Dizziness, Vertigo, and Imbalance

Symptoms Causes Type of Therapy

Dizziness is the second most common complaint heard in doctors' offices.  Statistics reported by The National Institute of Health indicate that dizziness will occur in 90 million of the nation's population at some time in their lives.  Dizziness is the #1 complaint for individuals over age 70.
Although very common, acute or chronic problems with equilibrium may limit a person's everyday living.
Equilibrium disorders fall into two categories:

  • Dizziness, vertigo or motion intolerance.  Acute or sharp attacks may last only seconds or sometimes for several hours.  This condition may be caused or worsened by rapid head movements, turning too quickly, walking or riding.
  • Persistent sense of imbalance, unsteadiness or what some people refer to as loss of surefootedness.  This may lead to a high risk of falling which can result in fractures or head trauma.

The good news is that diagnosis and treatment options have become more effective over the past 10 years. According to Johns Hopkins, 85% of all forms of dizziness and imbalance can be helped once a proper diagnosis is made.  There is hope for many who once thought there might be no relief.

The type of symptoms, whether it is dizziness, vertigo or imbalance, often helps determine the type of problem you have.


Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in your inner ear (vestibular system), which sense movement and changes in your head position. Sitting up or moving around may make it worse. Sometimes vertigo is severe enough to cause nausea, vomiting and imbalance.

Causes of vertigo may include:

  • Benign paroxysmal positional vertigo (BPPV).
    BPPV causes intense, brief episodes of vertigo immediately following a change in the position of your head, often when you turn over in bed or sit up in the morning. BPPV is the most common cause of vertigo.
  • Inflammation in the inner ear.
    Signs and symptoms of inflammation of your inner ear (acute vestibular neuritis) include the spontaneous onset of intense, constant vertigo that may persist for several days, along with nausea, vomiting and imbalance. It can be incapacitating, requiring bed rest. When associated with sudden hearing loss, this condition is referred to as labyrinthitis. Fortunately, vestibular neuritis generally subsides and clears up on its own.
  • Meniere's disease.
    This disease involves the excessive buildup of fluid in your inner ear. It is an uncommon condition that may affect adults at any age and is characterized by sudden episodes of vertigo lasting 30 minutes to several hours and hearing loss.
  • Migrainous vertigo.
    Migraine is more than a headache disorder. Just as some people experience a visual "aura" with their migraines, others can get vertigo episodes and have other types of dizziness between migraines.  
  • Acoustic neuroma.
    An acoustic neuroma (vestibular schwannoma) is a noncancerous (benign) growth on the vestibular nerve, which connects the inner ear to your brain. Symptoms of an acoustic neuroma generally include progressive hearing loss and tinnitus on one side accompanied by dizziness or imbalance.
  • Other causes.
    Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke, brain hemorrhage or multiple sclerosis. In such cases, other neurological symptoms are usually present, such as double vision, slurred speech, facial weakness or numbness, limb coordination, or severe balance problems.
There are 4 general categories of therapy.  More than one of these may be indicated to make the patient better as quickly as possible.

  • Canalith Repositioning/Liberatory Maneuver.
    Designed for an inner ear condition called Benign Paroxysmal Positional Vertigo (BPPV). This condition occurs when the salt-like crystals in the inner ear called otoconia become dislodged and float within the canals of the vestibular system.  Treatment includes one or two 20 minute visits as the crystals are gently repositioned.
  • Vestibular Rehabilitation.
    Designed for the patients whose symptoms may be severe and who requires supervision during exercise.  Therapy sessions include the use of vestibular therapy equipment which most people enjoy.  For older patients, there is an emphasis on fall prevention.  Typically the patient participates in two or three 60 minute sessions per week, with an average of 8-12 sessions.  As the patient progresses, home exercises are added to accelerate the results.
  • Balance Restraining.
    For patients who have a loss of balance, unsteadiness or loss of surefootedness.  Most of these patients do not report dizziness or motion intolerance.  We emphasize practical solutions to the common problems of difficulty getting around in the dark, walking on uneven surfaces and moving unencumbered on ramps or stairs.  Fall prevention, movement coordination, and improved participation in everyday activities are all high priorities of the program.
  • Self Directed Exercises.
    Home based therapy which the patient does on his own. Each program is individually and especially designed for the patient based on test results and the situations which bring on symptoms. This approach is most commonly used with patients that do not require supervision during exercise.  Best results occur when the patient spends 20-30 minutes per session two to three times a day.  Most patients report a significant reduction in their symptoms within a two to four week time span.