The Cause of Dizziness is Often Misdiagnosed

The Vestibular Disorders Association (VEDA) surveyed of hundreds of people suffering with a vestibular disorder and the results were published in the journal Otology & Neurotology in 2016. The results are as we would have predicted based on reported patient experiences prior to their initial visit to BalanceMD and are in keeping with many blogs and newsletter articles we have written on this subject over the past decade.

The purpose of the survey was to collect information on vestibular patients’ experiences with healthcare providers as they searched for answers to their problems – what they were told was causing their symptoms and what treatments they were given.

Some findings from the study are as follows:

Meniere’s disease was the top diagnosis given – 25% of those in the survey reported being diagnosed with Meniere’s disease. We know that Meniere’s actually represents a very small portion of vestibular disorder patients, less than 5%. On the other hand, only 18% of those in the study received the diagnosis of vestibular migraine, while nearly 50% actually have migraine as the underlying cause of their symptoms. Most experts place the Migraine:Meniere’s ratio 20-30:1. This highlights the popularity of the Meniere’s diagnosis and the under recognition of vestibular migraine.  Take home point: Meniere’s disease is a relatively rare condition and causes a specific type of hearing loss. Most who have been diagnosed with Meniere’s without hearing loss actually have a migraine syndrome as the underlying cause of their dizziness or vertigo spells.

Nearly half reported being treated with canalith repositioning maneuvers (such as the Epley maneuver) for BPPV, but only 15% reported being diagnosed with BPPV. In essence, over 30% of patients underwent an Epley maneuver, but never had BPPV. Take home point: BPPV is commonly over diagnosed. While there is no harm in doing an Epley maneuver, treating for a condition that isn’t present doesn’t work and appropriate treatment is delayed while the Epley maneuver is repeated unsuccessfully over weeks or months. There are several known types of BPPV amenable to immediate cure with a unique canalith repositioning maneuver over 90% of the time.

Close to 9% were diagnosed with bilateral vestibular hypofunction(weakness of both vestibular nerves). The actual number of patients with bilateral vestibular hypofunction is < 1%. The reason for this large discrepancy is that most facilities offering vestibular testing do not have a rotary chair. The diagnosis of “bilateral vestibular hypofunction” likely comes from weak caloric (air blown in the ears to induce nystagmus) responses in both ears. The best way to confirm (or refute) bilaterally weak vestibular nerves is the rotary chair. With bilateral vestibular hypofunction, the rotary chair test will be markedly abnormal. Take home point: Unfortunately, most facilities who perform vestibular testing do not have a rotary chair and will mis-diagnose a significant number of patients they test.

At BalanceMD, we have the knowledge, technologically advanced vestibular system test equipment and experience to accurately diagnose and effectively treat dizziness and vertigo no matter what the cause. Call 888-888-DIZZY (3499) or visit our website for further information.

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