The Challenge of Diagnosing Vestibular Disorders

Diagnosing a vestibular disorder, or a dizziness and balance problem, can be a difficult and frustrating journey for the patient experiencing the issue.

In fact, according to the Vestibular Disorders Association (VEDA), many people with dizziness, imbalance, or vertigo have trouble obtaining a diagnosis.

Many things contribute to this difficulty:

  • There are many different types of disorders that can cause dizziness.
  • The signs of vestibular disorders are often hard to recognize.
  • Patients have a difficult time describing their symptoms.
  • Vestibular disorders may stem from the inner ear or the brain, and can require multiple specialists to evaluate.

What is a vestibular disorder?

A vestibular disorder is an umbrella term used to describe the many different conditions that affect the inner ear and the parts of the central nervous system involved in maintaining balance. According to VEDA, there are more than 25 known vestibular disorders. Each is unique, but many share common diagnostic traits. This can make it difficult for healthcare professionals to easily differentiate them.

The most commonly diagnosed vestibular disorders include benign paroxysmal positional vertigo (BPPV), labyrinthitis or vestibular neuritis, Ménière’s disease, and secondary endolymphatic hydrops. Vestibular disorders also include superior semicircular canal dehiscence, acoustic neuroma, perilymph fistula, ototoxicity, enlarged vestibular aqueduct, migraine-associated vertigo, and Mal de Débarquement Syndrome. Other problems related to vestibular dysfunction include complications from aging, autoimmune disorders, and allergies.

Who can you turn to for help?

Patients often express frustration that they haven’t been able to get an accurate diagnosis for their dizziness and balance problems. Unfortunately, some even give up, unsure if they’ll ever find anyone who can help them.

The good news is there are many specialists who can help in diagnosing vestibular disorders. Generally, a primary care physician, ENT, neurotologist or neurologist will refer you to an audiologist for hearing or balance-related testing, a physical therapist for gait or balance-related testing, or a radiologist for imaging testing, like a CT scan. These specialists will communicate results back to your physician with an analysis, and your physician should follow up with you regarding results and possible treatment.

For those who see an audiologist, an evaluation can include:

  • Auditory Brainstem Response (ABR)
  • Electro-oculography
  • Video Head Impulse Test (vHIT)
  • Rotary Chair
  • Sensory Organization Performance (SOP)
  • Electrocochleography (ECOG)
  • Vestibular Evoked Myogenic Potential (VEMP)
  • Video/Electro-nystagmography (VNG/ENG)

When determining how to manage the individual’s dizziness, the first challenge is to identify the primary cause. Often, dizziness is caused by a vestibular disorder, which controls an individual’s sense of balance. Sometimes, underlying causes can be attributed to the central nervous system, bacterial or viral infections. Dizziness can also be a symptom of high blood pressure or other cardiovascular problems.

A number of well-researched, successful, and widely used management strategies are available for problems of the equilibrium system. These strategies address such issues as vertigo, dizziness, lightheadedness, and balance problems. All forms of management should be preceded by a comprehensive evaluation; this ensures that the specific strategy chosen is appropriate for you.

By evaluating and properly managing inner-ear disorders, dizziness and imbalance can often be improved or resolved.

Danielle Dorner, Au.D., Vestibular Audiologist, sees patients at our Overland Park Clinic. She provides comprehensive care for our patients experiencing dizziness, vertigo and imbalance problems.

Schedule an appointment with Dr. Dorner.