Balance FAQ's

I feel dizzy. Does this mean I have vertigo? What is vertigo?

Dizziness is a general term that refers to a sensation of imbalance. Vertigo is a very specific sensation characterized by an illusion of motion, or a sensation that “the room is moving.” All vertiginous patients are dizzy, but only some dizzy patients have vertigo. Vertigo can be brief or constant, mild or intense, but typically is worrisome and disabling to patients who experience it.

What causes dizziness, imbalance, and vertigo?

The balance system is very complex. It relies on cues from the eyes, the ears, the skin, and the feet. All of these cues are transmitted to the brain where they are processed in a manner that allows us to keep our balance. When any of these systems begin to function improperly, dizziness can result.

It is common for symptoms of dizziness and vertigo to be related to dysfunction along the balance organ pathway. Some sources of these problems include viral infections of the inner ear, fluid in the middle ear (otitis media), head trauma, and Meniere’s disease. Other sources include malposition of deposits in the hearing organ (Benign Paroxysmal Positional Vertigo), and growths and tumors along the balance nerve (Acoustic Neuroma/Vestibular Schwannoma), as well as systemic diseases such as Multiple Sclerosis. Some medications are also associated with vertigo, as are neurological disorders such as stroke, seizures, Parkinson’s disease. Some life threatening causes of vertigo, although rare, do exist and should be ruled out.

Can the symptoms of vertigo be manifestations of other diseases or conditions?

While vertigo is commonly due to a simple disorder of the inner ear, it may be associated with more central or systemic problems such as Stroke, Multiple Sclerosis, Parkinson’s Disease, and Tumors. Similarly, non-vertiginous dizziness is usually not due to problems from the inner ear and may be associated with problems in the heart or vascular system.

What is the balance system?

The balance, or vestibular system involves a complex set of neural pathways and structures that help the body perceive and maintain balance and posture. Peripheral anatomic structures (ears, eyes, hands, feet) gather cues which are sent to the central nervous system (brain, spinal cord) via nerves. In the central nervous system, these cues are processed and the body creates a sensation of balance.

What is a balance test? What should I expect?

When you come for a balance test – called a VNG (“Videonystagmography”), Dr. McQuaide-Bell will begin by taking a thorough history of your experience with dizziness, imbalance, and vertigo. She will then review your symptoms and prepare you for balance testing. In balance testing you will be asked to watch a variety of visual cues. In some instances, your eye movements will be monitored in response to several different stimuli, such as head position, eye position, and different temperatures in the ear. Some tests are interactive, others are not. The entire process will take approximately 1 and 1/2 hours, and typically includes a hearing test.

I am scheduled for a balance test. Is there anything I should do to prepare?

In order to achieve the best results, we ask you to do the following:

  • You may wish to have a driver to pick you up after the test.
  • Remove contact lenses before testing.
  • Wear comfortable clothing.
  • Wash face thoroughly –– no creams or makeup on the face, especially mascara or eyeliner.
  • No solid foods or milk on the day of the test.
  • No aspirin or medication containing aspirin for two days prior to test.
  • No caffeinated drinks, alcoholic beverages/liquid medications with alcohol for 48 hours prior to testing.
  • Discontinue all medications 24 hours prior to testing except those taken for heart, blood pressure, depression or seizures. Stop allergy, sleeping pills, decongestants, pain, diet or dizziness medications.
  • If you have any questions about your medications please call the office.

How is vertigo treated? What can I do?

Often, a balance test is one of the first steps towards treating your vertigo. Information from a balance test can provide solid clues about the sources of your symptoms. In some cases, the vertigo can be resolved with a simple maneuver designed to realign the displaced calcium stones in the inner ear. In other cases, information from the balance test will allow your physician to prescribe directed treatments or further tests that target the root cause of your symptoms.

When I first experienced vertigo, I went to the hospital for testing. Those tests came back “normal.” Why should I have a “balance test”?

A balance test – or “VNG” – is not typically performed in many hospitals for patients with vertigo. More commonly, tests on hospital inpatients are designed to rule out life-threatening causes of vertigo, such as a stroke or heart attack. Once a patient is discharged from a hospital is often the time to begin a detailed search for sources of persistent dizziness and vertigo. A balance test – or VNG – is usually an integral part of this follow-up evaluation.

Is the VNG a difficult test?

The VideoNystagmoGraphy test – or “VNG “ – consists of the patient looking at moving lights and moving his/her head in different positions, The patient wears goggles, so that the computer can record eye movements, using the eyes as windows to understanding the inner ears. Some patients experience some brief vertigo from the test, but many do not feel any extra dizziness.

What is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo. It is a common cause of vertigo. Tiny otoliths, or inner ear crystals, are out of place. Repositioning of these otoliths by a series of slow head movements, guided by the practitioner, causes rapid relief from symptoms.

I have episodes of severe vertigo. My mother and her sister also have this, and both have hearing loss. My doctor said it may be Meniere’s disease. What is that?

Meniere’s disease is an inner ear disorder that can give people severe vertigo for days at a time, and can be accompanied by nausea, vomiting, tinnitus, and hearing loss, sometimes only in one ear. Many people who have Meniere’s disease are totally disabled during the incidents of vertigo. It often runs in families. The VNG can be helpful, along with other tests, to diagnose this problem so that appropriate treatment can be started.

I have a grandmother who has fallen many times. Could that be related to vertigo?

Yes, it could be that she has an inner ear disorder. If she has never been checked, a VNG (balance test) would be appropriate. Of course, other tests may be useful as well, and you should discuss this with your grandparent’s physician.

It is also important to safeguard the home to reduce and remove falling obstacles. Throw rugs should be taken away. If she has pets she needs to be aware of where they are before she begins walking. Reduce clutter, especially on the floor. Pathways should be easily navigated. Thresholds should be easily crossed, with a smooth transition from room to room. Lighting should be sufficient. Safety concerns in the bathroom need to be addressed like railing in and around the shower and toilet. If she is unable to step over a tub side, the shower would need to be remade. A seat in the shower is safer than standing.

Some people need assistance in the bathroom; if a family member is not available, perhaps a home health aide can come into the home. Occupational therapists can assess the home for hazards and help people learn safe ways to do things in the home. Some people benefit from a medical alert service to help if the person has fallen and needs assistance.

I just got over a cold and now I have vertigo that doesn’t stop. It’s been three days!

People can acquire an inner ear infection, either labyrinthitis or neuritis, from an upper respiratory infection, which can cause vertigo and nausea. Because these infections are usually of viral origin, they will usually resolve on their own. Some patients are helped by medications to alleviate the symptoms while others find it does not help. In some instances, vestibular rehabilitation can help the brain habituate to the uneven signals it is receiving from the ears.

Infrequently, an inner ear infection can cause permanent hearing loss or long-term vertigo. If a sudden hearing loss is noticed at any time, it is considered a medical emergency and the patient must receive prompt medical attention. Once a middle ear infection has been ruled out, a patient may be given oral steroids in attempt to recover hearing. At least two to three hearing assessments should be scheduled to document baseline and recovery. These treatments must be directed by a physician.

What is vestibular rehabilitation and how does it work?

Vestibular rehabilitation or vestibular therapy helps retrain the central nervous system to habituate to the uneven signals it is receiving from the ears when a patient’s vertigo does not go away on its own. Vestibular rehabilitation consists of a series of exercises performed under the care of a specially trained physical therapist. While some exercises are done at the rehabilitation center; other exercises are performed by the patient to at home. A lot can be accomplished in a short period of time. There are no side effects or drug interactions. The program is tailored for the patient’s physical abilities.

Can migraines make you dizzy?

There is a type of migraine called vestibular migraine, or migraine associated vertigo, where the person has episodes of vertigo along with or instead of head pain. These can be triggered in the same way as other migraines, such as stress; lack of sleep; some foods like red wine, cheese, chocolate; fluctuating hormones; and smoking. Eliminating triggers and using prescription drugs known to treat migraines may help. Diagnoses and treatment of vestibular migraines should be discussed with a physician.

My daughter has had motion sickness all of her life. She can’t sit in the back seat of a car, and she has never been able to go on amusement rides. Can this be related to vertigo?

Motion sickness can be seen in up to half of patients with migraine associated vertigo. While there is no specific treatment for motion sickness, some patients may be candidates for vestibular rehabilitation to help with central nervous system compensation.