Audiology for Vertigo

Vertigo is not “your average dizzy spell.” In contrast to dizziness, which is characterized by temporary feelings of imbalance or unsteadiness, vertigo is the false sensation of movement. Vertigo often causes you to feel as if the room is spinning around you, or as if you are spinning around the room. Vertigo becomes worse with head movement and may be relieved by lying down.

Vertigo usually occurs suddenly and may be accompanied by stumbling or falling, hearing loss, tinnitus (ringing in the ear), vision disturbances, or symptoms of nausea or vomiting. An episode of vertigo may last from seconds to hours, or even several days.

The good news is that vertigo does not mean your life has to remain out of balance. Audiologists are specialists who diagnose and treat vertigo and can help you on your way to a steady, healthy future.

What Causes Vertigo?

Vertigo is not a condition itself but rather is a symptom of another medical condition. Vertigo may occur as the result of an abnormality in the vestibular system of the inner ear. The vestibular system is a complex system that controls balance and eye tracking motions and includes nerves and sensors in the inner ear (vestibular labyrinth), the upper neck (cervical proprioception), eyes, and brain.

Vertigo may also be caused by a condition affecting the central nervous system, head or neck trauma, or as the side effect of certain medications. In many cases, however, the cause of vertigo is unknown.

What is an Audiologist?

Audiology is the study of hearing and disorders in sound recognition. Audiologists are experts who specialize in identifying, treating and preventing hearing loss and related disorders. They are licensed by their state (where required), and have a master’s or doctoral degree. The American Speech-Language-Hearing Association also provides a certification of clinical competence to qualified audiologists. Audiologists often work with other specialists, including otolaryngologists and neurologists, to diagnose conditions that cause vertigo.

How Does an Audiologist Diagnose Vertigo?

An Audiologist’s examination to diagnose vertigo includes a physical evaluation and review of the patient’s medical history, plus some or all of these tests to evaluate hearing and balance functions:

• Audiogram (basic hearing test)
• Laboratory blood tests
• Electronystagmogram and Videonystagmogram (ENG and VNG)-- balance tests in which eye movements are recorded
• Tympanometry to detect fluid in the inner ear
• Advanced hearing tests such as audiometry tests, acoustic-reflex testing, electrocochleography (ECoG), otoacoustic emissions and auditory brainstem response test
• Tilt table test
• Dix-hallpike maneuver (patient is seated with head turned to one side, and rapidly reclined to a position where the head hangs over the edge of the table)
• Fakuda test (in which the patient walks in place with eyes closed)
• Rotating chair (type of balance test)
• Vestibular evoked myogenic potentials and brainstem auditory evoked potentials (sound is delivered to one ear and muscular activity is recorded)
• Magnetic resonance imaging (MRI)
• Computed tomography (CT scan)

The goal is to identify the underlying cause of vertigo so the condition can be properly treated.

How Does an Audiologist Treat Vertigo?

Underlying medical conditions that are causing the vertigo should first be promptly identified and appropriately treated, including:

• Vestibular neuritis (labyrinthitis): inflammation of the nerve cells in the inner ear or cranial nerve
• Ménière disease: irregular fluid buildup in the inner ear
• Acoustic neuroma: benign tumor on the balance nerve
• Benign positional paroxysmal vertigo (BPPV): damage to the sensory units of the balance portion of the inner ear
• Otitis media
• Epilepsy
• Migraine headaches

To treat symptoms of vertigo, an Audiologist may provide a type of physical therapy called vestibular rehabilitation therapy, a nonmedical treatment in which the patient is assisted in different postures to relieve vertigo. Specifically, the postures involve turning the head and shifting the upper body from an upright to a horizontal position, and then back again. Sometimes these maneuvers cause an episode of vertigo, but when they are repeated and completed properly, the patient should experience relief from vertigo. A 2008 evidence-based review of treatments for benign positional paroxysmal vertigo (BPPV) found that this type of postural therapy, also called canalith repositioning, was a safe and effective treatment for BPPV that helped resolve patients’ symptoms in the short term, for a minimum of one day up to four weeks. After receiving proper training in these exercises, patients may find relief by performing the exercises at home.

To relieve acute episodes of vertigo that last from several hours to a few days, an Audiologist may recommend medications to suppress the vestibular system, such as anticholinergics, antihistamines, phenothiazines and benzodiazepines. Other treatments for vertigo that an Audiologist may recommend include a low-salt diet, diuretic medications, oral anti-nausea medications, or an injection of medication into the ear to reduce nausea.

If you are Experiencing Vertigo

If you are experiencing vertigo, call your doctor so you can get a complete medical evaluation. If symptoms are severe, you should get medical attention right away. In some cases, dizziness is the only warning sign of a stroke.

When seeking treatment from an Audiologist, be sure to choose a doctor who is certified by the American Speech-Language-Hearing Association.

If you have experienced vertigo episodes before, be sure to take precautions in your home to reduce the risk of injury in the event of a fall.

Additional Resources on Audiology and Vertigo

Additional information on Audiology is available from the American Academy of Audiology.

The American Speech-Language-Hearing Association certifies Audiologist and Speech Pathologists.

The Vestibular Disorders Association provides information and support for patients and practitioners who treat vestibular disorders.