuronitis

Vestibular neuronitis is inflammation of the inner ear or an associated nerve (the vestibular portion of the vestibular cochlear nerve) that causes dizziness.Hearing can also be affected if the inflammation also affects the cochlear nerve.

Vertigo caused by vestibular neuronitis has a sudden onset and can be mild or extremely severe. Nausea, vomiting, unsteadiness, decreased concentration, nystagmus, and visual impairment may also occur. Most often, infections that cause inflammation of the inner ear or vestibulocochlear nerve are viral rather than bacterial. A proper diagnosis as to whether it is viral or bacterial is important to ensure the most effective and adequate treatment.

Acoustic Neuroma

An acoustic neuroma is a benign tumor on the vestibulocochlear nerve. Early symptoms are associated with hearing loss in the affected ear, ringing in the ear (tinnitus), dizziness, and a feeling of fullness in the ear. The tumor grows slowly, so symptoms appear gradually and can be easily missed in the early stages. As the tumor grows, it may press on other nerves in the area, and symptoms such as headache or facial pain and numbness may appear.Dizziness or other balance problems can occur with the growth of the tumor.

Vestibular symptoms

Peripheral or central vestibular abnormalities can lead to a number of different symptoms. VRT can potentially relieve or resolve any symptoms associated with vestibular disorder.

Common symptoms include:

  • dizziness
  • blurred vision
  • fatigue
  • anxiety
  • headaches
  • nausea and / or vomiting
  • cold sweat
  • ringing / tinnitus
  • hearing loss
  • eye twitching
  • pressure in the ear
  • panic attacks
  • declination towards
  • fear of falling
  • increased risk of falls
  • disturbed balance
  • wobbly walking
  • anxiety
  • depression

Diagnosis of the cause of dizziness

A detailed history of your disease is the most important information a doctor needs to diagnose the cause of your vestibular disorder and then apply the appropriate ART.

Your doctor will ask you to describe your vestibular symptoms in detail. Any symptoms listed above that you are experiencing or others should be mentioned. Your doctor will want to know when the first episode of your symptoms occurred, how long they lasted, and if they were associated with any other events, such as a car accident, head injury, illness, or infection.

He will also want to know how often the symptoms have recurred since the first episode and the overall picture of the frequency of symptoms.Explains what exactly causes you these symptoms, such as moving your head in a certain direction or getting out of bed. For vertigo, your doctor will ask about the nature of what you are feeling and whether you are experiencing episodes of true vertigo where you have a spinning sensation.

The doctor will also want to know if there is anything that reduces or aggravates your symptoms, if you are taking any medication, or if you have a family history of any inner ear or central nervous system disorder.

He may ask you to rate the intensity of some of your symptoms on an objective scale. Finally, they will ask you about all the daily activities that relate to your vestibular problem, such as walking, driving, working, and even household chores such as dressing, bathing, showering and housekeeping.

He will also want to know if you have falls.

The doctor examines your eye movement by asking you to follow certain objects with your eyes, or asking you to move your head while keeping your focus on a specific target.

An examination of the joints, neck muscles is also carried out to determine the cervicogenic nature of dizziness.

Finally, your doctor may ask you to fill out a questionnaire that will help him or her determine the intensity of your vestibular symptoms.

Depending on what the doctor discovers during the initial examination, they may send you for a series of other tests to further determine the cause of your vestibular symptoms.

Vestibular Rehabilitation

As stated above, ART can treat a variety of disorders that cause dizziness or imbalance. Virtually any disorder that occurs due to vestibular dysfunction and does not receive adequate compensation can be treated with ART. The effectiveness of ART depends on the correct diagnosis of the cause of the imbalance, the skill / training of the therapist in designing and delivering treatment, and adherence to the prescribed exercise program.

As explained earlier, the purpose of ART exercises is to induce the brain and spinal cord to compensate for any balance deficits that arise from diseases or abnormalities of the inner ear or central nervous system. In other words, patients are teaching their vestibular system to do one of several things; adapt to the stimuli presented, replace other sensory pathways, or get used to altered vestibular signals sent to their brains so that they can manage their vestibular disorder and maintain normal functioning despite possible ongoing symptoms.

In some cases, ART can eliminate vestibular symptoms. Unfortunately, however, this is not always the case, which is why minimizing symptoms or the frequency of recurrence of symptoms is considered a successful outcome of ART.

ART research shows that, in general, ART exercises are effective in alleviating many symptoms of vestibular disorder and that these improvements can often persist for several months after therapy. However, the effectiveness of therapy is often highly dependent on what causes vestibular symptoms in the first place, and on the use of individual exercise, rather than a standard exercise protocol.

ART, however, is not always effective for all vestibular problems. There are even some vestibular problems where exercise is not considered appropriate, so proper diagnosis of the cause of the symptoms is important.

ART exercises

If your physical therapist thinks ART is right for you after completing your diagnosis, he or she will prescribe a series of individual exercises for you to do on a regular basis. These exercises will address your specific vestibular problem and associated symptoms.

In addition, the exercises prescribed for you will focus on any day-to-day problems that you face as a result of your symptoms. Some exercises will be done with your physiotherapist on a stabilized platform, while others you will be training so that you can do them yourself as part of a home exercise program.

Medicines to treat your symptoms may be in addition to ART and should be discussed with your doctor.

Our approach to treatment (exercises on a stabilized platform)

Stabilometry is a modern method that allows you to assess the state of balance of a person with various diseases.

The patient is examined on a special platform that records the minimum vibrations of the human body with their subsequent computer processing. At the end of the study, a conclusion and recommendations for rehabilitation in the form of trainings are issued.

With the help of video games, a person, by moving the fulcrum, “directs” the actions of the character on the screen, thereby training his vestibular apparatus.Repeated carrying out of such training increases the effectiveness of the therapy.

Treatment on a stabiloplatform with biofeedback is prescribed as part of complex therapy for diseases and pathological conditions such as:

  • imbalance, loss of coordination;
  • frequent dizziness and headaches;
  • diseases of the vestibular apparatus;
  • dizziness panic attacks
  • polyneuropathy;
  • vascular diseases, conditions of impaired blood supply to the brain, incl.h. poststroke
  • various injuries of the spine (displacement of the vertebrae, curvature)
  • flat feet

Treatment of neck diseases

Some patients who experience dizziness or balance problems also have orthopedic neck problems that cause or worsen their symptoms. In these cases, your physiotherapist at Health Sports Health and Wellness Center may also provide practical treatment in conjunction with the other ART exercises described above.

Strategies for self-application

Secondary injuries due to vestibular problems can occur from frequent falls. As part of your ART, your doctor will explain simple strategies that can minimize the risk of secondary injury. For example, you may be advised to use walking aids if you are tired or in a particularly busy environment, such as a grocery store.


ART can be extremely helpful in reducing or eliminating any vestibular symptoms and imbalances you may be experiencing due to diseases or abnormalities of the inner ear or central nervous system.These exercises will lead to the best results if they are prescribed by one of our doctors of the Health and Wellness Complex “Healthy Sport”.

You can pass the examination in the Health-improving complex “Healthy Sport”, register by phone: 58-88-28

Vertigo Clinic

Our clinic for the treatment of vertigo provides services for the diagnosis and treatment of patients with dysfunction of the balance organ in the inner ear and the nerves of the vestibular apparatus.The symptoms of the disease are felt as dizziness with the sensation of riding a carousel or swimming, i.e. severe dizziness to loss of balance and falls; feelings of immersion or free fall.

Vertigo and dizziness

Vertigo is a sudden sensation of loss of balance or movement of the surrounding space in front of the eyes. You may feel that you are spinning like a carousel or that your head is spinning inward. In the first case, the patient feels that everything is spinning in front of him or his body is spinning.This usually occurs as a result of a sudden illness or disturbance of the organs of balance. Dizziness is characterized by weakness or frustration, usually caused by low blood sugar or low blood pressure in a chronic condition.

Vertigo can be observed after a long flight or travel on water, in which a person’s consciousness becomes accustomed to turbulence, which leads to the patient feeling that he is moving up and down. This feeling usually goes away after a few days.Vertigo also occurs when exposed to a very loud sound from its pressure in the inner ear, which relieves the load on the organ of balance. Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that vertigo can cause and is characterized by short-term episodes of mild to severe vertigo when head position changes.

Diseases that can cause vertigo and deafness

Vertigo may result from:

  1. Otitis media – inflammation or infection of the middle ear.
  2. Eustachian tube dysfunction (EST) or auditory tube dysfunction: Occurs when the tube cannot open when swallowing or yawning.
  3. Internal otitis media – inflammation of the labyrinth of the inner ear: the primary symptoms of internal otitis media are vertigo, which is accompanied by hearing loss and tinnitus.
  4. Head Injury: Refers to injuries that can affect the inner ear.
  5. Meniere’s disease: characterized by episodes of dizziness and tinnitus and usually unilateral hearing impairment.
  6. Positional vertigo: Benign paroxysmal positional vertigo (BPPV) (sometimes called DPV) is the most common cause of vertigo attacks. This group of patients suffers from vertebrobasilar insufficiency (VBI) or vertebrobasilar ischemia, which leads to the development of short-term symptoms of decreased blood supply in the vertebrobasilar area of ​​the brain.
  7. Degenerative changes or disorders in the central nervous system (CNS): Alzheimer’s disease, Parkinson’s disease or senile dementia.
  8. Acute peripheral vestibulopathy: sudden, persistent dysfunction of the peripheral vestibular system against the background of nausea, vomiting and vertigo. Vertigo usually lasts 2 weeks.
  9. Acoustic neuroma: (also known as acoustic neuroma, acoustic neuroma or acoustic schwannoma) is a benign, usually slow-growing tumor mass that develops in the vestibular and auditory nerves.
  10. Other syndromes of dysfunction of the central nervous system or brain: physical illness, diabetes mellitus, high blood pressure, infectious diseases, kidney disease, heart disease, thyroid dysfunction.

Given the variety of reasons, many factors must be taken into account when diagnosing, including:

  • The patient’s history of vertigo (its type and duration of seizures)
  • Physical examination
Special diagnostic techniques

A. Hearing examination

  1. Audiometry: to determine the speed of response of hearing
  2. Tympanometry and acoustic reflex to test middle ear function
  3. Bekesy – automatic audiometry

B.Examination of the vestibular apparatus

  1. Posturography
  2. Caloric test
  3. Positioning test
  4. VNG ​​

C. Physiological examination

  1. Audiometry of electrical reactions of the brain stem (BERA – ABR)

Vertigo – a sudden feeling of loss of balance and movement of objects around you. Feeling like you are spinning on a carousel or dizzy inside.There are many reasons for the development of this condition, so if you suffer from vertigo, you need to consult with a specialist to find out the cause and treatment.

90,000 Dizziness – (Clinic Di Center)


Dizziness indicates a mismatch of information coming from three systems responsible for orientation in the surrounding space: vestibular, visual, and tactile.

What it is?

Dizziness is most often spoken of as an “illusion of movement”, i. e.That is, dizziness is a misconception of body position and movement. Surely every person in his life has encountered dizziness. You may have experienced it as a child, after a few extra laps on attractions, or on an airplane, or after spending too much time with friends on holidays. Dizziness can occur at any age. If your head is spinning for no apparent reason and not for the first time, then you should try to find the cause of this disorder.

Why does this happen?

Dizziness indicates a mismatch of information coming from our three physiological systems responsible for orientation in the surrounding space: vestibular, visual and tactile.

There are many reasons for dizziness. For example, if dizziness occurs when you try to stand up or turn around and then gradually subside, then this may be a manifestation of autonomic dysfunction (vegetative-vascular, neurocirculatory dystonia).

When dizziness is accompanied by hearing loss, noise and ringing in the ears, and at the same time you have a cold, this suggests that you may have an inflammatory ear disease – otitis media. One of the common causes of dizziness and imbalance is dropsy of the inner ear or hydrops.

For a long time, back in the 19th century, it was reported about disorders in the form of dizziness, deafness, ringing in the ears, accompanying migraines. Moreover, people suffering from migraine, much more often than everyone else, suffer from dizziness that exists outside of headache attacks. this condition is also defined as “migraine without headache” or “headless migraine”.

With brain tumors, persistent dizziness is accompanied by increasing headaches. And an acute circulatory disorder, for example, a stroke, can, in addition to dizziness, be accompanied by a number of symptoms: speech impairment, weakness and impaired movement in the legs or arms, loss of consciousness.

Many people are familiar with the dizziness that occurs with sudden, sudden movements after prolonged sedentary work. It is accompanied by pain and tension in the muscles of the neck and is often found in untrained people who spend most of their time in a sitting position. The reason for this dizziness is a violation of the blood supply to the ear and parts of the brain that are responsible for the orientation of the body in space, as a result of overstrain of the neck muscles. Similar sensations can be experienced by people who have suffered an injury to the cervical spine.

Dizziness can be caused by certain medications, such as antibiotics or high blood pressure medications, especially if they are overdosed.

Finally, many who had to travel by air, sea, automobile and other transport, at least once experienced during the trip symptoms of motion sickness, or motion sickness. Currently, there is a fairly wide selection of drugs to relieve these unpleasant sensations.

Mention should also be made of the phenomenon of agoraphobia.This is a fear of open space syndrome, especially with a large number of people. In people with this disease, dizziness often occurs when they are in crowded places, and in severe cases, even if they need to leave the house.


If you experience frequent dizziness, you need to start with a visit to a neurologist, and then contact an otolaryngologist. At the same time, you will be offered to undergo vestibular tests (caloric test, rotational tests), as well as posturography – a study of the interaction of the visual, vestibular and muscular systems while maintaining balance.To diagnose a possible disease of the hearing aid, you may need tone threshold audiometry, acoustic impedance measurement; to find out the condition of the vessels – ultrasound scanning or computed tomography.


If you are suddenly caught by an attack of dizziness, try to calm down, do not panic. Sit down, try to focus your gaze on a specific object and not close your eyes. If dizziness is accompanied by unpleasant, painful sensations that were not there before (numbness of the arms or legs, speech impairment, severe pain in the abdomen, chest), you should immediately call a doctor.

Treatment of systematic dizziness is to combat its cause; treatment in each case is prescribed by the attending physician.


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What is vertigo?

True dizziness (vertigo) is a condition in which a person has a sensation of rotation of surrounding objects around him or a sensation of his own rotation or movement.An example of true, but not related to the disease, dizziness is the dizziness that occurs after riding the carousel, when, after an abrupt stop of the carousel, a person continues to see the movement of surrounding objects relative to himself, as if the carousel were still in motion.

The onset of true dizziness is most often a symptom of diseases of the balance system, which includes: the vestibular apparatus of the inner ear, eyes and sensory receptors of muscles, bones and joints of a person.Dizziness caused by a malfunction of the balance system is often accompanied by nausea and vomiting.

Which symptoms are not dizziness?

In folk life, dizziness is called a number of other symptoms, which, in fact, are not dizziness. The following phenomena are most often called “dizziness”:

  • Darkening in the eyes after a sharp rise to the feet from a sitting or lying position
  • Shroud before eyes
  • Weakness, feeling of confusion and unsteadiness in the legs
  • Nausea
  • Feeling close to fainting (loss of consciousness)
  • Feeling of disturbed balance and unstable gait

Unlike true dizziness, which, as mentioned above, is a consequence of a violation of the balance system, false dizziness, which is described by a person as a feeling of instability, weakness, veils before the eyes, darkening in the eyes, etc. , most often it can be a sign of chronic fatigue, hypovitaminosis, anemia, vegetative dystonia, hypotension. Also, episodes of lipotimia (a sharp decrease in muscle tone at the time of strong physical exertion), fainting, and short-term seizures of epilepsy can be confused with dizziness.

We draw special attention to attacks of acute dizziness and weakness in patients with diabetes mellitus. In this category of patients, dizziness and weakness can be a sign of a dangerous decrease in blood glucose levels.

Most common causes and forms of dizziness

According to modern research, dizziness is most often a symptom of the following diseases:

  • Benign paroxysmal positional vertigo (BPPV)
  • Basilar migraine
  • Meniere’s disease
  • Inflammation of the vestibular nerves (vestibular neuritis)
  • Psychogenic dizziness
  • Osteochondrosis of the cervical spine
  • Vertebrobasilar insufficiency
  • Brain tumors

It should be noted that BPPV accounts for more than 80% of all cases of true dizziness.

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo is one of the most common forms of true vertigo. The name of this disease is deciphered as follows: “Benign” means – a favorable and not dangerous course of the disease, “paroxysmal” – means the sudden appearance of dizziness; “Positional” – means the appearance of dizziness when turning the head in a certain direction.

The reason for the development of benign positional vertigo is irritation of the receptors of the vestibular apparatus by otolith stones located in the semicircular canals of the inner ear. BPPV can occur spontaneously in a person of any age, but it most often occurs in people over 50-60 years old, after an infection or injury.

  • The main symptoms of benign positional vertigo are as follows:
  • The onset of severe dizziness when turning in bed, when tilting or turning the head to the side, or when throwing the head back.
  • Severe dizziness lasts from several seconds to several minutes and may be accompanied by severe nausea or vomiting, weakness.
  • Dizziness attacks can occur in series, and then disappear without a trace for a while.

BPPV treatment is carried out with a special technique performed by a neurologist.

Dizziness with Meniere’s disease

Meniere’s disease is characterized by recurrent attacks of severe dizziness and deafness (most often in one ear), which gradually lead to hearing loss.

The exact cause of Meniere’s disease is currently unknown. There are suggestions that in some cases the disease may be caused by viral infections, trauma, or allergies.

A typical manifestation of Meniere’s disease is an acute attack of severe dizziness, which lasts several hours or days, accompanied by nausea, vomiting, hearing loss (in one ear), tinnitus and a feeling of pressure inside the ear.

Attacks of Meniere’s disease usually occur one after another for several weeks, and then disappear for a while, but sooner or later begin again.

Vertigo with vestibular neuritis

Vestibular neuritis is an inflammation of the vestibular nerve that conducts impulses from receptors in the inner ear to the brain. As a result of inflammation, the vestibular nerve temporarily loses its ability to conduct impulses, which is manifested by severe dizziness, nausea, vomiting and unstable gait.

Viral infections are considered the main cause of vestibular neuritis, therefore attacks of associated dizziness may be accompanied by fever, weakness, runny nose or cough.

Psychogenic dizziness

Psychogenic dizziness is the second most common after BPPV.

In contrast to benign paroxysmal dizziness, psychogenic dizziness is not true dizziness, that is, it is not associated with disruption of the vestibular apparatus.

The main characteristics of psychogenic vertigo are:

  • Description of vertigo as a sensation of confusion, fog in the head, or fear of falling and losing consciousness, but not as the spinning of objects or the subject himself
  • Dizziness attacks occur spontaneously, often in stressful situations, in crowded places and in a confined space (elevator, transport)

In addition to dizziness, patients have many other complaints that resemble some diseases of internal organs: sore throat or a lump in the throat, pain in the chest, in the heart or in the abdomen, feeling short of breath, pain and tension in muscles, feeling of inner fear and tension, disturbed sleep, anxiety, irritability, strong and unfounded concern for the state of one’s own health and the health of loved ones, etc.

Psychogenic dizziness can be considered as one of the most common manifestations of vegetative dystonia. Especially often attacks of false dizziness are observed in patients with panic attacks and anxiety disorders.

In psychogenic dizziness, treatment intended for vegetative dystonia (psychotherapy, sedatives) will be much more effective than specific drugs for dizziness that are prescribed in all cases of true dizziness.

When should I see a doctor immediately in case of dizziness?

You should consult a doctor as soon as possible in all cases when dizziness is accompanied by the following symptoms:

  • Temperature rise
  • Severe headache and muscle weakness in the legs or arms
  • Persistent vomiting
  • Severe dizziness does not go away for more than an hour
  • With dizziness, the patient fell and was badly injured
  • During an attack of dizziness, the patient lost consciousness
  • Severe dizziness occurred in patients with diabetes mellitus or hypertension
  • Diagnosis of dizziness

Neurologists and otolaryngologists are involved in the diagnosis and treatment of vertigo.To clarify the cause of dizziness and prescribe the correct treatment, the patient needs to go through:

  • audiographic examination
  • examination by an ophthalmologist
  • computed tomography (CT) or magnetic resonance imaging (MRI)
  • duplex scanning of neck arteries
  • X-ray of the skull and cervical spine

Vestibular syndrome – treatment, symptoms, causes, diagnosis

The vestibular system helps maintain a sense of balance and orientation in space, provides information about the position of the head and captures the image on the retina.Vestibular disorders (vestibular syndrome) can cause dizziness, confusion, and unsteadiness (feeling of movement, body rotation while standing or lying down). Vestibular disturbances can also cause nausea, vomiting, diarrhea, restlessness, or changes in blood pressure or heart rate.

Vestibular disorders can be caused by certain diseases, medications, or problems in the inner ear or brain.Many people experience imbalances as they age. Vestibular disturbances and dizziness can also occur as a result of taking certain medications.

The sense of balance is primarily governed by a labyrinth, a structure in the inner ear. One part of the labyrinth consists of semicircular canals and otolith receptors responsible for body balance. On the other side is the cochlea organ, which is responsible for hearing. The parts of the inner ear associated with balance are called the vestibular apparatus.The vestibular apparatus works in conjunction with other sensory-motor systems in the body, such as the visual system and the musculoskeletal system, to control and maintain body position at rest or in motion. It also helps maintain focus on a specific object, even if body position changes. The vestibular system does this by registering mechanical forces, including gravity, which acts on the vestibular organs during movement.Two parts of the labyrinth help to solve these problems: the semicircular canals and the otolith apparatus.

The semicircular canals are three fluid-filled loops located approximately at right angles to each other. They tell the brain when the head is in motion, such as when a person nods their head up and down or turns their head to the right or left. The visual system works in conjunction with the vestibular system to prevent blurring of visual images when the head is moving, for example, when walking or traveling in a car.Sensory receptors (proprioceptors) in joints and muscles also help maintain balance when standing or walking. The brain receives, interprets and processes information from these systems and thus controls the balance of the body.

The vestibular structures of the inner ear consist of an vestibule (oval and round sacs) and three semicircular canals. These structures operate on the level principle used by carpenters. There are a number of diseases of the structures of the inner ear, which lead to a malfunction of these structures, or the brain receives inaccurate information from the receptors of these structures.These conditions include Meniere’s syndrome, labyrinthitis, benign paroxysmal positional vertigo, middle ear infections, tumors, or trauma.

The most common causes of vestibular syndrome.

Benign positional vertigo is considered the most common type vestibular syndrome and vertigo syndrome.

Benign paroxysmal positional vertigo or positional vertigo is a brief, intense episode of vertigo that occurs due to a specific change in head position.In the presence of such a PG, dizziness may occur when the head is lifted up or when the head is turned. An episode of this dizziness can occur even when turning in bed. It is believed that the cause of this type of dizziness is a violation in the structure of the receptors of the semicircular receptors that send inaccurate information about the position of the head to the brain, which is the cause of the symptoms. The cause of benign paroxysmal positional vertigo (BPPV) can be head injuries, neuritis, age-related changes.The disorders are thought to be related to an abnormality in photocopy-cupula interaction within the membranous labyrinth, resulting from abnormal responses to endolymph movement during head movement.

Labyrinth infarction causes sudden, significant loss of auditory and vestibular function and usually occurs in older patients. This condition sometimes occurs in younger patients with atherosclerotic vascular disease or hypercoagulability.Episodic dizziness can be precursors of complete occlusion and proceed as a transient ischemic attack. After complete occlusion, the intensity of vertigo gradually decreases, but some instability may persist during movement, for several months until vestibular compensation occurs.

Vestibular neuronitis . Nerve damage has been linked to viral infections (herpes virus). The disease, as a rule, occurs in the autumn-spring period during the peak of acute respiratory infections.With vestibular neuronitis, episodes of dizziness occur without hearing loss, and may be accompanied by nausea and vomiting. The duration of an episode can vary from a few days to several weeks, with gradual regression of symptoms. Vestibular neuronitis may be accompanied by attacks of benign positional vertigo.


Labyrinthitis is caused by an inflammatory process within the membranous labyrinth, which can be caused by a bacterial or viral infection.Viral labyrinth infections cause vertigo symptoms similar to vestibular neuritis, but in combination with cochlear disorders. Infections such as measles, rubella, cytomegalovirus, as a rule, do not cause vestibular disorders. Bacterial labyrinthitis can be both with the defeat of the membranous labyrinth itself, and in the serous form. The serous form of labyrinthitis is often observed in acute otitis media, when bacterial toxins diffusely enter the labyrinth.

Meniere’s disease

Meniere’s disease is a disease of the inner ear and is characterized by episodic attacks of dizziness, sensorineural hearing loss, tinnitus, and a feeling of pressure on the ear membranes.First, hearing impairment occurs at low frequencies, with a gradual progression of impaired perception and at other frequencies, as the episodes of the disease recur. Episodes of Meniere’s disease ?? are characterized by true dizziness, usually with nausea and vomiting, and persist for several hours. It is believed that this disease is associated with the expansion of the endolymphatic space, with ruptures and subsequent regeneration of the membranous labyrinth.


Often migraine attacks can be similar to attacks of Meniere’s disease. But with migraines, hearing loss is less common than in dizziness, tinnitus, photophobia, and phonophobia. But, nevertheless, with migraine, there may be a certain sensorineural hearing loss for low-frequency sound vibrations. Therefore, sometimes the differential diagnosis between these diseases is sometimes difficult. Multiple sclerosis also presents a diagnostic challenge for the differential diagnosis of migraine. In 5% of cases, multiple sclerosis can debut with debilitating dizziness, and in 50% of patients with multiple sclerosis, episodes of dizziness occur during certain periods of the disease.Moreover, one in ten patients with multiple sclerosis may have hearing loss, which can be partial or complete, which makes the symptoms similar to Meniere’s disease or migraine.

Disease “unloading
Dizziness occurs after disembarkation and the person continues to feel the rocking motion that persists after returning to a stable environment after prolonged exposure to movement (eg, after traveling in a train, car, boat).

Other causes of vestibular syndrome . Damage to the vestibular analyzer can be caused by head trauma, “whiplash”, acoustic neuroma, drug intoxication with a condition after ear surgery, diseases of the musculoskeletal system (with impaired proprioception), diseases of the central nervous system.


When the vestibular analyzer malfunctions, a sensation of rotation arises.The person may stagger when trying to walk or fall when trying to get up. The main symptoms of vestibular syndrome are:

  • Dizziness or dizziness
  • Fall or feeling of possible fall
  • Weakness
  • Blurred vision
  • Disorientation

Other symptoms include nausea, vomiting, diarrhea, changes in heart rate, blood pressure, fear, anxiety, or panic.Some patients may experience fatigue, depression, and inability to concentrate. Symptoms may appear and disappear within a short period of time, or have long intervals between attacks.


Diagnosis of vestibular disorders is rather complicated, since there are many reasons for disorders of vestibular functions, both diseases and drugs that cause dizziness. Nevertheless, first of all, it is necessary to undergo a consultation with an ENT doctor.After studying the medical history, a detailed study of the symptoms, the doctor will examine the ear and prescribe the necessary examination plan. The examination plan may include both laboratory tests or special tests (audiometry, electronystagmography) and neuroimaging techniques such as MRI and CT. In addition, in recent years, such research methods have become widespread as: computer-dynamic visual test, testing of vestibular autorotation, GDP (vestibular-evoked potentials).

The simplest and most accessible tests are such tests as energy essence, which consists in cold or heat exposure to the middle ear, which is easiest to carry out using water of different temperatures. A difference in nystagmus of more than 25%, which occurs when exposed to a temperature factor, usually indicates the presence of peripheral or central dysfunction of the vestibular apparatus.


Treatment of vestibular syndrome depends primarily on the genesis of this syndrome.First of all, it is necessary to exclude damage to the vestibular analyzer of central genesis (brain diseases, trauma). Treatment will depend on the pathogenesis of the vestibular disorder.

In some cases of vestibular disorders, it is necessary to influence the factors of daily activity, such as travel, in a car or an elevator, to reduce the risk of injury. If you have BPPV, your doctor may order a series of simple movements, such as the Epley maneuver, to release otoconia in the semicircular canals.For Meniere’s disease, your doctor may recommend dietary changes such as cutting back on salt and limiting alcohol and caffeine. Getting rid of a habit such as smoking can also have a positive effect. Perhaps the introduction of such an antibiotic in small doses (gentamicin) or a steroid for the eardrum. In severe cases of Meniere’s disease, surgical treatment is possible. Drug treatment of vestibular disorders includes the use of drugs from the group of anticholinergics, antihistamines, benzodiazepines.Symptomatic medications, such as cerucal, are also used. Recently, a drug such as betaserc has been used to treat dizziness.

In the presence of inflammatory processes in the middle ear, it is necessary to use anti-inflammatory treatment or antibiotics.

In the presence of persistent vestibular disorders, a number of measures must be taken to reduce the risk of falling, for example, using handrails when climbing stairs, wearing low-heeled shoes, equipping handrails in the bathroom, avoiding driving, etc.d.

MC Neuro-Med. Dizziness.

D. Labyrinthitis

1. Bacterial labyrinthitis. In a bacterial infection of the middle ear or mastoid (such as chronic otitis media), bacterial toxins can cause inflammation of the inner ear structures (serous labyrinthitis). Symptoms may be minimal at first, but without treatment they gradually build up. Direct infection of the labyrinth (purulent labyrinthitis) is possible with bacterial meningitis or a violation of the integrity of the membranes separating the inner ear from the middle.Patients have severe vestibular dizziness, nausea, hearing loss, fever, headache and ear pain. Purulent labyrinthitis is a dangerous disease that requires early diagnosis and antibiotic therapy.

2. Viral labyrinthitis. Damage to the auditory and vestibular organs is observed in various viral infections, including influenza, herpes, rubella, mumps, viral hepatitis, measles, infection caused by the Epstein-Barr virus. Most patients recover on their own.

E. Functional dizziness occurs as a result of a violation of the interaction between the vestibular, visual and somatosensory systems, which normally jointly provide spatial orientation. Dizziness can also be caused by physiological stimulation of normally functioning sensory systems.

1. Motion sickness is caused by an unusual acceleration of the body or a mismatch between afferentation entering the brain from the vestibular and visual systems.In a person in a closed cabin of a ship or in the back seat of a moving car, vestibular afferentation creates a sensation of acceleration, while visual afferentation indicates the relative immobility of surrounding objects. The intensity of nausea and dizziness is directly proportional to the degree of sensory mismatch. The motion sickness is reduced with a sufficient panoramic view to make sure that the movement is real.

2. Visually caused dizziness occurs when observing moving objects – due to a mismatch of visual afferentation with vestibular or somatosensory (for example, when a person watches a movie with a car chase).

3. Altitude dizziness is a widespread phenomenon that occurs when the distance between a person and the stationary objects observed by him exceeds a certain critical value. Frequently observed fear of heights prevents adaptation to physiological mismatch between vestibular and visual afferentation.

G. Transient ischemia of the brain stem

1. General information

a. Clinical picture

1) Vestibular dizziness and imbalance are the two most common symptoms of transient ischemia of the brainstem resulting from damage to the arteries of the vertebrobasilar basin.At the same time, only in rare cases are they the only manifestations of this disease. If repeated attacks of dizziness are not accompanied by other signs of trunk ischemia (diplopia, dysarthria, impaired sensitivity of the face or extremities, ataxia, hemiparesis, Horner’s syndrome or hemianopsia), then they are usually caused not by vertebrobasilar insufficiency, but by peripheral vestibulopathy.

2) Imbalance and blurred vision occur both with vestibular neuronitis and with lesions of the trunk, and therefore do not allow to clarify the localization of the focus. Acute hearing loss is not typical for ischemic damage to the trunk; a rare exception is occlusion of the anterior inferior cerebellar artery, from which the internal auditory artery departs to the inner ear.

b. Differential diagnosis

1) Since transient ischemia of the brain stem requires active therapy aimed at preventing stem stroke, it is important to differentiate it from more benign disorders (in particular, vestibular neuronitis).

2) In the interictal period with transient ischemia of the trunk, there are no signs of focal brain damage. However, during an attack, a careful examination can reveal such disorders as Horner’s syndrome, slight strabismus, internuclear ophthalmoplegia, central alternating or vertical nystagmus, etc., characteristic of lesions of the trunk, but not the vestibular apparatus. With ischemia of the trunk, it is often possible to induce positional nystagmus. The Nilen-Barani test helps to distinguish the central lesion from the peripheral one.Vestibular dizziness and imbalance can also occur when the brain stem is affected by other etiologies, such as multiple sclerosis or tumors.

H. Cerebellar stroke

1. Clinical picture. The defeat of the cerebellum due to ischemia or hemorrhage in the basin of the posterior inferior cerebellar artery can manifest itself as severe vestibular dizziness and imbalance, which are easily mistaken for symptoms of acute vestibular neuronitis.Sometimes the lesion is limited to the cerebellar hemisphere, and in this case there are no signs of damage to the lateral part of the medulla oblongata (dysarthria, numbness and paresis of the facial muscles, Horner’s syndrome, etc.). A heart attack in the basin of the superior cerebellar artery causes abasia and ataxia, which are usually not accompanied by severe dizziness.

2. Diagnostics. An imbalance with a tendency to fall towards the lesion is observed when both the vestibular system and the cerebellar hemispheres are damaged and does not help in differential diagnosis. Central alternating nystagmus, the fast phase of which is directed towards the gaze, and hemiataxia suggest a lesion of the cerebellar hemisphere. CT can diagnose cerebellar hemorrhage, but may not detect a heart attack (especially if the test is done immediately after the onset of symptoms). A more reliable method for diagnosing cerebellar infarction is MRI.

3. Current. Cerebellar infarctions and hemorrhages are often limited in size, and the outcome is favorable.As a rule, there is a gradual recovery, and the residual defect is minimal. More extensive lesions, accompanied by cerebellar edema, can cause compression of the trunk and fourth ventricle. This serious complication requires surgical decompression, but it can be prevented with timely dehydration, so early diagnosis and careful monitoring in the acute phase are extremely important in cerebellar strokes.

I. Oscillopsia – the illusion of oscillation of motionless objects.Oscillopsia in combination with vertical nystagmus, instability and vestibular dizziness is observed in craniovertebral abnormalities (for example, Arnold-Chiari syndrome) and degenerative lesions of the cerebellum (including olivopontocerebellar atrophy and multiple sclerosis).

K. Vestibular epilepsy. Dizziness can be the leading manifestation of simple and complex partial seizures if they occur in the vestibular areas of the cortex (superior temporal gyrus and associative areas of the parietal lobe).Dizziness in this case is often accompanied by noise in the ear, nystagmus, paresthesia in the contralateral limbs. Attacks are usually short-lived and can easily be confused with other conditions that manifest as vestibular vertigo. In most cases, these seizures are associated with typical manifestations of temporal lobe epilepsy. The diagnosis is confirmed by EEG changes. Treatment: anticonvulsants or resection of the affected area of ​​the brain.

L. Migraine

1.The clinical picture. Dizziness can be the leading symptom of basilar migraine. During an attack, visual and sensory disturbances, impaired consciousness, and intense headache are also noted.

2. Diagnostics. Recurrent bouts of vestibular vertigo (in the absence of other symptoms) may be a manifestation of dissociated migraine. The diagnosis of migraine in this case is possible only if all other causes are excluded; it is more likely if there are other manifestations of the disease.

M. Chronic vestibular dysfunction

1. General information. The brain is able to correct the impaired connection between vestibular, visual and proprioceptive signals. Due to the processes of central adaptation, acute dizziness, regardless of its cause, usually disappears within a few days. However, sometimes vestibular disorders are not compensated for due to damage to the brain structures responsible for vestibulo-ocular or vestibulospinal reflexes.In other cases, adaptation does not occur due to concomitant visual impairments or proprioception.

2. Treatment. Constant dizziness, imbalance and coordination of movements can cause disability of the patient. Drug therapy in such cases is usually ineffective. Patients with persistent vestibular dysfunction are shown a set of special exercises (vestibular gymnastics).

a. Exercise goals

1) Reduce dizziness.

2) Improve balance.

3) Restore self-confidence.

b. Standard complex for vestibular gymnastics

1) Exercises for the development of vestibular adaptation are based on the repetition of certain movements or postures that cause dizziness or imbalance. It is believed that this should contribute to the adaptation of the vestibular structures of the brain and the inhibition of vestibular reactions.

2) Balance training exercises are designed to improve coordination and use information from various senses to improve balance.

IV. Diagnosis and treatment of diseases accompanied by imbalance

A. Multiple sensory insufficiency

1. General information. In case of violation of proprioception of the legs, pronounced instability, uncertainty and unsteadiness when walking (“drunk” gait) develop.The resulting feeling of instability, patients are often called “dizziness”. The cause of impaired proprioception is often polyneuropathy or myelopathy (due to vitamin B12 deficiency, cervical spondylosis, tabes dorsum). Because vision plays an important role in orientation and balance, dizziness and unsteadiness are often worse in darkness.

With simultaneous visual impairment (with cataract or macular degeneration), extrapyramidal disorders, orthostatic hypotension or vestibular dysfunction, even mild impairments to proprioception lead to severe imbalance (multiple sensory insufficiency syndrome).

2. Treatment should, if possible, be directed towards the underlying disease. Consultation with a specialist in exercise therapy is required. To avoid falls, use a stick or other device while walking. At night, it is recommended to leave a night light, in the light of which it is easier for the patient to get to the toilet room. Vestibular gymnastics is also carried out.

B. Diseases of the cerebellum (alcoholic cerebellar degeneration and other degenerative lesions, tumors, heart attacks) and extrapyramidal disorders (parkinsonism, progressive supranuclear palsy) often lead to imbalance, which patients often define as “dizziness.”

B. Schwannomas and other tumors of the cerebellopontine angle

1. General information

a. Schwannomas (Schwann cell tumors), also called neurinomas, usually grow from the vestibular cochlear nerve in the ear canal. As the tumor gradually grows into the cerebellopontine angle, new symptoms appear sequentially:

1) Hearing impairment, noise in the ear and mild imbalance.

2) Headache.

3) Severe imbalance and coordination.

4) Damage to adjacent cranial nerves (numbness and paresthesia of the face, weakness of facial muscles).

5) Symptoms of increased ICP. The first symptom of the disease, as a rule, is unilateral hearing loss, sometimes accompanied by a noise in the ear, but patients often do not attach importance to this and seek help only when headaches, imbalance or dizziness appear.

b. Meningiomas, epidermoid tumors and other neoplasms can also be localized in the region of the cerebellopontine angle, manifesting with similar symptoms.

2. Diagnostics. Launched inoperable schwannomas of the vestibular cochlear nerve cause severe disability. Therefore, early diagnosis of the tumor is important – at the stage when its removal is safe and does not leave a gross defect. Therefore, in all patients with sensorineural hearing loss (especially if it is combined with vestibular disorders), it is necessary to exclude a tumor of the cerebellopontine angle.

a. Neurological examination often reveals only hearing loss. Of the other symptoms, weakening of the corneal reflex, nystagmus, facial hypesthesia are most often detected.

b. Audiologic examination can distinguish between cochlear lesions and retrocochlear disorders. The latter are characterized by impaired speech intelligibility in combination with an increase in tone perception thresholds, the absence of the phenomenon of an accelerated increase in sound volume, tone fading and a decrease in the acoustic reflex.

c. The best method for diagnosing tumors of the posterior cranial fossa is MRI with gadolinium, which allows even small intracanalicular tumors to be detected.

, CT with high resolution with a small section thickness (with or without iv contrasting) also allows diagnosing tumors of the posterior cranial fossa, but does not reveal relatively small intracanalicular neoplasms.

3. Treatment. For most tumors of the cerebellopontine angle, resection is indicated.The schwannoma of the vestibular cochlear nerve can be removed in most cases, preserving the function of the facial nerve. With small tumors (less than 2 cm in diameter), hearing is sometimes also preserved. Since the tumor grows slowly, in the elderly it is sometimes possible not to rush into surgery, but to observe the condition (using CT or MRI).

G. Balance disorders caused by drugs. Imbalance, dizziness and other symptoms of labyrinth damage can be a consequence of the toxic effects of various drugs.Medicinal intoxication usually causes symmetrical vasoroparetic nystagmus. When viewed from the side, the eyes slowly return to the midline, followed by a rapid return movement in the direction of the gaze.

1. Anticonvulsants. Most of the widely used anticonvulsants (phenobarbital, phenytoin, ethosuximide, primidone, carbamazepine) cause vestibular symptoms (nystagmus, dizziness) and ataxia if their concentration in the blood reaches toxic levels.Symptoms usually disappear when the drug is discontinued and its concentration in the blood decreases.

2. Alcohol intoxication is usually accompanied by a shaky gait and dysarthria, which is probably associated with cerebellar dysfunction. Positional nystagmus and positional vertigo are just as common. Apparently, positional vertigo is caused by different rates of ethanol penetration into the cupula and endolymph, which causes transient changes in sensitivity to gravity.

3.Salicylates. The first symptoms of poisoning are noise in the ear and vestibular dizziness. Hearing loss is also possible, closely correlating with the level of salicylate in the blood. When these symptoms appear in patients who have been receiving large doses of salicylate for a long time, the drug is canceled or its dose reduced. Vestibular disorders and hearing loss disappear 2-3 days after withdrawal.

4. Aminoglycosides have a pronounced ototoxicity, causing both auditory and vestibular disorders.Streptomycin, gentamicin, and tobramycin usually cause vestibular disturbances, while amikacin, kanamycin, and neomycin cause auditory disturbances. Aminoglycosides damage the hair cells of the inner ear. Ototoxicity directly depends on the concentration of the drug in the blood and the duration of treatment.

a. Patients rarely complain of dizziness, more often they are worried about imbalance, which intensifies in the dark, when visual control is impossible. Another common symptom is oscillopsia, which occurs as a result of impaired vestibulo-ocular reflexes and manifests itself mainly with head movements.Cold test reactions gradually decrease on both sides.

b. Hearing loss (initially to high-frequency sounds) sometimes appears later than vestibular disorders.

c. There is no cure for the defeat of the labyrinth. After stopping the antibiotic, improvement usually occurs within a few days, however, recovery may take a year or more, and in some patients, especially the elderly, it may not come at all.

m.Preventive measures prevent the ototoxic effect of aminoglycosides. It is necessary to carefully monitor the daily dose, duration of therapy and the concentration of the drug in the blood. This is especially important in renal failure, when the excretion of aminoglycosides is impaired. During treatment, the vestibular and auditory functions are regularly examined. At the first symptoms of ototoxicity, the drug is canceled.

V. Hyperventilation syndrome and psychogenic dizziness

A.Hyperventilation syndrome is a common cause of dizziness. Hyperventilation attacks are triggered by anxiety or other affective disorders.

1. General information. Hyperventilation leads to hypocapnia, alkalosis, vasoconstriction and decreased cerebral blood flow. Patients complain of a vague feeling of lightheadedness, often accompanied by paresthesia of the lips and fingers, feeling short of breath, sweating, chills, palpitations and fear. A provocative test with a three-minute hyperventilation has not only diagnostic, but also important psychotherapeutic value, since the patient becomes clear about the origin of the symptoms.

2. Treatment. First of all, it is necessary to convince the patient that his disease is not dangerous. In severe cases, psychiatric consultation and psychotherapy are indicated. Attacks of hyperventilation can be stopped by inviting the patient to breathe in the bag (while he will inhale the carbon dioxide he exhales, which prevents hypocapnia and alkalosis).

B. Psychogenic dizziness

1. General information. With some neuroses and psychosis, dizziness occurs, which is not similar to any of the known conditions (vestibular dizziness, fainting, or imbalance) and is not reproducible in any of the provocative tests described above.Dizziness is observed in about 70% of patients with hypochondriacal neurosis and more than 80% with hysterical neurosis. Dizziness in such patients often lasts for years and is constant, not episodic. Many of them call “dizziness” general weakness, impaired attention, a feeling of confusion in the head.

2. Anxiety or depression does not necessarily indicate psychogenic dizziness, since they are often not a cause, but a consequence of acute and chronic vestibular disorders.During severe attacks of vestibular dizziness, there may be a feeling of impending death.

3. Treatment

a. The patient must be convinced of the absence of a dangerous disease, which is possible only with a trusting relationship with the doctor. However, patients are often not satisfied with the conclusion about the psychogenic nature of their illness, and having heard that they “have nothing serious”, they persistently continue to look for a serious illness in themselves, turning to one doctor after another.It is necessary to tactfully and easily explain the nature of the violation, show maximum participation and ensure constant monitoring.

b. Benzodiazepines (diazepam, lorazepam, or oxazepam) are especially effective for acute anxiety. In patients with hypochondriacal or hysterical neurosis, the use of these drugs must be carefully monitored. If depression is predominant, then tricyclic antidepressants are indicated.

VI. Tinnitus

A.Definition. Tinnitus is an unpleasant auditory sensation that occurs in the absence of an external sound source.

B. General information. Tinnitus in diseases of the middle ear, cochlea, and cochlear part of the vestibular cochlear nerve is usually described as ringing, roaring, buzzing, or as “the sound of the surf.” The nature of the noise does not indicate the localization of the lesion. Possible causes of tinnitus can be acoustic trauma, presbyacusia, Meniere’s syndrome, tympanosclerosis, schwannoma of the vestibular cochlear nerve.All these disorders are usually accompanied by hearing loss. When noise appears in the ear, first of all, the schwannus of the vestibular cochlear nerve is excluded. In more than half of patients with “ringing” in the ears, hearing is not impaired, it is rarely possible to establish the cause of the noise in this case.

B. Medicines (including salicylates, quinidine, aminophylline, indomethacin and caffeine) can cause tinnitus, not accompanied by hearing loss. With such complaints, these funds are canceled whenever possible.

G. Pulsating tinnitus, synchronous with the pulse, is often associated with turbulent blood flow. Patients may hear a murmur arising in a stenotic or tortuous carotid or vertebral artery. Pulsating murmurs can also cause vascular malformations and vascular tumors (eg, paraganglioma of the jugular glomus). Correction of the vascular anomaly usually removes such a murmur.

D. Treatment. Tinnitus can be extremely unpleasant and sometimes makes life unbearable.The murmur is usually more pronounced at night and often causes insomnia. Chronic anxiety and depression often develop with incessant noise. Treating emotional disorders can improve the condition.

1. Medicines for chronic tinnitus are usually ineffective. Sometimes a temporary improvement is achieved by IV administration of lidocaine, but it is not suitable for long-term therapy.

2. Masking noise. Many sufferers drown out tinnitus with external sounds.You can leave the radio turned on overnight or wear special headphones with “background” noise. Unfortunately, such techniques do not always help.

VII. Fainting. Many patients describe the feeling of impending loss of consciousness as dizziness, others – as a feeling of emptiness in the head, slight intoxication, lightheadedness. The same sensations occur with vestibular dizziness. A light-headed state may be accompanied by other symptoms characteristic of vestibular dizziness: nausea, pallor, sweating, a feeling of fear, a veil in front of the eyes.Therefore, complaints of dizziness can sometimes be difficult to interpret. In such cases, provocative tests are especially useful. Although it is possible for people with vestibular vertigo to fall due to sudden loss of balance, transient loss of consciousness is not common in this condition.

A. Reflex fainting occurs as a result of reflex autonomic reactions, mainly causing vasodilation. As a result, there is a decrease in OPSS, insufficient filling of the right heart and a drop in cardiac output.The attack usually occurs in a standing position, less often in a sitting position. Loss of consciousness is often preceded by nausea, pallor, sweating, lightheadedness, or dizziness.

1. Vasovagal syncope is usually triggered by fear, stress, or pain. This is the most common type of syncope in healthy young adults.

2. Situational syncope (vagovagal or visceral reflex syncope)

a. Fainting when urinating and stool.

b. Fainting when coughing.

c. Fainting on swallowing.

, Arterial hypotension after eating (one of the common causes of fainting in the elderly, in whom impaired baroreflexes are unable to compensate for the increase in celiac blood flow after eating).

3. Carotid sinus syndrome. Dizziness and fainting in this condition may be due to bradycardia, vasodilation, or a combination of both.

4. Orthostatic hypotension is caused by insufficiency of reflex sympathetic mechanisms that maintain blood pressure during the transition to a standing position.

a. Primary autonomic failure occurs in Shai-Dreager syndrome and idiopathic orthostatic hypotension.

b. Secondary orthostatic hypotension develops due to:

1) Vegetative polyneuropathies (with diabetes mellitus, alcoholism, amyloidosis).

2) Drug treatment (antihypertensive and vasodilators, nitrates, tranquilizers, antidepressants, phenothiazines, etc.).

3) Hypovolemia (with blood loss, vomiting, increased urine output, dehydration).

4) Prolonged bed rest, detraining the cardiovascular system.

B. Cardiogenic syncope is caused by a decrease in left ventricular ejection. In cardiogenic syncope, in contrast to reflex syncope, loss of consciousness often occurs suddenly, without prior symptoms.

1. Obstructive cardiogenic syncope is caused by narrowing of the outflow tract of the left ventricle (with aortic stenosis, hypertrophic cardiomyopathy, pulmonary hypertension, cardiac tamponade, atrial myxoma, etc.).

2. Arrhythmic cardiogenic syncope occurs with ventricular tachycardia, AV block, sick sinus syndrome, QT prolongation syndrome, etc.

3. Since cardiogenic syncope is life-threatening, in case of repeated syncope of unknown origin, it is necessary first of all to exclude heart disease.In most cases, this can be done on the basis of anamnesis, examination and conventional instrumental research methods. However, sometimes, to find out the cause of fainting, electrophysiological examination, samples on an orthostatic table, Holter ECG monitoring may be required.

V. For stenosing lesions of the cerebral arteries, fainting states are not typical, and therefore it is erroneous to explain these states by transient cerebral ischemia. However, occasionally syncope may occur with extensive stenosis or occlusion of the extracranial arteries.This happens with the following diseases:

1. Atherosclerotic bilateral occlusion of several extracranial arteries: in this case, primary orthostatic cerebral ischemia (isolated cerebral orthostatic hypotension) is possible.

2. Aortoarteritis (Takayasu’s disease).

3. Syndrome of subclavian steal.


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