Balance Disorders and Vertigo

Balance disorders are often complex problems, affecting millions of people each year, and causing unpleasant feelings that can include anything from mild unsteadiness, to sensations of spinning, moving or floating. Good balance requires interaction between many parts of the nervous system including the brain, the eyes, and a part of the inner ear known as the vestibular labyrinth. These complex systems interact with each other, and other body systems such as muscles, bones and joints to maintain balance. When any of these systems are impaired, you may experience symptoms of a balance disorder. Unfortunately, in some patients, the process of aging can compromise cerebellar function and result in balance problems, even when no other specific problems can be identified.

Because of their complexity, these problems cannot be addressed in a few paragraphs.  ENT doctors are often involved in the evaluation and treatment of disorders that involve dizziness as one of their symptoms because the inner ear may play a role in producing the dizziness symptoms. Neurologists are also often consulted to diagnose and treat patients with dizziness because the brain and nervous system are often the cause of symptoms.  Dr. Bryan and Dr. Mettman will consult with dizzy patients by referral only, after the patient has been evaluated by their primary care doctor or by a specialist, who has determined that the dizzy symptoms may be related to an inner ear problem. Our receipt of medical records from the referring provider will be required prior to the appointment with our specialists.

BPPV (Benign Paroxysmal Positional Vertigo)

Benign Paroxysmal Positional Vertigo is one of the most common causes of vertigo in adult patients. BPPV is a type of vertigo which is provoked by a change in head position such as lying down, turning in bed, looking up, or stooping. Episodes are brief (less than a minute), can be accompanied by nausea and vomiting, and cease when the head is still. Episodes may be sporadic and may not recur for weeks or months. The dizziness is due to a dislodged otolith crystal entering one of the semicircular balance canals. The diagnosis is made, in part, by the physician’s attempt to recreate the patient’s dizzy episode in the office by putting the head through specific positions.  This allows the physician to observe eye movements during the episode, which are a characteristic sign of BPPV, and provide valuable information for the treatment of the disorder. Because this provokes the dizzy feeling and may be accompanied by nausea, for the patient’s comfort, we advise them to eat only a light meal before their evaluation.

BPPV is treatable and is not usually a significant threat to a patient’s long-term health. The Epley “repositioning” treatment by an otolaryngologist is usually “curative,” although the procedure may need to be repeated if BPPV returns.


Vertigo is a specific type of balance problem and is really a symptom, not a diagnosis. It is the sensation of movement (usually spinning), and results from problems within the brain and/or inner ear. Unfortunately this symptom is common, with up to 40 percent of adults reporting vertigo at least once during their lifetime. Patients with vertigo can be temporarily incapacitated, often experiencing nausea and vomiting along with the vertigo.


The causes of vertigo can include a number of different conditions. Some examples include labyrinthitis (inflammation of the inner ear), Ménière’s diseasemigraine aura, neurologic diseases (e.g. multiple sclerosis), stroke, acoustic neuroma, effects from medications or toxic exposures, and benign paroxysmal positional vertigo (BPPV).

Evaluation of vertigo (or any other balance disorder) can be simple in some cases, but much more complicated and extensive in others. Despite vertigo’s common occurrence, it can be difficult or impossible to find a cause in some cases. Each patient must be individually assessed to determine the best course to take. Evaluations include a thorough examination, and often a series of audiologic, vestibular, radiologic, and/or laboratory tests. More info.

Treatment for vertigo may include simple office procedures, medications, dietary changes, or even surgery. Vestibular rehabilitation therapy (VRT) is a type of physical therapy that often helps patients who don’t respond to other treatments for balance disorders, and can reduce most symptoms and improve stability.

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