What Causes Dizziness?
From Dr. Reyes, Audiologist, Texas Sinus & Snoring
Dizziness has many possible causes, including inner ear issues, motion sickness, and medication side effects, to name a few. Sometimes it is caused by underlying health conditions, such as poor circulation, blood pressure irregularities, infections, or head injuries.
From Dr. Joseph, Physical Therapist, Get Physical Rx
Dizziness can be a symptom of several conditions, including low blood pressure, low blood sugar, cervical spine instability, upper cervical compression, and, of course, inner ear pathology where an otoconia is dislodged into one of the semicircular canals, which then leads to Vertigo.
What Is Vertigo?
From Dr. Reyes & Dr. Joseph
Vertigo is the feeling of spinning even when you are not moving. It is a symptom rather than a condition itself. Vertigo typically involves the inner ear. It can also be related to the cervical spine or some other underlying co-morbidity, such as diabetes or hypertension.
What Is the Difference Between Peripheral and Central Vertigo?
From Dr. Reyes & Dr. Joseph
Peripheral vertigo is caused by problems in the inner ear or the vestibular nerve, which carries balance signals from the inner ear to the brain. It’s often triggered by conditions like benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Ménière’s disease. Symptoms may include spinning sensations, nausea, and unsteadiness, and they tend to come on suddenly but improve over time or with specific treatments.
Central vertigo, on the other hand, stems from issues within the brain, such as stroke, multiple sclerosis, or tumors affecting the brainstem or cerebellum. These symptoms are usually more persistent, may include double vision or coordination problems, and often require neurologic evaluation.
To diagnose vertigo and determine whether it is peripheral or central, audiologists may perform caloric testing, which stimulates the inner ear with warm or cold air or water to measure how the vestibular system responds. A careful history, physical exam, and collaboration between specialties like audiology and physical therapy are often necessary to identify the exact cause and guide treatment.
How Do You Treat Dizziness and/or Vertigo?
From Dr. Reyes, Audiologist
It really depends on what the underlying cause of the symptom is. When it comes to BPPV, the Epley maneuver can help alleviate the symptoms of vertigo. In most cases, vestibular rehabilitation may also assist the patient. This therapy is performed by Dr. Joseph.
From Dr. Joseph, Physical Therapist
From a physical therapy perspective, we have to first determine if your dizziness is truly vertigo. There are several tests we can perform to determine if a patient truly has vertigo.
One of the main tests I use is called the Dix-Hallpike test. If a patient tests positive, they will complain of dizziness and experience a condition called nystagmus (involuntary eye movement). This nystagmus could be rotatory, horizontal, or vertical. The different positions help the physical therapist determine which semicircular canal the otoconia (crystal) is in.
The vertebral artery test evaluates the occlusion of the vertebral artery, which can also reproduce similar symptoms to vertigo. Once we determine if a patient truly has vertigo symptoms, we usually treat them with the Epley maneuver. This treatment involves positional changes of the cervical spine, including 45 degrees of rotation and 30 degrees of extension, once the patient lies in a supine position.
How Do Physical Therapy and Audiology Work Together to Help With These Issues?
From Dr. Reyes & Dr. Joseph
Audiologists and physical therapists assist in diagnosing and treating vertigo, alongside ENT physicians and, at times, neurologists. Audiologists have the capabilities of vestibular testing and testing to see where the vertigo and dizziness are originating, and PTs are capable of vestibular rehabilitation therapy for treatment of the vertigo/dizziness symptoms. Oftentimes, we work together for treatment and care.
Can You Treat Other Common Balance Disorders?
From Dr. Reyes, Audiologist
Yes, audiologists can evaluate and manage many conditions related to balance and vestibular function. When inner ear disorders contribute to instability, we may use diagnostic tools and collaborate with other providers to identify the underlying issue. In some cases, we recommend specific physical exercises that stimulate the vestibular system, helping patients maintain balance more effectively throughout their daily activities.
From Dr. Joseph, Physical Therapist
Absolutely. Physical therapy plays an essential role in treating balance disorders. After assessing a patient’s balance and vestibular function, we design personalized programs that include physical exercises to retrain the brain and body to respond to movement correctly. These exercises help patients maintain their balance, reduce the risk of falls, and improve their confidence with daily tasks.
Can Vertigo Lead to Hearing Loss Due to Problems in the Inner Ear?
From Dr. Reyes & Dr. Joseph
Yes, vertigo can sometimes be associated with hearing loss, especially when the cause lies within the inner ear. The vestibular system, which controls balance, is closely linked to the structures responsible for hearing and equilibrium. A condition like Ménière’s disease can affect both hearing and balance due to fluid buildup in the inner ear. This buildup can disrupt both vestibular and auditory function, leading to episodes of vertigo and progressive hearing loss over time. Identifying these connections early helps guide appropriate treatment and monitoring.
When Do You Prescribe Hearing Aids?
From Dr. Reyes, Audiologist
I prescribe hearing aids when patients are experiencing hearing loss due to ear disorders that do not respond to medical or surgical interventions. We evaluate the ear canal and the whole auditory system, taking into account the person’s lifestyle and communication needs. In some cases, hearing aids can also support the balance system by improving auditory cues, which may help reduce dizziness and disorientation. Hearing aids often become part of a broader treatment plan to support better hearing and overall well-being.
From Dr. Joseph, Physical Therapist
While I don’t prescribe hearing aids, I often collaborate with other healthcare professionals, such as audiologists, when balance issues overlap with ear disorders. If hearing loss contributes to instability or affects spatial awareness, hearing aids can be a valuable part of the patient’s treatment plan. My role is to ensure that physical rehabilitation addresses all aspects of the balance system, even as other specialists support better hearing.
Do You Review Medical History in Addition to Hearing Tests?
From Dr. Reyes, Audiologist
Yes, reviewing a patient’s medical history is a key part of evaluating vestibular disorders. Hearing tests alone are insufficient to understand the entire picture. I look for signs of sudden dizziness, abnormal eye movements, and any prior diagnoses, such as vestibular neuritis or Ménière’s disease. Certain medications, medical conditions, or a history of ear infections can also contribute to balance problems. Understanding these various factors helps me assess spatial orientation and determine the most effective treatment options.From Dr. Joseph, Physical Therapist
Definitely, during my evaluation, I take the time to review the patient’s full medical history, particularly when symptoms such as sudden dizziness or abnormal eye movements are present. Certain medications, neurological conditions, or a history of vestibular neuritis can influence vestibular disorders. I use this information to design a physical therapy program aimed at reducing symptoms and improving spatial orientation. A thorough history helps us explore the root causes and develop appropriate treatment options, whether the patient is dealing with Meniere’s disease or another condition.Any Final Thoughts?
From Dr. Reyes, Audiologist
There are differences between dizziness and vertigo. Vertigo is a true spinning sensation, whereas dizziness encompasses other sensations, such as feelings of being drunk, wooziness, imbalance, and lightheadedness. It’s important to remember this when explaining how you feel to your doctors.From Dr. Joseph, Physical Therapist
If you are experiencing vertigo or dizziness, the best solution is to be seen. Dr. Reyes and I work together to treat our patients and identify the root cause of their symptoms. It helps that our practices are right next door.
