Audiologists, hearing healthcare providers, and ear specialists can be the first line of differential diagnoses if you have symptoms and/or bouts of vertigo, lightheadedness, spinning, imbalance, unsteadiness, whirling, and difficulty walking while veering to one side or the other. These symptoms can often be overlooked as they can be episodic, subside, or be alleviated with medications. However, these symptoms are disruptive to daily life and can impact your quality of life. To avoid recurrence, it's vital that you seek a professional and medical consult to be able to document and evaluate your symptoms.
What to expect at your first visit with a hearing healthcare provider
First, you may be asked to fill out a questionnaire to assess your symptoms.
An accurate diagnosis is based on a complete medical history and series of vestibular function testing. EarQ Director of Audiology, Dr. Natalie Phillips, stresses the importance of obtaining a comprehensive history of symptoms and occurrences for each patient. "We look at the onset of dizziness. Was it sudden or gradual? We need to know the duration—does it last minutes, hours or days? Is the dizziness constant or does it occur in episodes? Are the symptoms improving? Can you identify what might worsen the symptoms? Are there any accompanying audiological symptoms such as hearing loss, pain in the ears, fullness, or tinnitus (ringing or sounds in the ears)? Is there a history of allergies or migraines? Is there a history or family history of heart problems or high blood pressure? Are there any recent head trauma or changes in vision? Are there any neurologic symptoms including numbness or weakness in the face or extremities?" Each of these questions provide more information to help identify if the cause of the symptoms is related to the ear or if other specialties need to be involved in the diagnosis, such as cardiology, allergy, physical therapy, ophthalmology, or neurology.
Common diagnoses of vertigo symptoms
The vestibular function testing that is performed at an audiologist's office searches for common causes of your symptoms including Meniere's disease, benign paroxysmal positional vertigo (BPPV), labyrinthitis and vestibular neuritis, as well as other common etiologies.
Meniere's disease is associated with a buildup in fluid pressure inside the inner ear. In addition to attacks of vertigo, a patient can also experience fluctuating levels of hearing loss, tinnitus (ear ringing or roaring) and a sense of fullness in the affected ear.
BPPV, a fairly common diagnosis, results when crystals inside the ear become dislodged. "Calcium crystals, normal structures in the inner ear, break loose and float into another part of the ear," explains Dr. Phillips. "This causes a spinning sensation when changing head positions, usually triggered by movement, such as getting out of or into bed, when laying down, rolling over onto the side, and even sometimes bending over and looking upward to grab something out of the kitchen cabinet. Each episode is brief, on the order of seconds to less than a minute."
Labyrinthitis and vestibular neuritis are disorders that result from an infection that can affect the transmission of sensory information from the ear to the brain. Symptoms can result in vertigo, dizziness, and balance, vision, and hearing issues. Labyrinthitis occurs when an infection can affect both branches of the vestibulo-cochlear nerve, resulting in hearing changes along with dizziness or vertigo. Vestibular neuritis affects the branch associated with balance, resulting in dizziness or vertigo, but no change in hearing. Symptoms usually last on the order of weeks to sometimes months and improve over time with the use of medications to control the nausea and suppress dizziness. In some cases, vestibular rehabilitation exercises help following medication therapy.
Although it may be difficult to identify what may have caused your symptoms, the proper diagnosis is vital for effective treatment. Some balance problems begin with allergies or a bad cold. Others are due to autoimmune disorders. A head injury can trigger episodes of vertigo or disequilibrium. Chronic neck pain or stiffness can cause vertigo or imbalance. In yet other cases, it's unclear what may have brought on the condition.
Treatments for balance disorders
Treatment depends on the diagnosis and can range from oral medications for symptom alleviation to physical therapy for balance retraining to surgical procedures. Treatment for BPPV involves repositioning the dislodged ear crystals. "We do repositioning maneuvers to get the crystals back to where they need to go," says Dr. Phillips. "It's a nice, simple treatment where the patient gets pretty immediate results. The difficult thing is that this condition can spontaneously occur, resolve, and reoccur. People who try to do these maneuvers at home may actually make it worse."
For some conditions, anti-nausea drugs may be prescribed to alleviate the symptoms associated with vertigo. Other patients will benefit from dietary adjustments such as a low-salt diet, or possibly surgical options to correct physical abnormalities associated with particular disorders. Many patients benefit from physical therapist directed vestibular rehabilitation therapies.
Pinpointing the source of a balance problem and coming up with an accurate diagnosis to put all the pieces together requires a thorough analysis of the patient's medical history to evaluate all symptoms as well as comprehensive vestibular function testing. Other specialists may be consulted prior to a diagnosis such as a neurologist, cardiologist, ophthalmologist, neuro-ophthalmologist, and physical therapist. With the end goal in sight of alleviation and possibly elimination of dizziness or other symptoms affecting balance, "I encourage patients that if they don't find the answer, seek a second opinion," recommends Dr. Phillips. "It's helpful to go to a clinic with the proper equipment and multiple specialties within the same office to be able to collaborate and intervene earlier for a quicker recovery and return to a better life and function."