Vestibular Disorders

UT Southwestern Medical Center’s physicians use state-of-the-art resources to diagnose, treat, and manage all types of balance disorders.

Our specialists are recognized experts at identifying the source of each patient’s symptoms and providing effective, compassionate care that restores quality of life. We use a multidisciplinary approach for comprehensive care. 

Optimal Management of Balance Disorders

Vestibular disorders are problems with the vestibular system, which includes the parts of the inner ear and brain that control balance. Common vestibular disorders include:

• Acoustic neuroma
  
• Barotrauma
  
• Benign paroxysmal positional vertigo (BPPV)
  
• Inner ear malformations
  
• Labyrinthitis or vestibular neuritis
  
• Mal de débarquement
  
• Ménière’s disease
  
• Migraine-associated dizziness
  
• Orthostatic hypotension
  
• Ototoxicity
  
• Perilymph fistula
  
• Superior canal dehiscence syndrome
  

Vestibular dysfunction can also be the result of complications from aging, autoimmune disorders, and allergies.

Physicians at UT Southwestern Medical Center are recognized experts in the diagnosis, treatment, and ongoing management of all types of balance disorders. We use a team approach to treating patients with vestibular disorders. By combin­ing the expertise of multiple specialties, surgical outcomes are greatly improved.

Symptoms of Balance Disorders

Patients with vestibular disorders might experience symptoms such as:

• Anxiety
  
• Cognitive or psychological changes
  
• Depression
  
• Hearing changes
  
• Imbalance
  
• Ringing in the ears
  
• Spatial disorientation
  
• Vertigo and dizziness
  
• Vision disturbance
  

Evaluation

We have a state-of-the-art vestibular testing center that includes:

• Videonystagmography (VNG)
  
• Rotatory chair testing
  
• Vestibular-evoked myogenic potential testing (VEMP)
  
• Video head impulse testing (vHIT)
  
• Electrocochleography (ECoG)
  
• Platform testing
  

We might also order imaging such as a computed tomography (CT) scan or MRI scan.

Treatment for Vestibular Disorders

At UT Southwestern, a team of doctors trained in balance disorders works with each patient to develop an individualized treatment plan based on that person’s specific condition. Patients might be seen by specialists in ear, nose, and throat conditions (otolaryngologists), brain and nervous system conditions (neurologists), and other disciplines.

A patient’s treatment plan might include one or a combination of the following:

• Diet and lifestyle changes: For patients with Ménière’s disease, reducing salt intake can help symptoms. Some people with migraine-related dizziness might also benefit by reducing caffeine, alcohol, nicotine, and chocolate. Patients who experience drops in blood pressure when standing (orthostatic hypotension) might need to drink more fluids, wear compressive stockings, or undergo postural conditioning.
  
• Fall prevention: Therapists can work with patients to help them prevent falls. Some people might benefit from a balance aid, such as a walking stick or cane. Therapists can also discuss home safety and assistive devices to help reduce the risk of falls in the home.
  
• Home exercise: Exercise is often a vital part of treatment. A physical or occupational therapist can prescribe specialized exercises to be performed at a certain pace, along with a progressive fitness program to increase energy and reduce stress.
  
• Medications: For patients with Ménière’s disease, migrainous vertigo, or psychiatric disorders, medications can help manage balance problems.
  
• Surgery: When medical treatment isn't effective in controlling vertigo and other symptoms caused by vestibular system dysfunction, surgery might be an option. Surgical procedures for peripheral vestibular disorders are either corrective or destructive. The goal of corrective surgery is to repair or stabilize inner ear function. The goal of destructive surgery is to stop the production of sensory information or prevent its transmission from the inner ear to the brain. For patients who have Ménière's disease or acoustic neuroma, the treatment team might recommend surgery. Stereotactic radiosurgery can be an option for some people with acoustic neuroma. This procedure delivers radiation precisely to the tumor and doesn’t require an incision.
• Talk therapy: Symptoms from vestibular disorders are invisible and unpredictable, and they often contribute to a wide range of psychological impacts. Patients might benefit from counseling to cope with lifestyle changes, depression, guilt, and grief that comes from no longer being able to meet their own or others’ expectations.
  
• Vestibular rehabilitation therapy (VRT): People with inner ear or central nervous system disorders might benefit from balance retraining exercises, also called vestibular rehabilitation. Therapists trained in improving balance problems work with patients to design a customized program of balance retraining and exercises. Therapy can help compensate for imbalance, adapt to less balance, and maintain physical activity.
  

               - Canalith repositioning maneuvers: A specialized form of VRT is available to treat benign paroxysmal positional vertigo, or BPPV. This treatment, often referred to as the Epley maneuver, involves a series of specifically patterned head and trunk movements to move tiny displaced otoliths to a place in the inner ear where they can’t cause symptoms.

              - Positioning procedure: If the cause of balance problems is benign paroxysmal positional vertigo (BPPV), a therapist can conduct a positioning procedure, which involves maneuvering the position of the head. This procedure clears particles from the inner ear canal and deposits them into a different area of the ear, often reducing or resolving symptoms. The Canalith repositioning procedure can also help improve the condition.