There are many causes for dizziness, vertigo and balance disorders and some may include neck, shoulders and back problems. Sometimes, these problems are secondary to dizziness and vertigo – patients may develop muscle tension and pain as they reduce head and neck movements in order to not trigger their dizziness. In these instances, patients may find chiropractic treatments to be helpful to them. On the other hand, there are several dizziness and balance problems that will most likely not improve with chiropractic treatments.

There isn’t enough evidence to support the diagnosis of cervical vertigo. Some argue that cervical vertigo can be related to compressed blood vessel and/or nerve endings. An MRI (magnetic resonance imaging) would not show this. MRIs are done to rule out growths such as tumours. People with motion sensitivity usually avoid moving their head and tend to move in a block without turning their neck.  Little by little, this leads to a stiff and sore neck; when you are forced to move your neck, you get dizzier.

Instead of using a firm pillow to keep your head immobile while sleeping, for example, consider doing some type of exercise, such as tai chi, involving gentle head movement; over time, you’ll be able to move your head more freely without feeling dizzy.

Very interesting observation! In order to keep balance, our brain collects information from the vestibular system (the inner ear balance sensors), the visual system and the proprioceptive system (the sensation coming from skin, muscles and joints). The brain analyzes these three “buckets” of information to figure out what the body is doing and to send orders back to the body to adjust and keep balance. When you are carrying a heavy object, either in one or both hands, you are enhancing the cues from the proprioceptive system going up to the brain. From your report, this seems to help your brain to adjust more easily and for you to feel more balanced.

This principle, as a means of strategically calculated and positioned weighted vests, has been used in balance rehabilitation of some central nervous system balance disorders, such as Parkinson’s Disease. You may wish to explore this option with your health care professionals team.

The half-somersault manoeuvre is meant to be self-taught and performed, but, depending on how dizzy, fit and healthy you are, it may be difficult to accomplish. It is an alternative to the Epley manoeuvre, which can also be self-administered. You can read more about the half-somersault maoneuvre here.

Alternatively, you can see a vestibular physiotherapist who can help you with the manoeuvres, both teaching you how to do them and performing them for you. You can find a Vestibular Physiotherapist in your area here. Choose “Find a Physio” or “Find a Clinic” and select the “Advanced Search” option. Enter your criteria, including your city.

I couldn’t help but notice that you mentioned in your email that you suffer from Ménière’s Disease. Note that these manoeuvres are aimed at positional vertigo, which may occur in Ménière’s disease. Positional vertigo presents as short-lived episodes of spinning dizziness that occur only when you move your head in certain ways. On the other hand, Ménière’s Disease presents with intense spinning (dizziness) episodes, that come on suddenly, often for no apparent reason. These are often accompanied by vomiting and last for hours. The manoeuvres for positional vertigo are not recommended when these longer and more severe episodes occur.

You have expressed the feelings of many people affected by dizziness! It is not always easy to find support in your community; you end up seeing quite a few professionals and they aren’t always on the same page as to your diagnosis and treatment plan, and you are left with uncertainty about what you can expect in the future. Without getting into too much detail about your diagnosis and treatment (you can read more about BPPV here) I would like to encourage you to:

1) get informed (the link above is a good place to start) and then clarify with your healthcare professionals what their treatment plan is. Ask as many questions as you need. Read some more if you need to. Here is a list of recommended books.

2) once you feel you have a direction to follow for treatment, stick with it for a set amount of time. Six weeks is a reasonable time frame. During this time, try your very best to stick with the treatment plan and to stay positive.

3) use the online resources of our Society and your local sources of support. Since you mentioned that there are no specific dizziness support groups, how about you try your community for balance exercises, for example? You can also look for Tai Chi classes and classes designed for falls prevention. You will most likely find others dealing with similar issues.

4) At the end of your “trial” with this plan, reassess your symptoms and your goals. You may find that you were on the right track OR you may need to start on number one all over again and try a different treatment plan.

Keep in mind that, even if you need to go back and follow a different course of action, that is okay, it will not be forever. Give yourself again about six weeks time and reassess. Stay in the present moment as much as you can, focusing on what you can effectively do right then and there.

The otoliths are a chandelier-like structure hanging from the ceiling of the inner ear. As we move, its canals bend from side to side and we sense these movements. Like a chandelier, this structure is weighted by crystals. These tiny rocks can come loose and fall into the canals causing BPPV (benign paroxysmal positional vertigo).

Every time someone with BPPV does a particular head movement, for example putting their head back to look for something on an upper shelf or rolling over in bed, they get dizzy.  This happens because the loose crystals overstimulate the movement sensors in the canal. There are canal-specific manoeuvres that can be performed by a doctor, audiologist or physiotherapist to shift the crystals back to where they belong.

Between 85 to 90% of BPPV affects the posterior canal; for most patients, it is easily fixed using the Epley manoeuvre. The Barbeque Roll (rotational) manoeuvre is used when the horizontal canal is affected. Read more about BPPV.

You might have an underlying condition that behaves like BPPV. A second possibility is recurrent BPPV; it can be fixed by a manoeuvre but then comes back. It’s also possible that the source of your problem isn’t in the inner ear, but higher up in your brain; if the sensors in your brain that interpret the information sent by the ear aren’t working properly, these manoeuvres will be of no use.

There are many causes for dizziness, vertigo and balance disorders and some may include neck, shoulders and back problems. Sometimes, these problems are secondary to dizziness and vertigo – patients may develop muscle tension and pain as they reduce head and neck movements in order to not trigger their dizziness. In these instances, patients may find chiropractic treatments to be helpful to them. On the other hand, there are several dizziness and balance problems that will most likely not improve with chiropractic treatments.

Vision is an essential part of the balance system. If you are noticing that your vision is changing and you are finding it hard to read it seems reasonable to visit your optometrist and have your eyes checked.

In addition to that, given your history of concussion, it would probably be a good idea to see a neuro-ophthalmologist or a neuro-optometrist to assess how your eyes are working together and how you are processing visual information as these are also contributing factors to human balance. You can learn more about how these professionals can help here: https://www.balanceanddizziness.org/pdf/Health-Professionals.pdf

Also, please make sure you keep your vestibular therapist informed of your vision changes, as well as any falls you may experience. Your rehabilitation programme should continue to address these issues.

We have a comprehensive article on the topic of PPPD here.

Several types of medications list dizziness as a potential side effect. These episodes of dizziness are often better described as drowsiness and/or light-headedness. In a few instances, however, it can also refer to true vertigo (spinning sensation).

Anti-nausea medications usually act on the central nervous system through a process of slight sedation. These medications inhibit signal transmission pathways from the body to the brain. Prolonged use of anti-nausea medications is not recommended for people who have had an inner ear problem and/or loss of balance function because these medications can slow down the recovery process driven by the brain. The new signals going from the inner ear will not be properly received by the brain, which will in turn take longer to adjust to the new vestibular function. It is, however, very unlikely that anti-nausea medications can cause inner-ear related dizziness.

The half-somersault manoeuvre is meant to be self-taught and performed, but, depending on how dizzy, fit and healthy you are, it may be difficult to accomplish. It is an alternative to the Epley manoeuvre, which can also be self-administered. You can read more about the half-somersault maoneuvre here.

Alternatively, you can see a vestibular physiotherapist who can help you with the manoeuvres, both teaching you how to do them and performing them for you. You can find a Vestibular Physiotherapist in your area here. Choose “Find a Physio” or “Find a Clinic” and select the “Advanced Search” option. Enter your criteria, including your city.

I couldn’t help but notice that you mentioned in your email that you suffer from Ménière’s Disease. Note that these manoeuvres are aimed at positional vertigo, which may occur in Ménière’s disease. Positional vertigo presents as short-lived episodes of spinning dizziness that occur only when you move your head in certain ways. On the other hand, Ménière’s Disease presents with intense spinning (dizziness) episodes, that come on suddenly, often for no apparent reason. These are often accompanied by vomiting and last for hours. The manoeuvres for positional vertigo are not recommended when these longer and more severe episodes occur.

Yes, some vestibular disorders are by essence less responsive to vestibular rehabilitation than others. The principle of vestibular rehabilitation is to decrease symptoms by training the brain to optimize the use of the inner-ear input and to integrate that input effectively with the visual and proprioceptive information. Sudden changes in inner ear function can produce severe symptoms of vertigo and vomiting but once the inner ear function stabilizes, the brain can be trained to readjust to it.

However, if the nature of the vestibular disorder is to fluctuate or to deteriorate progressively, it can be extremely challenging for the brain to adjust to these repetitive changes. Individuals suffering from Ménière’s disease, for example, are not good candidates for vestibular rehabilitation when they are going through active stages of the disorder in which spells are happening often. Patients with recurrent types of vestibular disorders often benefit more from medical management of the attacks than from vestibular rehabilitation.

One vestibular disorder that does not classically fluctuate but also does not respond well to vestibular rehabilitation is superior canal dehiscence. In cases not treated surgically, avoidance of triggers remains the best management strategy; for example, patients should avoid exposure to loud sounds that can trigger dizziness or imbalance.

All of us experience the need to “pop” our ears when changes in elevation occur. However, people who suffer from Ménière’s disease are more markedly affected by the change in atmospheric pressure. While normal people feel instant relief opening the Eustachian Tube and equalizing pressure in the middle ear, people who suffer from Ménière’s Disease also get the inner ear affected by the pressure. This may cause increased tinnitus, dizziness and changes in hearing.

The ventilation tube aims at equalizing the middle ear pressure with the outside environment, but it will likely not change the inner ear effects of the atmospheric pressure changes. Studies done comparing symptoms between groups of people with and without ventilation tubes fail to show a significant improvement in the group with tubes.

In summary, ventilation tubes have been shown to be effective in middle ear disorders (such as fluid behind the eardrum), but may not alleviate inner ear symptoms associated with changes in atmospheric pressure. The tube may help equalize the pressure and you may feel less of an urge to “pop,” but you may continue to experience these symptoms due to the inner ear disorder. Make sure to discuss pros and cons of having ventilation tubes put in with your Ear, Nose and Throat doctor. Read more about Ménière’s disease.

The relationship between changes in barometric pressure and dizziness have been described in medical literature, particularly in patients suffering from migraine related vertigo and Ménière’s disease. Both of these vestibular disorders are characterized by an episodic nature. This means that the symptoms come and go, in spells.

For some people, these episodes can be triggered by changes in atmospheric pressure, such as weather changes before a storm or travelling from sea level to higher altitude. Read our recent post on Facebook about this topic.

You mention the recurrent nature of your dizziness – vestibular neuritis is not classically recurrent like you describe. It is usually caused by a single viral or bacterial attack on the vestibular nerve. Symptoms typically start quite suddenly and may include severe vertigo and vomiting lasting for several hours. This is due to a loss in function of the vestibular nerve that can be temporary or permanent. During the recovery stage, which can last for several weeks, symptoms gradually improve and plateau.

We recommend speaking to your family doctor and/or your ENT doctor about the episodic/recurrent nature of your dizziness and vasovagal spells. Further investigation may be warranted into their cause.

Complex vestibular disorders are challenging to treat. For example, it can be very difficult to tease out the symptoms that distinguish Ménière’s disease or migrainous vertigo; they have very similar symptoms, but are treated very differently.

More complex cases are very individual and cannot always be pigeon-holed as Ménière’s or migrainous vertigo or some other particular disorder. Patients may have some but not all of the characteristics of Ménière’s disease, for example, and that is frustrating for doctors.

About a third of patients benefit from medications such as betahistine. Others benefit from a reduced salt diet and other dietary changes. When spells happen often and quality of life is reduced, intratympanic (within the middle ear) steroid injections may be used by the ear specialist (otologist). The objective of the injections is to prevent or reduce further attacks as each attack results in a further loss of hearing and balance. Read more about Ménière’s disease.

Vestibular rehabilitation usually doesn’t help in the early stages of Ménière’s disease. Patients will have attacks that can neither be predicted nor be kept under control with exercises. Vestibular rehabilitation doesn’t work well when a patient’s condition fluctuates – that is, good hearing and balance between attacks and poor during attacks.

With continued attacks, patients lose much of their hearing and balance. Once the balance function is greatly diminished and doesn’t change a lot when in or between attacks, the patient is a candidate for vestibular rehabilitation. If a patient has lost balance function on one side, the brain can be trained to compensate for the loss; however, it takes practice.

Motion sickness and an overall reduced tolerance to movement is often reported in patients who suffer from migraines. The recommendation is to treat the migraine first. When migrainous episodes are under control, patients benefit greatly from vestibular rehabilitation aimed at increasing motion tolerance. Identifying and avoiding triggers is one way to keep migraines under control as well reduce the number of episodes. Triggers include stress, foods (e.g., cheese), alcohol (e.g., red wine), smells. Preventative medications can also be used to avoid migraine episodes from happening.

The relationship between changes in barometric pressure and dizziness have been described in medical literature, particularly in patients suffering from migraine related vertigo and Ménière’s disease. Both of these vestibular disorders are characterized by an episodic nature. This means that the symptoms come and go, in spells.

For some people, these episodes can be triggered by changes in atmospheric pressure, such as weather changes before a storm or travelling from sea level to higher altitude. Read our recent post on Facebook about this topic.

You mention the recurrent nature of your dizziness – vestibular neuritis is not classically recurrent like you describe. It is usually caused by a single viral or bacterial attack on the vestibular nerve. Symptoms typically start quite suddenly and may include severe vertigo and vomiting lasting for several hours. This is due to a loss in function of the vestibular nerve that can be temporary or permanent. During the recovery stage, which can last for several weeks, symptoms gradually improve and plateau.

We recommend speaking to your family doctor and/or your ENT doctor about the episodic/recurrent nature of your dizziness and vasovagal spells. Further investigation may be warranted into their cause.

Complex vestibular disorders are challenging to treat. For example, it can be very difficult to tease out the symptoms that distinguish Ménière’s disease or migrainous vertigo; they have very similar symptoms, but are treated very differently.

More complex cases are very individual and cannot always be pigeon-holed as Ménière’s or migrainous vertigo or some other particular disorder. Patients may have some but not all of the characteristics of Ménière’s disease, for example, and that is frustrating for doctors.

We’re still not sure of the process by which motion sickness happens. Drugs for this condition have not changed for 60 years. The believed mechanism is a conflict of information between the inner balance sensors, visual, and proprioceptive systems. Those who suffer from motion sickness tend to rely predominantly on their visual system for balance. If you can’t see where you are going, for example while seated in the back seat of a moving car, your motion sickness gets triggered. If you drive, you see where you’re going and feel fine.

For similar reasons, watching things move can also be a major trigger. The brain wants stable vision. Watching moving objects causes problems for some. Examples include crowded situations, action movies, and scrolling computer screens. In these circumstances, the brain has no stable frame of reference. It becomes confused, resulting in nausea and/or dizziness.

We can help the brain by fixing our eyes on a stable object. In a crowd, try to focus on something that isn’t moving. If in a moving car, try to concentrate on a distant stationary object. Nearby objects that are rapidly moving will confuse the brain. Flashes of light or a pattern of light and shadow also trigger motion sickness.

If your problem is “central positional nystagmus,” the approach is through habituation. Instead of having Epley or other manoeuvres performed, you can try Brandt-Daroff or other vestibular rehabilitation exercises. These habituation exercises retrain the brain and are beneficial for most patients. They are helpful for both peripheral and central types of dizziness.

If you are motion sensitive, you can start by doing tiny doses of movements that make you feel nauseated. For example, move your head back and forth for just 30 seconds. Then push yourself for one or two seconds longer and give your brain a chance to overcome the feeling of nausea. Gradually, your brain will get habituated to more motion.

If done properly and routinely, those with motion sensitivity, BPPV or central positional nystagmus should start to feel some benefit from habituation exercises in three to four weeks and feel a lot better in about five to six weeks. If you are unsure how to do these exercises, have back or neck problems, or can’t do them quickly enough on your own, have a physiotherapist, audiologist or ENT do them.

The balance system is complex and in fact involves 3 major sensory input systems, all controlled by the brain. The inner ear sensors for balance, eyes and the proprioceptors on the body all send information to the brain. Balance centres receive, analyze and integrate these bits of information and then send orders to the body to readjust according to the movement done in the first place.

When you are dizzy with computer use, it usually means that the balance system is relying more heavily on the visual input. It is not fully reassured by the inner ear sensors telling them you are not moving. You can read more about it here: https://balanceanddizziness.org/do-you-get-headaches-or-motion-sickness-from-playing-computer-games/

Having the weights on you or changing your posture as you walk is increasing the cues coming from the proprioceptive system to the brain. This additional input seems to help you balance.

I would recommend you to have your inner ear sensors tested. It might be that they are working just fine but your centres in the brain are not using their information properly or it might be that your brain is in need of all this additional information (visual and proprioception) because your inner ear sensors are dysfunctional.

It is very common to have dizziness triggered by watching things move, as opposed to moving oneself. Many people feel dizzy in busy visual environments, such as browsing in a crowded grocery store, at busy intersections, or even seeing someone carrying a boldly striped bag. This problem, referred to by British researchers as visual vertigo, is caused by your brain not being able to match up the information coming from your eyes, your inner ear and the proprioception sensors on your joints. When you watch a 3-D movie, your eyes follow things around as if you were actually moving. If your brain is hard-wired to believe your eyes more than your inner ear or body, the message from your eyes will dominate and you’ll feel dizzy.

A treatment for visually-stimulated vertigo consists of watching things in motion. Audiologist Erica Zaia suggests repeatedly watching full-screen versions of the NED Leader (right and left) video clips on YouTube. When you get the feeling that you want to look away, watch for three to five seconds longer. Becoming accustomed to doing the tai chi “cloud hands” movement follows the same principle; it habituates your brain to the movement of your hands.

Below are some optokinetic videos.

• https://www.youtube.com/watch?v=iwm4acc3wRc&t=13s
• https://www.youtube.com/watch?v=-7DqDnBNmfY

Once you are used to these, try this one:

• https://www.youtube.com/watch?v=YWaGzTFRlWg

The following playlists compile complex exercises:

• https://www.youtube.com/channel/UCwDX4UUxFH7BZhs2gFYw6oA/playlists

The half-somersault manoeuvre is meant to be self-taught and performed, but, depending on how dizzy, fit and healthy you are, it may be difficult to accomplish. It is an alternative to the Epley manoeuvre, which can also be self-administered. You can read more about the half-somersault maoneuvre here.

Alternatively, you can see a vestibular physiotherapist who can help you with the manoeuvres, both teaching you how to do them and performing them for you. You can find a Vestibular Physiotherapist in your area here. Choose “Find a Physio” or “Find a Clinic” and select the “Advanced Search” option. Enter your criteria, including your city.

I couldn’t help but notice that you mentioned in your email that you suffer from Ménière’s Disease. Note that these manoeuvres are aimed at positional vertigo, which may occur in Ménière’s disease. Positional vertigo presents as short-lived episodes of spinning dizziness that occur only when you move your head in certain ways. On the other hand, Ménière’s Disease presents with intense spinning (dizziness) episodes, that come on suddenly, often for no apparent reason. These are often accompanied by vomiting and last for hours. The manoeuvres for positional vertigo are not recommended when these longer and more severe episodes occur.

We have a comprehensive article on the topic of PPPD here.

The half-somersault manoeuvre is meant to be self-taught and performed, but, depending on how dizzy, fit and healthy you are, it may be difficult to accomplish. It is an alternative to the Epley manoeuvre, which can also be self-administered. You can read more about the half-somersault maoneuvre here.

Alternatively, you can see a vestibular physiotherapist who can help you with the manoeuvres, both teaching you how to do them and performing them for you. You can find a Vestibular Physiotherapist in your area here. Choose “Find a Physio” or “Find a Clinic” and select the “Advanced Search” option. Enter your criteria, including your city.

I couldn’t help but notice that you mentioned in your email that you suffer from Ménière’s Disease. Note that these manoeuvres are aimed at positional vertigo, which may occur in Ménière’s disease. Positional vertigo presents as short-lived episodes of spinning dizziness that occur only when you move your head in certain ways. On the other hand, Ménière’s Disease presents with intense spinning (dizziness) episodes, that come on suddenly, often for no apparent reason. These are often accompanied by vomiting and last for hours. The manoeuvres for positional vertigo are not recommended when these longer and more severe episodes occur.

You have expressed the feelings of many people affected by dizziness! It is not always easy to find support in your community; you end up seeing quite a few professionals and they aren’t always on the same page as to your diagnosis and treatment plan, and you are left with uncertainty about what you can expect in the future. Without getting into too much detail about your diagnosis and treatment (you can read more about BPPV here) I would like to encourage you to:

1) get informed (the link above is a good place to start) and then clarify with your healthcare professionals what their treatment plan is. Ask as many questions as you need. Read some more if you need to. Here is a list of recommended books.

2) once you feel you have a direction to follow for treatment, stick with it for a set amount of time. Six weeks is a reasonable time frame. During this time, try your very best to stick with the treatment plan and to stay positive.

3) use the online resources of our Society and your local sources of support. Since you mentioned that there are no specific dizziness support groups, how about you try your community for balance exercises, for example? You can also look for Tai Chi classes and classes designed for falls prevention. You will most likely find others dealing with similar issues.

4) At the end of your “trial” with this plan, reassess your symptoms and your goals. You may find that you were on the right track OR you may need to start on number one all over again and try a different treatment plan.

Keep in mind that, even if you need to go back and follow a different course of action, that is okay, it will not be forever. Give yourself again about six weeks time and reassess. Stay in the present moment as much as you can, focusing on what you can effectively do right then and there.

The balance system is complex and in fact involves 3 major sensory input systems, all controlled by the brain. The inner ear sensors for balance, eyes and the proprioceptors on the body all send information to the brain. Balance centres receive, analyze and integrate these bits of information and then send orders to the body to readjust according to the movement done in the first place.

When you are dizzy with computer use, it usually means that the balance system is relying more heavily on the visual input. It is not fully reassured by the inner ear sensors telling them you are not moving. You can read more about it here: https://balanceanddizziness.org/do-you-get-headaches-or-motion-sickness-from-playing-computer-games/

Having the weights on you or changing your posture as you walk is increasing the cues coming from the proprioceptive system to the brain. This additional input seems to help you balance.

I would recommend you to have your inner ear sensors tested. It might be that they are working just fine but your centres in the brain are not using their information properly or it might be that your brain is in need of all this additional information (visual and proprioception) because your inner ear sensors are dysfunctional.

It sounds as though the stroke was the hemorrhagic type, which is why she needed surgery. Strokes affecting the back of the head can have vertigo as their main symptom and this is likely what happened to your wife. This vertigo is very unlikely related to an inner ear problem. At this point, having a vestibular or inner ear assessment is not recommended. The focus should be on her recovery from surgery. As she recovers and feels able to start moving, sitting up and so on, there should be a physiotherapy team at the hospital that can help her in regaining function. Then, after discharge, a more formal rehabilitation process can begin with physiotherapy.

You have expressed the feelings of many people affected by dizziness! It is not always easy to find support in your community; you end up seeing quite a few professionals and they aren’t always on the same page as to your diagnosis and treatment plan, and you are left with uncertainty about what you can expect in the future. Without getting into too much detail about your diagnosis and treatment (you can read more about BPPV here) I would like to encourage you to:

1) get informed (the link above is a good place to start) and then clarify with your healthcare professionals what their treatment plan is. Ask as many questions as you need. Read some more if you need to. Here is a list of recommended books.

2) once you feel you have a direction to follow for treatment, stick with it for a set amount of time. Six weeks is a reasonable time frame. During this time, try your very best to stick with the treatment plan and to stay positive.

3) use the online resources of our Society and your local sources of support. Since you mentioned that there are no specific dizziness support groups, how about you try your community for balance exercises, for example? You can also look for Tai Chi classes and classes designed for falls prevention. You will most likely find others dealing with similar issues.

4) At the end of your “trial” with this plan, reassess your symptoms and your goals. You may find that you were on the right track OR you may need to start on number one all over again and try a different treatment plan.

Keep in mind that, even if you need to go back and follow a different course of action, that is okay, it will not be forever. Give yourself again about six weeks time and reassess. Stay in the present moment as much as you can, focusing on what you can effectively do right then and there.

The half-somersault manoeuvre is meant to be self-taught and performed, but, depending on how dizzy, fit and healthy you are, it may be difficult to accomplish. It is an alternative to the Epley manoeuvre, which can also be self-administered. You can read more about the half-somersault maoneuvre here.

Alternatively, you can see a vestibular physiotherapist who can help you with the manoeuvres, both teaching you how to do them and performing them for you. You can find a Vestibular Physiotherapist in your area here. Choose “Find a Physio” or “Find a Clinic” and select the “Advanced Search” option. Enter your criteria, including your city.

I couldn’t help but notice that you mentioned in your email that you suffer from Ménière’s Disease. Note that these manoeuvres are aimed at positional vertigo, which may occur in Ménière’s disease. Positional vertigo presents as short-lived episodes of spinning dizziness that occur only when you move your head in certain ways. On the other hand, Ménière’s Disease presents with intense spinning (dizziness) episodes, that come on suddenly, often for no apparent reason. These are often accompanied by vomiting and last for hours. The manoeuvres for positional vertigo are not recommended when these longer and more severe episodes occur.

Yes, some vestibular disorders are by essence less responsive to vestibular rehabilitation than others. The principle of vestibular rehabilitation is to decrease symptoms by training the brain to optimize the use of the inner-ear input and to integrate that input effectively with the visual and proprioceptive information. Sudden changes in inner ear function can produce severe symptoms of vertigo and vomiting but once the inner ear function stabilizes, the brain can be trained to readjust to it.

However, if the nature of the vestibular disorder is to fluctuate or to deteriorate progressively, it can be extremely challenging for the brain to adjust to these repetitive changes. Individuals suffering from Ménière’s disease, for example, are not good candidates for vestibular rehabilitation when they are going through active stages of the disorder in which spells are happening often. Patients with recurrent types of vestibular disorders often benefit more from medical management of the attacks than from vestibular rehabilitation.

One vestibular disorder that does not classically fluctuate but also does not respond well to vestibular rehabilitation is superior canal dehiscence. In cases not treated surgically, avoidance of triggers remains the best management strategy; for example, patients should avoid exposure to loud sounds that can trigger dizziness or imbalance.

Most acoustic neuromas and other tumours seen in NF (Neurofibromatosis) can be detected by an MRI (Magnetic Resonance Imaging), particularly if contrast is used.

Unfortunately, cases have been described in the literature of patients who did not have acoustic neuromas but reported dizziness. In these cases, dizziness was caused by tumours in other areas of the central nervous system and not on the VIII nerve (vestibulocochlear nerve).

Vision is an essential part of the balance system. It works with the inner ear sensors for balance, the proprioceptors (sensation of touch) and the brain to keep us balanced. Any vision problems can negatively affect your balance and should, therefore, be addressed as much as possible. In general, the vision improvement after a successful cataract surgery has a positive impact on balance and quality of life.

Motion sickness and an overall reduced tolerance to movement is often reported in patients who suffer from migraines. The recommendation is to treat the migraine first. When migrainous episodes are under control, patients benefit greatly from vestibular rehabilitation aimed at increasing motion tolerance. Identifying and avoiding triggers is one way to keep migraines under control as well reduce the number of episodes. Triggers include stress, foods (e.g., cheese), alcohol (e.g., red wine), smells. Preventative medications can also be used to avoid migraine episodes from happening.

We’re still not sure of the process by which motion sickness happens. Drugs for this condition have not changed for 60 years. The believed mechanism is a conflict of information between the inner balance sensors, visual, and proprioceptive systems. Those who suffer from motion sickness tend to rely predominantly on their visual system for balance. If you can’t see where you are going, for example while seated in the back seat of a moving car, your motion sickness gets triggered. If you drive, you see where you’re going and feel fine.

For similar reasons, watching things move can also be a major trigger. The brain wants stable vision. Watching moving objects causes problems for some. Examples include crowded situations, action movies, and scrolling computer screens. In these circumstances, the brain has no stable frame of reference. It becomes confused, resulting in nausea and/or dizziness.

We can help the brain by fixing our eyes on a stable object. In a crowd, try to focus on something that isn’t moving. If in a moving car, try to concentrate on a distant stationary object. Nearby objects that are rapidly moving will confuse the brain. Flashes of light or a pattern of light and shadow also trigger motion sickness.

All of us experience the need to “pop” our ears when changes in elevation occur. However, people who suffer from Ménière’s disease are more markedly affected by the change in atmospheric pressure. While normal people feel instant relief opening the Eustachian Tube and equalizing pressure in the middle ear, people who suffer from Ménière’s Disease also get the inner ear affected by the pressure. This may cause increased tinnitus, dizziness and changes in hearing.

The ventilation tube aims at equalizing the middle ear pressure with the outside environment, but it will likely not change the inner ear effects of the atmospheric pressure changes. Studies done comparing symptoms between groups of people with and without ventilation tubes fail to show a significant improvement in the group with tubes.

In summary, ventilation tubes have been shown to be effective in middle ear disorders (such as fluid behind the eardrum), but may not alleviate inner ear symptoms associated with changes in atmospheric pressure. The tube may help equalize the pressure and you may feel less of an urge to “pop,” but you may continue to experience these symptoms due to the inner ear disorder. Make sure to discuss pros and cons of having ventilation tubes put in with your Ear, Nose and Throat doctor. Read more about Ménière’s disease.

You have expressed the feelings of many people affected by dizziness! It is not always easy to find support in your community; you end up seeing quite a few professionals and they aren’t always on the same page as to your diagnosis and treatment plan, and you are left with uncertainty about what you can expect in the future. Without getting into too much detail about your diagnosis and treatment (you can read more about BPPV here) I would like to encourage you to:

1) get informed (the link above is a good place to start) and then clarify with your healthcare professionals what their treatment plan is. Ask as many questions as you need. Read some more if you need to. Here is a list of recommended books.

2) once you feel you have a direction to follow for treatment, stick with it for a set amount of time. Six weeks is a reasonable time frame. During this time, try your very best to stick with the treatment plan and to stay positive.

3) use the online resources of our Society and your local sources of support. Since you mentioned that there are no specific dizziness support groups, how about you try your community for balance exercises, for example? You can also look for Tai Chi classes and classes designed for falls prevention. You will most likely find others dealing with similar issues.

4) At the end of your “trial” with this plan, reassess your symptoms and your goals. You may find that you were on the right track OR you may need to start on number one all over again and try a different treatment plan.

Keep in mind that, even if you need to go back and follow a different course of action, that is okay, it will not be forever. Give yourself again about six weeks time and reassess. Stay in the present moment as much as you can, focusing on what you can effectively do right then and there.

We would recommend that you consult with your Family Doctor or GP (General Practitioner) since you have been feeling dizzy for a few days days and the symptoms have not subsided spontaneously. Should you have other symptoms or your current symptoms become acute, we recommend that you to go to Emergency. For instance, if you are vomiting, you could become dangerously dehydrated.

Your family doctor will be able to identify any risk factors for dizziness in your medical history and on your medication list. They will obtain a detailed description of your dizziness and other associated symptoms and may perform some clinical tests to decide whether a referral to an ENT (Ear, Nose and Throat doctor), Neurologist or any other specialist, such as a Vestibular Physiotherapist, is warranted.

Often the Vestibular Physiotherapist can provide you with a trial rehabilitation program while you wait to the see the specialists. This program may be effective in addressing your symptoms and may therefore be worthwhile exploring sooner rather than later. Visit our Health Professionals Directory to find a qualified provider near you.

We have a comprehensive article on the topic of PPPD here.

If your problem is “central positional nystagmus,” the approach is through habituation. Instead of having Epley or other manoeuvres performed, you can try Brandt-Daroff or other vestibular rehabilitation exercises. These habituation exercises retrain the brain and are beneficial for most patients. They are helpful for both peripheral and central types of dizziness.

If you are motion sensitive, you can start by doing tiny doses of movements that make you feel nauseated. For example, move your head back and forth for just 30 seconds. Then push yourself for one or two seconds longer and give your brain a chance to overcome the feeling of nausea. Gradually, your brain will get habituated to more motion.

If done properly and routinely, those with motion sensitivity, BPPV or central positional nystagmus should start to feel some benefit from habituation exercises in three to four weeks and feel a lot better in about five to six weeks. If you are unsure how to do these exercises, have back or neck problems, or can’t do them quickly enough on your own, have a physiotherapist, audiologist or ENT do them.

The otoliths are a chandelier-like structure hanging from the ceiling of the inner ear. As we move, its canals bend from side to side and we sense these movements. Like a chandelier, this structure is weighted by crystals. These tiny rocks can come loose and fall into the canals causing BPPV (benign paroxysmal positional vertigo).

Every time someone with BPPV does a particular head movement, for example putting their head back to look for something on an upper shelf or rolling over in bed, they get dizzy.  This happens because the loose crystals overstimulate the movement sensors in the canal. There are canal-specific manoeuvres that can be performed by a doctor, audiologist or physiotherapist to shift the crystals back to where they belong.

Between 85 to 90% of BPPV affects the posterior canal; for most patients, it is easily fixed using the Epley manoeuvre. The Barbeque Roll (rotational) manoeuvre is used when the horizontal canal is affected. Read more about BPPV.

The relationship between changes in barometric pressure and dizziness have been described in medical literature, particularly in patients suffering from migraine related vertigo and Ménière’s disease. Both of these vestibular disorders are characterized by an episodic nature. This means that the symptoms come and go, in spells.

For some people, these episodes can be triggered by changes in atmospheric pressure, such as weather changes before a storm or travelling from sea level to higher altitude. Read our recent post on Facebook about this topic.

You mention the recurrent nature of your dizziness – vestibular neuritis is not classically recurrent like you describe. It is usually caused by a single viral or bacterial attack on the vestibular nerve. Symptoms typically start quite suddenly and may include severe vertigo and vomiting lasting for several hours. This is due to a loss in function of the vestibular nerve that can be temporary or permanent. During the recovery stage, which can last for several weeks, symptoms gradually improve and plateau.

We recommend speaking to your family doctor and/or your ENT doctor about the episodic/recurrent nature of your dizziness and vasovagal spells. Further investigation may be warranted into their cause.

The balance system is complex and involves the brain analyzing and interpreting information from three major systems: the inner ear sensors for balance (vestibular system), the visual system, and the sensation that goes from the skin, muscles and joints (proprioceptive system).

Any sensation of dizziness and imbalance may result when one or more of these four parts are not functioning well. Therefore, the perceived asymmetries you experience may stem from the vestibular organs, from the proprioceptive system and/or from the brain’s processing of the their information. You did not mention visual issues, but treating these symptoms often involve also addressing the processing of visual information, with and without head movements.

You may wish to pursue assessments to clarify whether you do have asymmetries in your balance system, namely a vestibular assessment (for the inner ear sensors and their connections with eyes and brain) and a physiotherapy assessment, for the proprioceptive and musculo-skeletal systems. Proper treatment/rehabilitation can then be tailored to your needs. 

You might have an underlying condition that behaves like BPPV. A second possibility is recurrent BPPV; it can be fixed by a manoeuvre but then comes back. It’s also possible that the source of your problem isn’t in the inner ear, but higher up in your brain; if the sensors in your brain that interpret the information sent by the ear aren’t working properly, these manoeuvres will be of no use.

It is great that you notice that you are hyperventilating. From that awareness, you can try voluntarily changing your breathing pattern. Slowing down, holding your breath in for at least three seconds improves your oxygenation. Another conscious effort you can make is to breathe deep into your belly. Place your hand on your abdomen and feel it expanding as you breathe in and contract as you breathe out.

Complex vestibular disorders are challenging to treat. For example, it can be very difficult to tease out the symptoms that distinguish Ménière’s disease or migrainous vertigo; they have very similar symptoms, but are treated very differently.

More complex cases are very individual and cannot always be pigeon-holed as Ménière’s or migrainous vertigo or some other particular disorder. Patients may have some but not all of the characteristics of Ménière’s disease, for example, and that is frustrating for doctors.

The balance system is complex and in fact involves 3 major sensory input systems, all controlled by the brain. The inner ear sensors for balance, eyes and the proprioceptors on the body all send information to the brain. Balance centres receive, analyze and integrate these bits of information and then send orders to the body to readjust according to the movement done in the first place.

When you are dizzy with computer use, it usually means that the balance system is relying more heavily on the visual input. It is not fully reassured by the inner ear sensors telling them you are not moving. You can read more about it here: https://balanceanddizziness.org/do-you-get-headaches-or-motion-sickness-from-playing-computer-games/

Having the weights on you or changing your posture as you walk is increasing the cues coming from the proprioceptive system to the brain. This additional input seems to help you balance.

I would recommend you to have your inner ear sensors tested. It might be that they are working just fine but your centres in the brain are not using their information properly or it might be that your brain is in need of all this additional information (visual and proprioception) because your inner ear sensors are dysfunctional.

It is very common to have dizziness triggered by watching things move, as opposed to moving oneself. Many people feel dizzy in busy visual environments, such as browsing in a crowded grocery store, at busy intersections, or even seeing someone carrying a boldly striped bag. This problem, referred to by British researchers as visual vertigo, is caused by your brain not being able to match up the information coming from your eyes, your inner ear and the proprioception sensors on your joints. When you watch a 3-D movie, your eyes follow things around as if you were actually moving. If your brain is hard-wired to believe your eyes more than your inner ear or body, the message from your eyes will dominate and you’ll feel dizzy.

A treatment for visually-stimulated vertigo consists of watching things in motion. Audiologist Erica Zaia suggests repeatedly watching full-screen versions of the NED Leader (right and left) video clips on YouTube. When you get the feeling that you want to look away, watch for three to five seconds longer. Becoming accustomed to doing the tai chi “cloud hands” movement follows the same principle; it habituates your brain to the movement of your hands.

Below are some optokinetic videos.

• https://www.youtube.com/watch?v=iwm4acc3wRc&t=13s
• https://www.youtube.com/watch?v=-7DqDnBNmfY

Once you are used to these, try this one:

• https://www.youtube.com/watch?v=YWaGzTFRlWg

The following playlists compile complex exercises:

• https://www.youtube.com/channel/UCwDX4UUxFH7BZhs2gFYw6oA/playlists

About a third of patients benefit from medications such as betahistine. Others benefit from a reduced salt diet and other dietary changes. When spells happen often and quality of life is reduced, intratympanic (within the middle ear) steroid injections may be used by the ear specialist (otologist). The objective of the injections is to prevent or reduce further attacks as each attack results in a further loss of hearing and balance. Read more about Ménière’s disease.

Vestibular rehabilitation usually doesn’t help in the early stages of Ménière’s disease. Patients will have attacks that can neither be predicted nor be kept under control with exercises. Vestibular rehabilitation doesn’t work well when a patient’s condition fluctuates – that is, good hearing and balance between attacks and poor during attacks.

With continued attacks, patients lose much of their hearing and balance. Once the balance function is greatly diminished and doesn’t change a lot when in or between attacks, the patient is a candidate for vestibular rehabilitation. If a patient has lost balance function on one side, the brain can be trained to compensate for the loss; however, it takes practice.

Complex vestibular disorders are challenging to treat. For example, it can be very difficult to tease out the symptoms that distinguish Ménière’s disease or migrainous vertigo; they have very similar symptoms, but are treated very differently.

More complex cases are very individual and cannot always be pigeon-holed as Ménière’s or migrainous vertigo or some other particular disorder. Patients may have some but not all of the characteristics of Ménière’s disease, for example, and that is frustrating for doctors.

The relationship between changes in barometric pressure and dizziness have been described in medical literature, particularly in patients suffering from migraine related vertigo and Ménière’s disease. Both of these vestibular disorders are characterized by an episodic nature. This means that the symptoms come and go, in spells.

For some people, these episodes can be triggered by changes in atmospheric pressure, such as weather changes before a storm or travelling from sea level to higher altitude. Read our recent post on Facebook about this topic.

You mention the recurrent nature of your dizziness – vestibular neuritis is not classically recurrent like you describe. It is usually caused by a single viral or bacterial attack on the vestibular nerve. Symptoms typically start quite suddenly and may include severe vertigo and vomiting lasting for several hours. This is due to a loss in function of the vestibular nerve that can be temporary or permanent. During the recovery stage, which can last for several weeks, symptoms gradually improve and plateau.

We recommend speaking to your family doctor and/or your ENT doctor about the episodic/recurrent nature of your dizziness and vasovagal spells. Further investigation may be warranted into their cause.

The half-somersault manoeuvre is meant to be self-taught and performed, but, depending on how dizzy, fit and healthy you are, it may be difficult to accomplish. It is an alternative to the Epley manoeuvre, which can also be self-administered. You can read more about the half-somersault maoneuvre here.

Alternatively, you can see a vestibular physiotherapist who can help you with the manoeuvres, both teaching you how to do them and performing them for you. You can find a Vestibular Physiotherapist in your area here. Choose “Find a Physio” or “Find a Clinic” and select the “Advanced Search” option. Enter your criteria, including your city.

I couldn’t help but notice that you mentioned in your email that you suffer from Ménière’s Disease. Note that these manoeuvres are aimed at positional vertigo, which may occur in Ménière’s disease. Positional vertigo presents as short-lived episodes of spinning dizziness that occur only when you move your head in certain ways. On the other hand, Ménière’s Disease presents with intense spinning (dizziness) episodes, that come on suddenly, often for no apparent reason. These are often accompanied by vomiting and last for hours. The manoeuvres for positional vertigo are not recommended when these longer and more severe episodes occur.

Yes, some vestibular disorders are by essence less responsive to vestibular rehabilitation than others. The principle of vestibular rehabilitation is to decrease symptoms by training the brain to optimize the use of the inner-ear input and to integrate that input effectively with the visual and proprioceptive information. Sudden changes in inner ear function can produce severe symptoms of vertigo and vomiting but once the inner ear function stabilizes, the brain can be trained to readjust to it.

However, if the nature of the vestibular disorder is to fluctuate or to deteriorate progressively, it can be extremely challenging for the brain to adjust to these repetitive changes. Individuals suffering from Ménière’s disease, for example, are not good candidates for vestibular rehabilitation when they are going through active stages of the disorder in which spells are happening often. Patients with recurrent types of vestibular disorders often benefit more from medical management of the attacks than from vestibular rehabilitation.

One vestibular disorder that does not classically fluctuate but also does not respond well to vestibular rehabilitation is superior canal dehiscence. In cases not treated surgically, avoidance of triggers remains the best management strategy; for example, patients should avoid exposure to loud sounds that can trigger dizziness or imbalance.

No, that is usually not the case. Patients are advised to set goals for their rehabilitation program with their vestibular therapists. Once these goals are achieved a maintenance plan can be put in place. This should include finding a level of physical activity that is suitable to the individual and that continues to stimulate and challenge the vestibular system enough to maintain a healthy balance.

Motion sickness and an overall reduced tolerance to movement is often reported in patients who suffer from migraines. The recommendation is to treat the migraine first. When migrainous episodes are under control, patients benefit greatly from vestibular rehabilitation aimed at increasing motion tolerance. Identifying and avoiding triggers is one way to keep migraines under control as well reduce the number of episodes. Triggers include stress, foods (e.g., cheese), alcohol (e.g., red wine), smells. Preventative medications can also be used to avoid migraine episodes from happening.

You have expressed the feelings of many people affected by dizziness! It is not always easy to find support in your community; you end up seeing quite a few professionals and they aren’t always on the same page as to your diagnosis and treatment plan, and you are left with uncertainty about what you can expect in the future. Without getting into too much detail about your diagnosis and treatment (you can read more about BPPV here) I would like to encourage you to:

1) get informed (the link above is a good place to start) and then clarify with your healthcare professionals what their treatment plan is. Ask as many questions as you need. Read some more if you need to. Here is a list of recommended books.

2) once you feel you have a direction to follow for treatment, stick with it for a set amount of time. Six weeks is a reasonable time frame. During this time, try your very best to stick with the treatment plan and to stay positive.

3) use the online resources of our Society and your local sources of support. Since you mentioned that there are no specific dizziness support groups, how about you try your community for balance exercises, for example? You can also look for Tai Chi classes and classes designed for falls prevention. You will most likely find others dealing with similar issues.

4) At the end of your “trial” with this plan, reassess your symptoms and your goals. You may find that you were on the right track OR you may need to start on number one all over again and try a different treatment plan.

Keep in mind that, even if you need to go back and follow a different course of action, that is okay, it will not be forever. Give yourself again about six weeks time and reassess. Stay in the present moment as much as you can, focusing on what you can effectively do right then and there.

Vision is an essential part of the balance system. If you are noticing that your vision is changing and you are finding it hard to read it seems reasonable to visit your optometrist and have your eyes checked.

In addition to that, given your history of concussion, it would probably be a good idea to see a neuro-ophthalmologist or a neuro-optometrist to assess how your eyes are working together and how you are processing visual information as these are also contributing factors to human balance. You can learn more about how these professionals can help here: https://www.balanceanddizziness.org/pdf/Health-Professionals.pdf

Also, please make sure you keep your vestibular therapist informed of your vision changes, as well as any falls you may experience. Your rehabilitation programme should continue to address these issues.

If your problem is “central positional nystagmus,” the approach is through habituation. Instead of having Epley or other manoeuvres performed, you can try Brandt-Daroff or other vestibular rehabilitation exercises. These habituation exercises retrain the brain and are beneficial for most patients. They are helpful for both peripheral and central types of dizziness.

If you are motion sensitive, you can start by doing tiny doses of movements that make you feel nauseated. For example, move your head back and forth for just 30 seconds. Then push yourself for one or two seconds longer and give your brain a chance to overcome the feeling of nausea. Gradually, your brain will get habituated to more motion.

If done properly and routinely, those with motion sensitivity, BPPV or central positional nystagmus should start to feel some benefit from habituation exercises in three to four weeks and feel a lot better in about five to six weeks. If you are unsure how to do these exercises, have back or neck problems, or can’t do them quickly enough on your own, have a physiotherapist, audiologist or ENT do them.

Yes! Although you don’t want to overdo it, you must make yourself dizzy in order to get better. Little by little, you will give your brain a chance to overcome the dizziness.

Though generalized sets of movements, such as the Cawthorne-Cooksey exercises, are helpful, they do not work as well as custom-tailored exercises. Based on your written vestibular test results, an audiologist or vestibular physiotherapist should be able to give you a personalized set of exercises to best address your particular symptoms.

Some of the vestibular rehabilitation activities done under supervision are taught to clients to practice at home in a safe and controlled manner. These activities include:

• motion-sensitivity exercises such as rolling in bed, sitting to standing, and walking while turning the head
• many different balance exercises
• visual or gaze exercises
• “target shooting,” that is keeping the head still while moving the eyes, or moving the head and keeping the eyes still
• the Epley maneuver to re-position ear crystals

A treatment for visually-stimulated vertigo consists of watching things in motion. Audiologist Erica Zaia suggests repeatedly watching full-screen versions of the NED Leader (right and left) video clips on YouTube. When you get the feeling that you want to look away, watch for three to five seconds longer. Becoming accustomed to doing the tai chi “cloud hands” movement follows the same principle; it habituates your brain to the movement of your hands.

Below are some optokinetic exercise videos.

This is a basic one:

• http://dizziness-and-balance.com/treatment/rehab/mdd/okn.php?arg1=50 (use the arrow keys to start the movement and control the speed)

These two are harder:

• https://www.youtube.com/watch?v=iwm4acc3wRc&t=13s
• https://www.youtube.com/watch?v=-7DqDnBNmfY

Once you are used to these, try this one:

• https://www.youtube.com/watch?v=YWaGzTFRlWg

The following playlists compile complex exercises:

• https://www.youtube.com/channel/UCwDX4UUxFH7BZhs2gFYw6oA/playlists

The balance system is complex and involves the brain analyzing and interpreting information from three major systems: the inner ear sensors for balance (vestibular system), the visual system, and the sensation that goes from the skin, muscles and joints (proprioceptive system).

Any sensation of dizziness and imbalance may result when one or more of these four parts are not functioning well. Therefore, the perceived asymmetries you experience may stem from the vestibular organs, from the proprioceptive system and/or from the brain’s processing of the their information. You did not mention visual issues, but treating these symptoms often involve also addressing the processing of visual information, with and without head movements.

You may wish to pursue assessments to clarify whether you do have asymmetries in your balance system, namely a vestibular assessment (for the inner ear sensors and their connections with eyes and brain) and a physiotherapy assessment, for the proprioceptive and musculo-skeletal systems. Proper treatment/rehabilitation can then be tailored to your needs. 

You might have an underlying condition that behaves like BPPV. A second possibility is recurrent BPPV; it can be fixed by a manoeuvre but then comes back. It’s also possible that the source of your problem isn’t in the inner ear, but higher up in your brain; if the sensors in your brain that interpret the information sent by the ear aren’t working properly, these manoeuvres will be of no use.

In a nutshell, vestibular rehabilitation gets our brains used to what makes us uncomfortable. The overall goal of vestibular rehabilitation is to increase quality of life by acclimatizing the body to the disorder. Vestibular rehabilitation is:

• symptom-based
• matched to the individual’s particular needs
• appropriate for people with a vestibular disorder or a secondary complication

During vestibular rehabilitation, the vestibular symptoms are intentionally provoked in a safe and controlled manner to desensitize the brain. Clients are taught how to move their heads, for example, so their brains gradually become habituated to the movement and recognize that it isn’t a scary thing to be avoided.

The initial visit to a vestibular physiotherapist includes a full assessment that allows the physiotherapist to set up a rehabilitation program that allows the client to progress safely through sets of exercises.

Physiotherapists take a big picture approach, promoting overall health and exercise to prevent secondary complications as well as increased activity levels to guide clients towards full recovery. They emphasize the importance of stress and sleep management: anxiety and fatigue result in exaggerated symptoms. Keeping a log and rating your symptoms on a one (best) and ten (worst) scale is recommended. If your dizziness it ten out of ten on a really bad day, look back and see what happened – how was your sleep, did something stressful happen?

Vestibular rehabilitation is not appropriate during the acute stage of a vestibular disorder. The best time to start is after the acute stage has passed or, for recurrent conditions such as Ménière’s disease, between bouts. Although it is not necessary to have a doctor’s referral to start vestibular rehabilitation, it is a good idea to see your doctor about dizziness problems and be cleared from any medical “red flags.” It is also important to get other medical tests done to rule out other reasons why you are feeling dizzy or light-headed. In addition to the vestibular system, problems with major body systems can cause dizziness.

It is very common to have dizziness triggered by watching things move, as opposed to moving oneself. Many people feel dizzy in busy visual environments, such as browsing in a crowded grocery store, at busy intersections, or even seeing someone carrying a boldly striped bag. This problem, referred to by British researchers as visual vertigo, is caused by your brain not being able to match up the information coming from your eyes, your inner ear and the proprioception sensors on your joints. When you watch a 3-D movie, your eyes follow things around as if you were actually moving. If your brain is hard-wired to believe your eyes more than your inner ear or body, the message from your eyes will dominate and you’ll feel dizzy.

A treatment for visually-stimulated vertigo consists of watching things in motion. Audiologist Erica Zaia suggests repeatedly watching full-screen versions of the NED Leader (right and left) video clips on YouTube. When you get the feeling that you want to look away, watch for three to five seconds longer. Becoming accustomed to doing the tai chi “cloud hands” movement follows the same principle; it habituates your brain to the movement of your hands.

Below are some optokinetic videos.

• https://www.youtube.com/watch?v=iwm4acc3wRc&t=13s
• https://www.youtube.com/watch?v=-7DqDnBNmfY

Once you are used to these, try this one:

• https://www.youtube.com/watch?v=YWaGzTFRlWg

The following playlists compile complex exercises:

• https://www.youtube.com/channel/UCwDX4UUxFH7BZhs2gFYw6oA/playlists

Vestibular rehabilitation usually doesn’t help in the early stages of Ménière’s disease. Patients will have attacks that can neither be predicted nor be kept under control with exercises. Vestibular rehabilitation doesn’t work well when a patient’s condition fluctuates – that is, good hearing and balance between attacks and poor during attacks.

With continued attacks, patients lose much of their hearing and balance. Once the balance function is greatly diminished and doesn’t change a lot when in or between attacks, the patient is a candidate for vestibular rehabilitation. If a patient has lost balance function on one side, the brain can be trained to compensate for the loss; however, it takes practice.

In BC, patients need a referral from an ENT (ear, nose and throat) specialist; this requires a referral from a family doctor. The process usually involves a waiting period of three to six months or more.

You have expressed the feelings of many people affected by dizziness! It is not always easy to find support in your community; you end up seeing quite a few professionals and they aren’t always on the same page as to your diagnosis and treatment plan, and you are left with uncertainty about what you can expect in the future. Without getting into too much detail about your diagnosis and treatment (you can read more about BPPV here) I would like to encourage you to:

1) get informed (the link above is a good place to start) and then clarify with your healthcare professionals what their treatment plan is. Ask as many questions as you need. Read some more if you need to. Here is a list of recommended books.

2) once you feel you have a direction to follow for treatment, stick with it for a set amount of time. Six weeks is a reasonable time frame. During this time, try your very best to stick with the treatment plan and to stay positive.

3) use the online resources of our Society and your local sources of support. Since you mentioned that there are no specific dizziness support groups, how about you try your community for balance exercises, for example? You can also look for Tai Chi classes and classes designed for falls prevention. You will most likely find others dealing with similar issues.

4) At the end of your “trial” with this plan, reassess your symptoms and your goals. You may find that you were on the right track OR you may need to start on number one all over again and try a different treatment plan.

Keep in mind that, even if you need to go back and follow a different course of action, that is okay, it will not be forever. Give yourself again about six weeks time and reassess. Stay in the present moment as much as you can, focusing on what you can effectively do right then and there.

Unfortunately the wait lists for vestibular testing in the public system are indeed very long.

Some of the hospital services in BC have an urgent or expedited testing policy; whether this is your case or not will be determined by your referring physician at the time of your consult. You may also be able to get an early appointment if you can be available on short notice and ask to be put on a cancellation list.

However, there are a few private facilities in BC that currently offer formal vestibular assessment. To find them, use our online Directory of Health Professionals – limit your search to audiologists.

The balance system is complex and involves the brain analyzing and interpreting information from three major systems: the inner ear sensors for balance (vestibular system), the visual system, and the sensation that goes from the skin, muscles and joints (proprioceptive system).

Any sensation of dizziness and imbalance may result when one or more of these four parts are not functioning well. Therefore, the perceived asymmetries you experience may stem from the vestibular organs, from the proprioceptive system and/or from the brain’s processing of the their information. You did not mention visual issues, but treating these symptoms often involve also addressing the processing of visual information, with and without head movements.

You may wish to pursue assessments to clarify whether you do have asymmetries in your balance system, namely a vestibular assessment (for the inner ear sensors and their connections with eyes and brain) and a physiotherapy assessment, for the proprioceptive and musculo-skeletal systems. Proper treatment/rehabilitation can then be tailored to your needs. 

Complex vestibular disorders are challenging to treat. For example, it can be very difficult to tease out the symptoms that distinguish Ménière’s disease or migrainous vertigo; they have very similar symptoms, but are treated very differently.

More complex cases are very individual and cannot always be pigeon-holed as Ménière’s or migrainous vertigo or some other particular disorder. Patients may have some but not all of the characteristics of Ménière’s disease, for example, and that is frustrating for doctors.

The balance system is complex and in fact involves 3 major sensory input systems, all controlled by the brain. The inner ear sensors for balance, eyes and the proprioceptors on the body all send information to the brain. Balance centres receive, analyze and integrate these bits of information and then send orders to the body to readjust according to the movement done in the first place.

When you are dizzy with computer use, it usually means that the balance system is relying more heavily on the visual input. It is not fully reassured by the inner ear sensors telling them you are not moving. You can read more about it here: https://balanceanddizziness.org/do-you-get-headaches-or-motion-sickness-from-playing-computer-games/

Having the weights on you or changing your posture as you walk is increasing the cues coming from the proprioceptive system to the brain. This additional input seems to help you balance.

I would recommend you to have your inner ear sensors tested. It might be that they are working just fine but your centres in the brain are not using their information properly or it might be that your brain is in need of all this additional information (visual and proprioception) because your inner ear sensors are dysfunctional.

Vision is an essential part of the balance system. It works with the inner ear sensors for balance, the proprioceptors (sensation of touch) and the brain to keep us balanced. Any vision problems can negatively affect your balance and should, therefore, be addressed as much as possible. In general, the vision improvement after a successful cataract surgery has a positive impact on balance and quality of life.

Vision is an essential part of the balance system. If you are noticing that your vision is changing and you are finding it hard to read it seems reasonable to visit your optometrist and have your eyes checked.

In addition to that, given your history of concussion, it would probably be a good idea to see a neuro-ophthalmologist or a neuro-optometrist to assess how your eyes are working together and how you are processing visual information as these are also contributing factors to human balance. You can learn more about how these professionals can help here: https://www.balanceanddizziness.org/pdf/Health-Professionals.pdf

Also, please make sure you keep your vestibular therapist informed of your vision changes, as well as any falls you may experience. Your rehabilitation programme should continue to address these issues.

The balance system is complex and involves the brain analyzing and interpreting information from three major systems: the inner ear sensors for balance (vestibular system), the visual system, and the sensation that goes from the skin, muscles and joints (proprioceptive system).

Any sensation of dizziness and imbalance may result when one or more of these four parts are not functioning well. Therefore, the perceived asymmetries you experience may stem from the vestibular organs, from the proprioceptive system and/or from the brain’s processing of the their information. You did not mention visual issues, but treating these symptoms often involve also addressing the processing of visual information, with and without head movements.

You may wish to pursue assessments to clarify whether you do have asymmetries in your balance system, namely a vestibular assessment (for the inner ear sensors and their connections with eyes and brain) and a physiotherapy assessment, for the proprioceptive and musculo-skeletal systems. Proper treatment/rehabilitation can then be tailored to your needs. 

The balance system is complex and in fact involves 3 major sensory input systems, all controlled by the brain. The inner ear sensors for balance, eyes and the proprioceptors on the body all send information to the brain. Balance centres receive, analyze and integrate these bits of information and then send orders to the body to readjust according to the movement done in the first place.

When you are dizzy with computer use, it usually means that the balance system is relying more heavily on the visual input. It is not fully reassured by the inner ear sensors telling them you are not moving. You can read more about it here: https://balanceanddizziness.org/do-you-get-headaches-or-motion-sickness-from-playing-computer-games/

Having the weights on you or changing your posture as you walk is increasing the cues coming from the proprioceptive system to the brain. This additional input seems to help you balance.

I would recommend you to have your inner ear sensors tested. It might be that they are working just fine but your centres in the brain are not using their information properly or it might be that your brain is in need of all this additional information (visual and proprioception) because your inner ear sensors are dysfunctional.

Vision is an essential part of the balance system. It works with the inner ear sensors for balance, the proprioceptors (sensation of touch) and the brain to keep us balanced. Any vision problems can negatively affect your balance and should, therefore, be addressed as much as possible. In general, the vision improvement after a successful cataract surgery has a positive impact on balance and quality of life.

It is great that you notice that you are hyperventilating. From that awareness, you can try voluntarily changing your breathing pattern. Slowing down, holding your breath in for at least three seconds improves your oxygenation. Another conscious effort you can make is to breathe deep into your belly. Place your hand on your abdomen and feel it expanding as you breathe in and contract as you breathe out.

The balance system is complex and in fact involves 3 major sensory input systems, all controlled by the brain. The inner ear sensors for balance, eyes and the proprioceptors on the body all send information to the brain. Balance centres receive, analyze and integrate these bits of information and then send orders to the body to readjust according to the movement done in the first place.

When you are dizzy with computer use, it usually means that the balance system is relying more heavily on the visual input. It is not fully reassured by the inner ear sensors telling them you are not moving. You can read more about it here: https://balanceanddizziness.org/do-you-get-headaches-or-motion-sickness-from-playing-computer-games/

Having the weights on you or changing your posture as you walk is increasing the cues coming from the proprioceptive system to the brain. This additional input seems to help you balance.

I would recommend you to have your inner ear sensors tested. It might be that they are working just fine but your centres in the brain are not using their information properly or it might be that your brain is in need of all this additional information (visual and proprioception) because your inner ear sensors are dysfunctional.

It is very common to have dizziness triggered by watching things move, as opposed to moving oneself. Many people feel dizzy in busy visual environments, such as browsing in a crowded grocery store, at busy intersections, or even seeing someone carrying a boldly striped bag. This problem, referred to by British researchers as visual vertigo, is caused by your brain not being able to match up the information coming from your eyes, your inner ear and the proprioception sensors on your joints. When you watch a 3-D movie, your eyes follow things around as if you were actually moving. If your brain is hard-wired to believe your eyes more than your inner ear or body, the message from your eyes will dominate and you’ll feel dizzy.

A treatment for visually-stimulated vertigo consists of watching things in motion. Audiologist Erica Zaia suggests repeatedly watching full-screen versions of the NED Leader (right and left) video clips on YouTube. When you get the feeling that you want to look away, watch for three to five seconds longer. Becoming accustomed to doing the tai chi “cloud hands” movement follows the same principle; it habituates your brain to the movement of your hands.

Below are some optokinetic videos.

• https://www.youtube.com/watch?v=iwm4acc3wRc&t=13s
• https://www.youtube.com/watch?v=-7DqDnBNmfY

Once you are used to these, try this one:

• https://www.youtube.com/watch?v=YWaGzTFRlWg

The following playlists compile complex exercises:

• https://www.youtube.com/channel/UCwDX4UUxFH7BZhs2gFYw6oA/playlists