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Vertigo and dizziness are debilitating conditions that can render people incapacitated and hopeless. If you don’t know what’s causing these symptoms, it can be quite scary to have an attack. Our patients describe their symptoms as feeling off-balance, unsteady, lightheaded, room spinning, they are spinning, being pushed, on a rollercoaster ride or rocking on a boat.

Vertigo is typically a perception of spinning that is caused by dysfunction of the vestibular system. The vestibular system is located in the inner ear and includes the vestibular apparatus and vestibular nerves that travel to corresponding areas of the brain. The vestibular system integrates into many areas of the nervous system, including the brainstem, cerebellum and cortex. A miscommunication between the vestibular system and these areas may give the illusion of movement or sensitivity to movement. If the condition persists without being corrected, the brain may develop compensations, such as using reflexive head and eye movements, to get a better sense of where it believes you are in space. Causes of different types of vertigo and dizziness vary drastically and comprehensive neurological testing is required to pinpoint the origin of dysfunction.

One of the most common causes of vertigo is Benign Paroxysmal Positional Vertigo (BPPV). The inner ear consists of two receptor systems: the semicircular canals and otoliths. These systems require specialized receptors to detect movement, such as tilting the head or riding up/down in an elevator. The semicircular canals are tubes filled with viscous fluid & hair cells with small calcium crystals, known as otoconia. When the fluid deflects the hair cells located inside of the canals, such as when you look left or right, your brain receives a signal that your head is rotating.  In the case of BPPV, these crystals become dislodged from hair cells and float freely in the semicircular canals, giving the perception of movement even when you are still. This sensory mismatch can be very disorienting. Though it is not directly life threatening, many patients can experience a sudden spell of vertigo without warning, such as when driving. 

BPPV can be simple to fix with a very specific sequence of head movements called repositioning maneuvers. These maneuvers allow the otoconia to exit through the semicircular canal, to a chamber known as the utricle, where there are no hair cells to cause this sensory mismatch. Some cases require multiple repositioning maneuvers to clear one canal or multiple maneuvers to clear multiple canals. 

Our approach to vertigo/dizziness symptoms begins with a comprehensive neurological exam to determine the cause. At Oculus Brain Centers, we use advanced eye tracking technology called Video Oculography to determine which canals, if any, have free-floating otoconia in them. This equipment can tell us with much greater certainty when a canal is affected and if the crystals have been cleared.

In the next blog post, we will explore other common causes of vertigo, including Meniere’s disease, Mal De Debarquement Syndrome, Postural Orthostatic Hypotension (POTS), and Vestibular Migraines.

Dr. Benjamin Terrano DC, DACNB, CCEP

Dr. Benjamin Terrano DC, DACNB, CCEP

Dr. Terrano, born and raised in California, specializes in post-concussion syndrome, movement disorders, chronic pain and athletic performance.

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