Vertigo

If you have a balance disorder, your symptoms might include:

• Dizziness or a spinning sensation
• Falling or feeling as if you are going to fall
• Staggering when you try to walk
• Lightheadedness, faintness, or a floating sensation
• Blurred vision
• Confusion or disorientation

Other symptoms might include nausea and vomiting; diarrhea; changes in heart rate and blood pressure; and fear, anxiety, or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression.

Diagnosis of a balance disorder is difficult. To find out if you have a balance problem, your primary doctor may suggest that you see an otolaryngologist and an audiologist. An otolaryngologist is a physician and surgeon who specializes in diseases and disorders of the ear, nose, neck, and throat. An audiologist is a clinician who specializes in the function of the hearing and vestibular systems.

You may be asked to participate in a hearing examination, blood tests, a video nystagmogram (a test that measures eye movements and the muscles that control them), or imaging studies of your head and brain. Another possible test is called posturography. For this test, you stand on a special movable platform in front of a patterned screen.

Posturography measures how well you can maintain steady balance during different platform conditions, such as standing on an unfixed, movable surface. Other tests, such as rotational chair testing, brisk head-shaking testing, or even tests that measure eye or neck muscle responses to brief clicks of sound, may also be performed. The vestibular system is complex, so multiple tests may be needed to best evaluate the cause of your balance problem.

When should I seek help if I think I have a balance disorder?

To help you decide whether to seek medical help for dizziness or balance problems, ask yourself the following questions. If you answer “yes” to any of these questions, talk to your doctor:

• Do I feel unsteady?
• Do I feel as if the room is spinning around me, even for a very brief time?
• Do I feel as if I’m moving when I know I’m sitting or standing still?
• Do I lose my balance and fall?
• Do I feel as if I’m falling?
• Do I feel lightheaded or as if I might faint?
• Do I have blurred vision?
• Do I ever feel disoriented—losing my sense of time or location?

How can I help my doctor make a diagnosis?

You can help your doctor make a diagnosis and determine a treatment plan by answering the questions below. Be prepared to discuss this information during your appointment.

1. The best way I can describe my dizziness or balance problem is:
   • Is there a spinning sensation, and if so, which way does the room spin?
   • Is the dizziness/spinning caused by any specific motion or does it occur even when sitting or lying still?
   • Are there any other symptoms that occur at the same time as the dizziness/spinning, such as hearing loss, tinnitus, a feeling of pressure in one or both ears, or a headache?
   • Does anything seem to help the dizziness/spinning?
2. How often do I feel dizzy or have trouble keeping my balance? How long do the dizziness or spinning episodes last (seconds, minutes, hours, days)?
3. Have I ever fallen?
   • When did I fall?
   • Where did I fall?
   • Under what conditions did I fall?
   • How often have I fallen?
4. These are the medicines I take. Include all prescription medications; all over-the-counter medicine, such as aspirin, antihistamines, or sleep aids; and all vitamin supplements and alternative or homeopathic remedies:
   • Name of medicine or supplement: ______________________.
   • How much (milligrams) _____ and how often (times) ______ per day.
   • The condition I take this medicine for is: __________________________.

The first thing an otolaryngologist will do if you have a balance problem is determine if another health condition or a medication is to blame. If so, your doctor will treat the condition, suggest a different medication, or refer you to a specialist if the condition is outside his or her expertise.

If you have BPPV, your otolaryngologist or audiologist might perform a series of simple movements, such as the Epley maneuver, to help dislodge the otoconia from the semicircular canal. In many cases, one session works; other people need the procedure several times to relieve their dizziness.

If you are diagnosed with Ménière’s disease, your otolaryngologist may recommend that you make some changes to your diet and, if you are a smoker, that you stop smoking. Anti-vertigo or anti-nausea medications may relieve your symptoms, but they can also make you drowsy. Other medications, such as gentamicin (an antibiotic) or corticosteroids may be used. Although gentamicin may reduce dizziness better than corticosteroids, it occasionally causes permanent hearing loss. In some severe cases of Ménière’s disease, surgery on the vestibular organs may be needed.

Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan.

Talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling and getting hurt during daily activities, such as when you walk up or down stairs, use the bathroom, or exercise. To reduce your risk of injury from dizziness, avoid walking in the dark. Wear low-heeled shoes or walking shoes outdoors. If necessary, use a cane or walker and modify conditions at your home and workplace, such as adding handrails.

Scientists supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) are studying animal ears to learn if inner-ear structures that help with balance but are destroyed by aging, medications, infections, or trauma can someday be regrown in people with balance problems. Other NIDCD-supported scientists are testing vestibular prostheses—miniature devices that may be worn outside the body or implanted into the ear to regulate the function of balance organs in the inner ear and ease dizziness. Some of these devices are being tested on volunteers in clinical trials, and others are still being developed. Visit the NIH Clinical Research Trials and You website to read about these and other clinical trials that are recruiting volunteers.

NIDCD-funded scientists are also working to develop much-needed tests to appropriately diagnose balance disorders. Standardized tests will help doctors determine the best way to help individuals restore their sense of balance and quality of life. These tests will also help us understand how many people suffer from balance disorders, and track whether the sense of balance is restored following treatment.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

For more information, contact:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
nidcdinfo@nidcd.nih.gov