Vestibular Medicine

Dr. Scott K. Sanders specializes in the diagnosis and treatment of those suffering from dizziness, vertigo, or imbalance. The whole field of vestibular medicine has evolved over the past 20 years and we now know much more about how to help those that are 'dizzy'. In fact, the most common cause of peripheral vertigo may be cured in about one minute by manipulating the head in a certain sequence. This type of vertigo is called benign paroxysmal positional vertigo (BPPV).

Approximately 15-18% of people who report vertigo will have BPPV, a condition that causes episodic vertigo depending on head position. Positional vertigo occurs as a result of a normal constituent of our inner ear (otolith) breaking free and becoming displaced into the semicircular canal system of our inner ear. People with BPPV often report vertigo lying down in bed, rolling over in bed, arising from bed, bending over or looking up. Dr. John Epley developed a sequence of head manipulation movements to remove the otoliths from the semicircular canal system and place them back into a region of the inner ear where natural enzymes may destroy the displaced otolith. This maneuver, described in 1992, is termed the "Epley" maneuver. This maneuver provides relief of positional vertigo in approximately 90% of patients. Many physicians are not aware of this maneuver and how successfully it may be utilized to cure patients with this disorder.

Other causes of dizziness and imbalance are numerous and may be subdivided into central (central nervous system), peripheral (inner ear), and systemic (generalized medical conditions). The most common central cause of dizziness, and the most common cause of dizziness overall, is migraine. Migraine-associated dizziness is one of the most under-recognized conditions in medicine today and represents about 50% of all those reporting dizziness or vertigo. It can occur at any age, and despite the use of the term "migraine", may occur without pain at all. Common symptoms include simply a sense of light-headedness and imbalance, typically worse in the morning. There is a sensation of floating and that the head and eyes are not moving together. Visual motion or activities that require visual stimulation are particularly bothersome. Light and/or noise sensitivity may be present. Scanning for items at the grocery store or being in large, open buildings is often met with much difficulty. Treatment requires elimination of any trigger factors that might be exacerbating the migrainous symptoms, but often medications that serve to prevent migraine symptoms, are necessary.

Vidoenystagmography (VNG) is a diagnostic test that has been developed to provide information on the various causes of dizziness and imbalance and to direct appropriate treatment for each individual. This tests the upper division of the vestibular nerve and it's connections with the brain. Videonystagmography utilizes infrared technology to track eye movements by locking on to the pupil. Recordings of how one's eye moves in response to various stimuli often provides the information necessary for diagnosis. The Vestibular Evoked Myogenic Potential (VEMP) is another more recently developed test, which evaluates the lower half of the vestibular nerve, and provides additional information about a person's vestibular system.

When people develop symptoms of dizziness or balance difficulty, the natural tendency is to avoid the positions or activities that exacerbate or provoke such symptoms. This leads to a decreased quality of life. Furthermore, avoiding positions or activities that result in undesirable symptoms will never allow normal adaptation processes to occur. The central nervous system and inner ear harbor built-in mechanisms to compensate for damage to either structure that may result in symptoms of dizziness or balance difficulty. This mechanism is termed 'plasticity'. In order to utilize this 'plasticity', people must purposely place themselves into the position or activity that provokes their symptoms. This is the basis for vestibular rehabilitation therapy, and is similar to providing physical therapy to a stroke patient who has weakness of a portion of the body that requires strengthening. Vestibular rehabilitation therapy has emerged over the past several years as a successful treatment for patients with dizziness and balance disorders.

Unfortunately, many "dizzy" patients continue to receive vestibular suppressant medications such as meclizine (Antivert), diazepam (Valium), or phenergan. Such medications merely suppress vestibular function, have significant side effects, and prevent adaptation or compensatory mechanisms to occur. While useful in the short-term for some patients, these medications should rarely be used for long-term treatment. Vestibular rehabilitation therapy is much more useful in improving symptoms without the need for long-term use of medications.

FAQs

What is "vestibular medicine?"
The vestibular system of our bodies is comprised of several components that work together to allow us to keep from falling. These components include the inner ear, the eyes, and nerves running throughout our brains and our bodies. If one of these parts is not functioning properly, we may feel dizzy, experience vertigo (a sense of movement or spinning), or suffer imbalance, placing us at a risk for falling. Vestibular medicine is simply the study of these systems, with the goal being to properly diagnose, then treat the malfunctioning part, and prevent a painful and often debilitating injury.

Is there something new about the way patients with dizziness or vertigo are diagnosed and treated?
Absolutely. The whole field of vestibular medicine has developed and evolved over the past 20 years. We know so much more about the vestibular system, what can go wrong with it, and most importantly, what to do to fix the problem. In fact, a cure for the most common form of vertigo was established just 15 years ago. This “cure” may be performed in the office at a single visit. Other causes of dizziness may improve or go away completely with a specialized type of physical therapy. Patients no longer need to take medications for dizziness in most cases.