About 15% of the population experiences dizziness. Of these cases, the majority are caused by otologic disorders. To determine the cause of dizziness and the best treatment option for each specific patient, different evaluations are available that include:
Electronystagmography (ENG)
Electronystagmography (ENG): This test is used to evaluate the inner ear’s balance system, known as the vestibular system. Its components help to identify deficits in various portions of this system like the sensory cells, the vestibular nerve, and the semicircular canals of the vestibular organ.
Auditory Brainstem Response (ABR)
Auditory Brainstem Response (ABR): The hearing and balance nerve can be evaluated by using electrodes on the head to record the brain’s responses to loud auditory stimuli. This test is often recommended in cases of vertigo and may also be used to rule out acoustic nerve involvement in cases of asymmetric hearing loss or tinnitus.
Electrocochleography (ECochG)
Electrocochleography (ECochG): The ECochg is used to evaluate the inner ear’s hearing system for signs of a very specific condition in which excessive fluid builds up. This condition, called Endolymphatic Hydrops or Ménière’s Disease, may cause severe episodes of vertigo, fluctuating hearing loss, a plugged sensation in the ears, and/or a buzzing tinnitus.
Repositioning Maneuvers
Repositioning Maneuvers: In certain cases of dizziness, particularly in the case of Benign Paroxysmal Positional Vertigo (BPPV), repositioning maneuvers may alleviate symptoms. The patient’s head and body is moved into different positions to realign portions of the vestibular system. This procedure can be performed in office, allowing the patient to return to their normal activities vertigo-free.
Ménière’s Disease
Ménière”s Disease, also known as Endolymphatic Hydrops, is a hearing condition where excessive fluid builds up in the inner ear. This can cause fluctuating hearing loss, a plugged sensation in the ear, roaring or humming tinnitus, and/or severe episodes of vertigo. Diagnosis is based on symptoms, ECochG testing, and response to treatment. Treatment options include dietary changes to reduce fluid retention (such as controlled salt intake), the use of diuretics, and in some cases, surgery.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a type of positional dizziness caused when inner ear crystals become dislodged and move freely within the balance canals. Symptoms typically include brief (20-45 second) episodes of spinning vertigo triggered by specific head positions, such as rolling over in bed or tilting the head back. It is diagnosed with the Dix-Hallpike test and treated with a repositioning maneuver. Many people find symptoms resolve after just one treatment.
Vestibular Labyrinthitis
This condition is caused by a viral infection of the inner ear”s balance system. It can lead to intense spinning vertigo lasting for hours or even days. Diagnosis is typically made using ENG testing. Treatment may include medication and physical therapy. Most people experience significant symptom improvement within a few weeks, with full recovery over time.