701, First Floor, Malik Solitaire, Road No: 36, Jubilee Hills,Hyderabad - 500033
We are the FIRST and ONLY center to offer TRUE comprehensive vestibular evaluation and rehabilitation in Hyderabad. We are established by American based Vestibular Neuroscientist and Professor to bring American standard services in Dizziness and Balance.
We offer multidisciplinary approach for VERTIGO, DIZZINESS and BALANCE disorders and help the patient from beginning of their journey to the end of the treatment in association with multiple specialists as required.
Dizziness or vertigo are one of the most common reasons adults visit doctors or hospitals. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition.
Balance is a complex system, always active that never stops working.
The balance system works with the vestibular, proprioceptive, visual systems and with brain constantly by sharing the information and adjust as needed. If any of these systems and others may have issues or stop functioning, the balance system alerts us with symptoms like VERTIGO, DIZZINESS, IMBALANCE, and others.
The human balance system primarily includes
Vestibular system is part of inner ear, and consists of 10 sensory organs of balance, five each in ear. These sensors are categorized into semicircular canals, 3 on each side (Lateral/horizontal canal, posterior canal, and anterior/superior canal) arranged at right angles to each other and are responsible for detecting angular movements of the head such as head turn, looking down/up.
The second category are 2 otolith organs (macule & saccule) that are responsible to detect linear motions of the head such as going up or down in lift or going forward or backward in a car even with eyes closed.
After detecting these and other complex motions, the vestibular system send information to Midbrain to be processed and integrate with other senses.
Visual system consists of Eyes, its muscles and part of the brain that coordinate vision. It is the responsibility of visual system to keep images steady during head motions by sensing the speed and direction of the head motion in relation to the world around us.
The integration of Visual system with vestibular system results in vestibulo-ocular reflex (VOR),that helps in aiming and gazing eyes on the target, such as the capability of maintaining the gaze of your eyes even while walking or running.
Muscles, joints and skin are part of the proprioceptive system. Its major responsibility is to sense body position in relation to the world. The vestibulospinal (VSR)
is a combination of vestibular system and its integration with proprioceptive system, this enables controlling the body muscles based on vestibular senses to stabilize our body in space by utilizing the gravity as a reference point.
Brainstem, Cerebellum and Cerebral cortex involve in integration and coordination of human balance system. Vestibular Nuclei in brainstem receives and integrates information coming from vestibular system, visual system, and proprioceptive information.
Cerebellum plays an important role in providing learned autonomic balance and movements. The cerebral cortex provides spatial orientation and self-motion perception. The brainstem integrates all information from three senses, and two other parts of brain cerebral cortex and cerebellum, after integration the brain then sends signals back to the eyes as VOR reflex and other parts of the body as VSR reflex and maintain body stability and posture.
“DIZZINESS” or “VERTIGO” or “IMBALANCE” or “LIGHTHEADEDNESS” are not disorders but they are symptoms that are used to describe the sensations of wooziness, spinning or instability, respectively.
Sometimes your symptoms may be accompanied by nausea or vomiting. The episode may last seconds or hours or days and may recur.
If you experience any of the following sensations, you may need to discuss them with your doctor or specialist.
Describing these symptoms with as many details as possible to your doctor or specialist is very important to understand the issue and to strategize the diagnosis and treatment to help with appropriate diagnosis and to recover from the issue.
REMEMBER, there is no right or wrong way to describe your symptoms and it should be as accurate and detailed as possible.
Vertigo is a specific term to describe the “spinning” sensation. Vertigo is a FALSE sensation that may feel like either YOU or your surroundings are spinning or moving.
Example: If you spin yourself or a kid in circles and stop suddenly you will feel spinning sensation and may feel like you will fall.
Triggering Factors: Quick or sudden head turns, bending down, looking up, rolling on bed can provoke vertigo. The spinning sensation can be noticeable for few seconds to hours depending on the underlying cause.
Imbalance can also be referred as disequilibrium. Imbalance could feel like walking on uneven ground or floating on a water surface.
Triggering factors: Being in heights, watching moving lights can trigger imbalance.
If you feel like fainting, or woozing, and may be associated with nausea. This condition may also be referred as presyncope.
Triggering Factors: Standing up after prolonged seating or physical exertion.
let’s start here….
Select the symptoms you experience to see possible suggestions:
There are many possible causes for Dizziness or Vertigo or Imbalance. Depending on how long you experience dizziness or vertigo, associated triggers for your symptoms and how you feel dizziness can help in finding causes.
The following are the common causes
Vestibular Disorders are one of the most common causes for vertigo or dizziness. The following are the few common vestibular disorders that may cause vertigo or dizziness.
Repeated and brief episodes of vertigo triggered by head turns. BPPV is a condition of misplaced Otoconia (inner ear crystals). With proper diagnosis treatment can be quick and is done by guided head movement to replace the otoconia back in its position.
Dizziness or vertigo resulting from neck injury or neck issues but no other causes. With proper diagnosis a combination of physical therapy, vestibular rehabilitation and medicines may help overcome Cervicogenic Dizziness.
Sudden attack of vertigo that lasts for hours and typically associated with Tinnitus and hearing loss. Several patients feel free of vertigo between attacks. With proper diagnosis the treatment strategy includes medication, lifestyle change, and vestibular rehabilitation.
Repeated attacks of dizziness with or without headaches with signs of sensitivity to loud sounds or bright lights. Usually lifestyle change, medications and vestibular rehabilitation as needed can help overcome with this issue.
Sudden attack of vertigo, usually a single episode associated nausea or vomitings that may last less few minutes and may convert to dizzy sensation. Vestibular Neuritis is commonly caused due to vestibular nerve damage. With proper diagnosis vestibular rehabilitation is the best option with vestibular suppressant medications at the early stages to reduce the symptoms.
Generally, vestibular specialist will try to get more information regarding your condition through few questionnaires and through a short interview.
Later, based on your signs the specialist may recommend a combination of following tests to find out the cause for the issues you are complaining. Once the cause is identified, a proper treatment plan will be discussed with you.
VNG is a group of tests administered using Infrared goggles to measure the involuntary eye movement (nystagmus). The assessment includes following several visual targets on a screen with eyes to assess central function, and measuring eye movement when head and body is put under several positions to assess vestibular function.
Peripheral vestibular function, Central Vestibular Function, ocular motor function, Cervical function, Vascular function.
Peripheral vestibular disorders, BPPV, Unilateral vestibular neuritis, Central Vestibular Function, Vestibular Migraine, Vascular disorders, Cervical Dizziness.
No vertigo medications at least 24-72 hours before the test. An Accompanying person to drive you home, if needed.
40 to 60 minutes
Computer based, Tasking, Infrared goggles.
The video head impulse test (vHIT), also known as the head thrust test.
vHIT is a powerful clinical tool to assess vestibular function by testing all six semicircular canals. vHIT provides quick and objective measurements of the vestibular-ocular reflex (VOR). It efficiently assesses the dizzy patient and determines if the dizziness is related to a vestibular disorder.
All six semicircular canals
Semicircular lesions, Peripheral vestibular disorders, Unilateral vestibular neuritis.
No vertigo medications at least 24-72 hours before the test.
15 minutes
Computerized, High speed infrared goggles.
Rotary chair testing is considered as the gold standard for confirmation of suspected bilateral vestibular hypofunction. The rotary chair test has three parts.
1. Sinusoidal Harmonic Acceleration (SHA)
2. Visual Fixationfor VOR suppression
3. Step Velocity
With the help of above three rotary chair tests, we can evaluate the function of the inner ear, vestibular nerve, brain stem, and cerebellum (part of the brain). This system regulates balance, coordination, posture, and body orientation in space.
Rotary chair testing is usually performed in addition to videonystagmography (VNG). The purpose of rotational testing is to determine whether or not dizziness may be due to a disorder of inner ear or brain, and particularly to determine whether or not both inner ears are impaired at the same time.
Vestibular periphery, vestibular central pathway, posture, cerebellum function
Peripheral vestibular disorders, Monitoring peripheral vestibular function over time, pediatric vestibular testing, central vestibular disorders, Vestibular Migraine.
No vertigo medications at least 24-72 hours before the test.
45 minutes
Computerized, Infrared goggles, Rotary Chair.
Objective functional test that assesses visual acuity during active head movement relative to baseline static visual acuity. DVA can be assessed actively or passively to assess efference copy contribution or to isolate the contribution of vestibular function to the VOR.
Vestibular function, Vision, Perception, Brain Function, Vestibular Compensation
Vestibular Disorders, Brain Injury, Central Integration
Prepare to sit for 10 to 15 minutes with a headband. Carefully follow the clinician instructions.
15 minutes
Computerized, Head motion tracker.
The Vestibular Myogenic Potentials (VEMP) evaluates the otolith and vestibular nerve function. The VEMP is a short latency electromyographic (EMG) potential and it is evoked in response to high-level acoustic stimuli. The responses are mediated by the vestibular system.
VEMP also provides ear-specific information about otolith and nerve function. It helps in evaluating sound-evoked vestibular symptoms such as Tullio phenomenon or superior canal dehiscence (SCD). VEMP can be done in two ways.
1. Cervical VEMP (cVEMP)
cVEMP can assess the saccule and the inferior portion of the vestibular nerve for different vestibular pathologies like Ménière’s or vestibular neuritis.
2. Ocular VEMP (oVEMP)
oVEMP can also assess the utricle and the superior portion of the vestibular nerves.
VEMP's can also do an assessment of young children and infants before cochlear implantation to know if the system is intact before the implant array is placed. Can also be used to establish a baseline for how things were working before compensation for a comparison.
Can also use in assessment of auditory neuropathy. These children in many cases have abnormal VEMPs. The same is true for concussions.
Vestibular periphery, central vestibular lesions, auditory lesions
Superior Canal Dehiscence (SCD), Utricle, Saccule, Superior and inferior vestibular nerve, Auditory neuropathy, Ménière’s disease, vestibular neuritis,
No medications 24 hours prior to the test, prepared to hold the neck or eyes in a specific position for few minutes.
45-60 minutes
Computerized, Electrodes, sound evoked.
Electrocochleography (ECochG) is a electrophysiological measurement of the cochlea. For ECochG we use tip-trode electrode for achieving better cochlear neural responses. The measurements with stimulus onset (baseline), then we record the response of the cochlea to the stimulus (summating potential - SP), and response to the synchronous firing of nerve fibers (action potential - AP). The AP in ECochG is also known as Wave I of ABR/BERA. The cochlear microphonic (CM) is also part of the ECochG and has its own protocol.
Cochlear Endolymphatic pressure, Cochlear Hydrops, Vestibular Disorders
Ménière's Disease, Cochlear Hydrops
No medications 24 hours prior to the test, prepared to hold the neck or eyes in a specific position for few minutes.
60 minutes
Computerized, Electrodes, sound evoked.
The otolithic organs, utricle and saccule in the vestibular system sense gravity and are responsible to the sense of verticality. If there is an injury to the otoliths, or to the nerve that transmits information from the otoliths and other parts the ear to the brain, judgement of vertical may be affected leading to dizziness or imbalance.
Vestibular System, Somatosensory, Visual, Otolith function
Otolith (Utricle & Saccule) and nerve function
No medications 24 hours prior to the test, prepared to hold the neck or eyes in a specific position for few minutes.
10-15 minutes
Computerized, Instructions.
There are multiple treatment options depending on the appropriate diagnosis in finding out the actual the cause of vertigo or dizziness. Below are the few common options.
Vestibular rehabilitation Therapy (VRT) primarily focuses on improving the integration and coordination of information between the body (proprioceptive system), eyes, brain and inner ear (vestibular system) for most patients.
The primary goal of the VRT is to improve the quality of life by adapting and compensating your disorder, thus decreasing your symptoms and improving overall balance function.
Research suggests that rehabilitation programs are most effective when they are customized. The type, frequency, and intensity of effective exercises varies from person to person.
Some imbalance and dizziness issues are associated with increased anxiety. In spite of your symptoms, cognitive behavioural therapy (CBT) can be a useful technique for establishing coping mechanisms.
The most often suggested therapy for addressing anxiety is CBT. A form of conversation therapy (psychotherapy). It often has a brief duration and is targeted at a certain objective.
It is effective for many dizzy persons to combine CBT with vestibular rehabilitation therapy. Make sure your treatment strategy for balance and dizziness is well understood by each member of your healthcare team for maximum efficiency.
Not all dizziness and balance disorders can be treated by medications or with vestibular rehabilitation. Depending on the disorders the appropriate treatment options will be considered by the professionals.
However, most of the time the prolonged use of these medications can induce imbalance in long run. One has to be careful that medications can adversely affect few disorders can increase fall risk.
Few medications such as vestibular suppressants such as Betahistine (Vertin), Cinnarizine (Spin free), are used. Antiemetic medications may also be used to reduce the signs along with vestibular suppressants. Anxiety or depression medications may also be suggested in case of few balance disorders like PPPD or Vestibular Migraines.
Generally, it is described as an illusion of motion or altered sense of orientation. A person may feel as if the room or environment around them is moving, even when they themselves are still. It can be accompanied by lightheadedness, nausea or vomiting. Also, patient may describe it in different ways like spinning, dizziness, giddiness, imbalance, rocking or feeling that they may fall. Vertigo can present as acute attacks or recurrent episodes.
Vertigo can be caused by many kinds of disorders of the balance system. Most commonly they are due to inner ear problems. Less commonly, it may be associated with central nervous system, systemic disorders, such as inadequately controlled BP or diabetes or psychological disorders. One of most common type of vertigo, benign paroxysmal positional vertigo (BPPV) is a result of tiny calcium particles (canaliths) clumping in the inner ear. The dysfunction of the canaliths when the head change position sends signals to the brain that make a person feel as if their environment is spinning.
Other common causes are head trauma, migraines, cold viruses or ear infection and balance and hearing disorders etc
Most causes of vertigo are readily treatable with Vestibular Maneuvers or by vestibular rehabilitation exercises. Identifying the cause of the vertigo will help to decide whether you require medicines or exercises to control the problem
Stress can have a dramatic impact on our physical and mental health, triggering all sorts of symptoms and making many medical conditions worse. Elevated levels of stress/anxiety hormones including cortisol can negatively impact the transmission of neural information from your vestibular system to your brain. It’s thought that these hormones may disrupt ion channels in your nerves and neurotransmission in your brain. Your body also releases other chemicals including histamine and neurosteroids when you’re stressed that may indirectly impair neurotransmission between your vestibular system and your brain. Also, Anxiety/ stress and vertigo can have the opposite relationship, too. Stimulation of the vestibular system and worrying about experiencing vertigo can cause anxiety.
The best way to prevent stress-induced vertigo is to try to minimize stress in your life. You may find the following methods can help you relieve stress: listening to calming music, scheduling time for things that make you laugh, meditation, light exercise, talking about the stressful situation with a friend or family member. The following healthy habits may also help alleviate symptoms: minimize caffeine, alcohol, or tobacco use, stay hydrated, sit or lie down until you feel better, see a doctor if the vertigo is severe or long-lasting.
The anxiety component of the problem may need medical treatment. Most interventions for anxiety involve psychological counselling, cognitive-behavioural therapy, and medication. A physician may recommend a limited use of medications in order to control the anxiety in order to achieve the best benefits of physical therapy.
Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are 1) to enhance gaze stability, 2) to enhance postural stability, 3) to improve vertigo, and 4) to improve activities of daily living.
Vestibular Rehabilitation helps dizzy patients recover their balance. It works by helping the brain develop alternate strategies to improve balance function. These exercises need to be tailored to work on the weak balance areas identified by the vestibular tests. They need to be progressively challenging to help the patient recover balance over several weeks.
To be honest, there is no one right medicine to treat vertigo, as vertigo is just a symptom and itself is not a disorder. It is best to treat the cause of vertigo rather than suppressing its symptom. For eg; Vestibular neuritis in the acute stage is treated with steroids followed by vestibular rehabilitation. Vestibular migraine requires migraine prophylactic drugs along with lifestyle modifications. Thus treatment is given according to the disease. Vestibular suppressants may be given in the acute stage for few days. However, these medicines should not be given for more than few days as these will interfere with the recovery of the patient.
Yes, certain causes of vertigo can run in families like Vestibular migraine. In comprehensive history, family history of vertigo, headaches, and hearing loss should be looked in patients complaining of vertigo.
Several conditions can results in vertigo, in majority cases the vertigo is observed in vestibular related (ear) issues. However, for aperson to balnce properly the vestibular system need to work with other senses such as proprioceptive, visual and brain. ANy abnormality to these system that include brain related issues can also result in vertigo. The prevalence of vertigo due to brain issues is less compared to ear issues.
Any defect in the balance system resulting in vertigo, unsteadiness or imbalance will affect the day-to-day activities of the patient and diminish the quality of life. It may result in reduced confidence level of the patient as well as induce a fear o falling or movement. Treating vertigo restore balance and confidence of the patients. The fear of movements may cause the patient to restrict themselves to a sedentary lifestyle and lead to depression and anxiety.
Dizziness generally describes a feeling of being off-balance. When you’re dizzy, moving can be difficult. You may stagger while you’re walking or feel like you’re going to fall. Dizziness is the feeling of being lightheaded, foggy or unsteady. Vertigo feels more like spinning sensation.
While benign paroxysmal positional vertigo is a common cause of vertigo, it is not associated with symptoms of dizziness. There are many other potential reasons for spells of dizziness.
Generally, post treatment by specialists doing maneuvers at home can help reduce any residual issues. However, without specialist supervision and doing maneuvers with out proper diagnosis can not only be harmful, it can cause more problems. Attempting to reposition crystals without instruction from your health care provider can cause the crystals to be moved incorrectly. There have been instances where patients have given themselves a concussion during the process or damaged their eardrums from flushing liquid into their ears.
Long-term dizziness and vertigo should not be ignored. Rather, appropriate physician or vestibular audiologists should treat these conditions.
Meniere’s disease is an disorder that causes fluid build-up in the inner ear that can lead to episodes of vertigo and ringing in the ear. It can be treated with antibiotics and steroids and with diet restrictions.
Research suggests that rehabilitation programs are most effective when they are customized based on the proper diagnosis. The type, frequency, and intensity of effective exercises varies from person to person. Vestibular Rehabilitation is not no one-size-fits-all and it has to be strategized for each patient on their issue. Doing wrong VRT may also adversely affect, so follow only if you are diagnosed properly and notice improvement, but must STOP if vertigo becomes worse.
Our specialty care centre offers exceptional balance, audiology and speech and language services to people of all ages at our clinic.
