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Sudden dizziness and vertigo symptoms can cause fear and confusion the first time they occur. Navigating the health care system to get the proper diagnosis and treatment for a dizziness disorder can be just as confusing. Matthew G. Crowson, MD, a member of the Vestibular Division at Mass Eye and Ear, explains all things vertigo and where to turn for care.
A bout of vertigo can come out of nowhere: one moment you’re lying in bed or standing, the next you feel as if the room is spinning and lose your balance. While many factors may cause a person to feel “dizzy” or imbalanced, a vertigo episode can be especially concerning the first time it occurs.
“Vertigo can be very scary. It is not subtle, and people might think they’re having a medical emergency and call 9-1-1,” Dr. Crowson, a neurotologist at Mass Eye and Ear who specializes in vestibular disorders, told Focus. “Unfortunately, many patients I see tell me they had no idea where to get care for these symptoms, and this delayed them from getting the treatments they needed.”
Focus asked Dr. Crowson some frequently asked questions about vertigo and how it is properly treated.
What is vertigo?
Vertigo is defined as the illusion of movement: it occurs when parts of your balance system receive false signals telling you that you are moving when, in reality, you are not. This leads to differences in sensation that contributes to feeling a loss of balance.
People with vertigo may feel like they can’t move. In some cases, vertigo is so intense that they become nauseous and sick to their stomach. An episode can resolve in anywhere from seconds to hours depending on the cause.
Some patients will just describe these sensations as feeling “dizzy,” but that can mean different things to different people. Differentiating the symptoms between “vertigo” for the illusion of motion, and “imbalance” for the loss of balance feeling, can help doctors better understand the symptoms and improve a patient’s chancing of getting proper care.
In rarer cases, vertigo symptoms can be a result of a stroke or heart attack, which are medical emergencies. If this vertigo or profound imbalance is the patient’s first attack and if there are any accompanying neurological symptoms of confusion, changed mental status and cognitive function, altered facial movement on one side, slurred speech or loss of strength or coordination of any of the extremities, this is a potentially life-threatening stroke. The person must be taken to the nearest emergency room immediately. In the absence of these symptoms, it might be a vertigo episode of another origin.
Which specialists treat vertigo?
For patients who suspect they have vertigo, it is best to see a physician who is familiar with the most common causes of dizziness and balance disorders, also known as vestibular conditions. True vertigo typically involves a problem with the balance center of the inner ear. A neurotologist is a type of otolaryngologist (ENT) who specializes in care and surgery for conditions of the inner ear. While many general ENTs may have a special interest in vestibular conditions, it can difficult to find a general practitioner who treats them. Unfortunately, some patients will see a clinician who does not have as much experience in vestibular disorders, and are told nothing can be done.
Sometimes, patients with vertigo symptoms have disorders that do not involve the inner ear. A neurotologist might refer these patients to other medical professionals depending on the suspected cause. For example, a neurologist can be helpful if a central nervous system disorder is suspected. If the vertigo is caused by a disorder in eye movements, the patient may see a neuro-ophthalmologist. Patients with general balance disorders might benefit from vestibular therapy with a physical therapist. Some patients with vestibular disorders may develop anxiety or major depression. In these situations, behavioral and mental health professionals may be able to help.
Patients with vertigo will often benefit from a team approach to their care.
What causes vertigo?
Vertigo can be caused by many conditions. Among the most common is benign paroxysmal positional vertigo (BPPV) where small calcium particles end up in one of the inner ear’s balance canals. BPPV causes patients to have intense but brief vertigo with abrupt changes in head position, such as when patients roll over in bed, or tilt their head back.
Vestibular migraine is one of the most common diagnoses I see in my clinic. This is when episodes of vertigo occur in a person with a history of migraines. The symptoms have a lot of overlap with other vestibular disorders, so it is often overlooked. Meniere’s disease is a chronic progressive disorder of the ear that causes vertigo along with hearing loss over time. This is rarer and is sometimes over-diagnosed. Some infections or inflammatory events happen in the inner ear – such as labyrinthitis or vestibular neuritis – can also cause vertigo.
A neurotologist can help determine the cause of the vertigo, which will influence the treatment course.
How is vertigo diagnosed and treated?
A thorough medical history can provide much of the information we use for a diagnosis. We will ask a patient when and how the dizziness happened, and uncover the triggers. We also will order a hearing test since some disorders affect both systems. We may order additional vestibular tests if we think that extra information would be helpful, or imaging if the central nervous system is involved.
Some vestibular disorders respond to medications. For example, if we suspect a patient has a vestibular migraine, we will discuss different therapies, medications, a special diet and supplements, in addition to techniques for modifying lifestyle factors that may trigger symptoms.
We also regularly engage our physical therapy colleagues for many of these chronic vestibular disorders. These specially trained physical therapists are an underutilized and essential part of vestibular disorder care. Many patients benefit greatly from vestibular therapy.
For certain causes of vertigo that can’t be controlled with medication and lifestyle changes, more invasive options such surgery may be an option.
Why should I do physical therapy?
This is one of the most common questions patients ask, and I tell them that this isn’t the same physical therapy they are thinking of where people are ‘pumping weights,’ stretching, or working on general conditioning after an injury.
In vestibular therapy, physical therapists are doing exercises for the brain to reestablish the sense of balance. This might include exercises that desensitize a patient to the things that make them feel imbalanced, or help improve eye gaze stability. These exercises can take the form of balancing on a foam pad or doing eye and head movements.
Patients with vestibular disorders may become overloaded with stimuli in their daily lives. Balance disorders can cause the brain to have less tolerance and stamina for daily activities. Outings as simple as going to a busy grocery store, crowded restaurants, or driving in heavy traffic can trigger vestibular symptoms. Vestibular therapy treatments can help habituate patients with the triggers so that they can operate activities as they did before their symptoms began.
One thing to keep in mind is that it is important to make sure your therapist has expertise and dedicated training in vestibular therapy. We find our patients do best with therapists who devote most, if not all of their time, to treating patients with balance disorders.
About our expert
Matthew G. Crowson, MD, is a fellowship-trained ENT who specializes in adult and pediatric balance disorders, in addition to treating patients with hearing loss. He sees patients at the Main Campus in Boston, and the Quincy and Braintree locations.