Vertigo & Balance Disorders

There are different types of conditions caused by the inner ear that can result in dizziness and balance disorders, but two of the most common are Benign Paroxysmal Positioning Vertigo and Meniere’s Disease.

Watch this TED talk that looks at balance problems and how to maintain balance as we get older.
Greg Whitman MD is a neurologist and co-author of: Dizziness Why You Feel Dizzy and What Will Help You Feel Better. He sees dizzy patients at Shohet Ear Associates in Orange County, CA and on various telehealth platforms.

Benign Paroxysmal Positioning Vertigo

What is it?

Vertigo is often described as a sensation of dizziness or spinning, a feeling of falling, lightheadedness or feeling woozy, visual blurring and disorientation. It has estimated that at least 20% of patients who suffer from vertigo have Benign Paroxysmal Positioning Vertigo (BPPV) which is defined as an abnormal sensation of motion brought on by certain positions or movements of your head.


The main symptom is a feeling that you are spinning or tilting when you are not. This can happen when you move your head in a certain way, like rolling over in bed, turning your head quickly, bending over, or tipping your head back. BPPV episodes usually last less than a minute. It can be mild, or it can be bad enough to make you feel sick to your stomach and vomit. You may even find it hard to stand or walk without losing your balance.


There are over 70 different causes of vertigo which can make it difficult to diagnose. Migraines are a very common cause of vertigo (migraine-associated vertigo) which may exist even without the typical headaches. Other medical conditions such as ear infections, inflammation, blood pressure changes, trauma and vision problems may contribute to the disorder as well as certain medications

① Examination – the first step is to conduct a thorough review of your symptoms and a physical exam.

② Testing – Diagnostic tests that may be conducted include:

  • Dix-Hallpike Test which is a noninvasive positional procedure that involves turning your head to one side and then briskly laying you onto your back from a seated position. If positive, you will feel very dizzy and your eyes will make rotational movements.
  • Electronystagmography (ENG) and Vestibular Autorotational Test (VAT) to evaluate balance function.
  • Electrocochleography (ECOG) and Auditory brainstem response tests (ABR) to assess the cochlea and acoustic nerve.


There are various options for treating the causes of vertigo. Depending on the diagnosis, treatment may involve sophisticated, multidisciplinary methods or simpler approaches to curing the root cause of the balance disorder.

Treatment entails a noninvasive positioning procedure. Performing these easy head maneuvers move the particles out of the canals in the inner ear and can stop the symptom of dizziness.

Positioning Procedure – the primary treatment for BPPV is a series of noninvasive head maneuvers that move the particles out of the canals in the inner ear and can stop the symptom of dizziness. It usually takes about three days before you will begin to feel better after this maneuver and in some cases, it can take more than one maneuver to get you better. We typically see you back at weekly intervals until you are better. Exercises may be prescribed as well.

Vestibular Rehabilitation – another treatment option involves balance retraining exercises (vestibular rehabilitation) that help patients to compensate for their balance disorder. The exercises include movements of the head and body developed especially for the patient. Vestibular retraining programs are conducted by professionals with knowledge and understanding of the vestibular system and its relationship with other systems in the body.

Meniere’s Disease

What is it?

Ménière’s disease is a condition in which excessive fluid build-up in the inner ear causes severe dizziness (vertigo), ringing in the ears (tinnitus), fluctuating hearing loss, and a feeling of fullness or congestion in the ear. Ménière’s disease usually affects only one ear. Ménière’s disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age.


Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some people with Ménière’s disease have vertigo so extreme that they lose their balance and fall. These episodes are called “drop attacks.”


Many theories exist about what happens to cause Ménière’s disease, but no definite answers are available. Some researchers think that Ménière’s disease is the result of constrictions in blood vessels similar to those that cause migraine headaches. Others think Ménière’s disease could be a consequence of viral infections, allergies, or autoimmune reactions. Because Ménière’s disease appears to run in families, it could also be the result of genetic variations that cause abnormalities in the volume or regulation of endolymph fluid.


Diagnosis is based on the findings of a history and examination, and audiometric and vestibular tests.


Although there is no cure for Ménière’s disease, there are treatment options that can help control the symptoms and lessen the frequency of attacks of vertigo.

Endolymphatic Sac Surgery is a procedure that drains and opens the endolymphatic sac, the structure that is responsible for inner ear fluid metabolism. The operation takes approximately 1-2 hours and is performed under general anesthesia at our Orange County office.

Meniett Device – the device sends pressure pulses to the middle ear that help reduce excess fluid and restore the balance of the inner ear’s hydrodynamic system. The treatment is performed at home several times per day for an indefinite period.

Transtympanic Gentamicin – In severe cases of episodic vertigo, Transtympanic Gentamicin treatment may be used to deaden the balance portion of the inner ear. An anesthetic is used to numb the ear drum and then using a small needle, a drug called gentamicin is injected into the ear drum. This procedure can be used to treat one side, without affecting the other. Between one and three treatments are usually necessary.


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