125 E. De La Guerra St. Ste. 203
Santa Barbara, CA 93101
9675 Brighton Way, Ste 418
Beverly Hills, CA 90210
Vertigo, or dizziness, affects millions of people around the world each year.
Vertigo occurs when the vestibular system is over-activated. This can happen from a number of things such as whiplash, infection, or a common condition known as BPPV. Another form of dizziness is lightheadedness. This happens from an area that is dysfunctional in the lower brainstem. This is different cause from vertigo and has to be addressed totally differently than if you have a vestibular problem.
Removing the cause is extremely important, but sometimes this doesn't take care of all the issues. The brain can actually become accustom to the extra stimulation, which leaves you with a feeling of unsteadiness or imbalance.
Once your medical doctor has ruled out more serious conditions (such as vestibular neuronitis, labyrinthitis or fistulas), your dizziness/vertigo could be caused by the cerebellum or brain stem. There is something going on functionally with the way the brain interprets where you are in space. We will evaluate this and employ appropriate treatments.
In many cases, the area of dysfunction in the nervous system is the cerebellum. The cerebellum controls our coordinated movements. There are specific neurological tests that we will utilize to determine cerebellar function. For instance, Romberg's, finger-to-nose and rapid alternating movement tests. These tests, and others, are used to determine the function of the cerebellum. Our goal is to use those tests to find out what we need to do to correct those symptoms.
The brain stem is the integration point between the vestibular system and cerebellum. It controls many things, including heart rate, blood pressure, postural muscles, helps coordinate eye movements and intrinsic spinal muscles.
The vestibular system is a series of little canals in your ear that tell your brain when your head moves.
The cerebellum and brain stem work together to adapt to over-activation or under-activation by the vestibular system. When these systems are damaged or not working properly, the result is a miserable feeling of spinning, light-headedness and/or nausea. This functional dizziness/vertigo is what our doctors specializes in treating. They are very knowledgeable about all types of dizziness, whether acute or chronic, and can treat and correct a myriad of dizziness symptoms.
What is BPPV?
In Benign Paroxysmal Positional Vertigo (BPPV), the little crystals (also referred to as "rocks" or "debris") in the ears overstimulate the canals of the vestibular system, so it thinks you're moving when you're not moving. Therefore, your brain stem and cerebellum have to adapt their function, so you don't feel like you are constantly dizzy. This is why you know you're not spinning, even though you feel like you are. Your eyes can see that you are stationary, but your vestibular system is telling your brain that you're spinning. This improper communication to the brain is what we evaluate and treat.
BPPV is a very common form of vertigo. It is most commonly found in the posterior canals, and can be helped with things like the Epley Maneuver. However, you can also get BPPV in the horizontal or anterior canals, which can cause similar symptoms. We will test for which canal is affected and can help using other maneuvers specific to the canals affected. This additional knowledge about vertigo and the other canals is very rarely known by most doctors, and is why we are so well known for helping so many "rare" vertigo cases.
For example, you may feel like you are constantly moving to the right, but you're not. Therefore, the cerebellum has to downplay how much it uses the input coming from the vestibular system. This overstimulation changes the way your brain works, and can cause chronic neck tightness, dizziness, balance issues, improper coordination, headaches, nausea, etc. If the cerebellum didn't make those adaptations, it would take years to recover, if ever. So the quicker you get dizziness/vertigo treated, the less adaptation takes place in the cerebellum. Therefore, the easier dizziness is to correct. However, even if you've had vertigo for years, our doctors also know how to correct the brain adaptation as well as the vertigo.
When we do your initial examination, we will perform several vestibular and neurological tests to pinpoint what is causing the breakdown that allows your dizziness to occur. Additional testing such as balance and postural analysis, peripheral vision awareness testing and/or vestibular testing may be performed as well. Treatments can include repositioning maneuvers, brain rehabilitation, customized vestibular rehabilitation, eye movement therapy, neuromuscular rehabilitation, non-invasive peripheral nerve stimulation, high-frequency vibratory therapy, and/or various manual therapies. We will also teach you any necessary at-home neurological therapies. Many times we will even teach a spouse or close friend/family member a few simple positioning maneuvers you can have handy in case you have a flare-up during non-office hours or travel. Our doctors are extremely caring and thorough and our goal is to get you back to feeling normally as quickly as possible.
Tinnitus, or Ringing in the Ears
Some patients also experience tinnitus with their dizziness. The reason for this is is that the nerve that transmits vestibular inputs (the Vestibular Cochlear Nerve) also transmits the information from the Cochlea, or auditory input, to the brain. Therefore it is common to have dizziness disrders that involve hearing in some way. We have a variety of therapies for this and will customize them based on the case.
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