Dr. Steven M. Doetti, AuD, CCC-A

As an audiologist, I frequently have conversations with patients about symptoms of dizziness, imbalance, and vertigo. I typically begin the conversation by asking them to describe their dizziness. Often I hear, “well, I am X years old, so it’s normal be dizzy” or “isn’t it normal to have a little dizziness at my age?”

The most important thing to know about dizziness is that, while it is true that as we age, we often experience a change in our overall balance function, it is never normal to experience dizziness, vertigo or imbalance with falls, and it is not something we should learn to live with as we age.

If a person is experiencing dizziness, vertigo and/or imbalance with falls, there is likely an underlying condition. This not only needs to be evaluated and diagnosed, but also treated and managed. The good news is there are several common causes of dizziness, vertigo and imbalance that are easily identifiable and treated.

Inner ear problems represent the clear majority of all cases of reported dizziness and vertigo. In fact, a specific inner ear problem called Benign Paroxysmal Positional Vertigo, or BPPV, is the most common cause of dizziness and vertigo in adults.

BPPV most often presents with a sudden onset of dizziness, vertigo or imbalance that occurs when getting out of bed, rolling over in bed, lying down in bed, looking up, bending over, or with a quick turn of the head. The symptoms can be true spinning vertigo, light headed-ness, imbalance, blurry vision and/or other dizziness-related symptoms that last for seconds to minutes. An overall constant feeling of imbalance may also be present. The majority of cases of BPPV are spontaneous with no obvious precipitating event; however, BPPV can also occur after surgery, illnesses, head injuries (even slight head bumps) and falls.

BPPV is a benign mechanical dysfunction of the inner ear. One of the roles of the inner ear is to constantly measure gravitational forces and head position to allow the body to coordinate movements. One way in which the ear accomplishes this is with microscopic crystals. These crystals, called otoconia, are embedded in a gel-like membrane and move in response to gravity and head motion.

In BPPV, these crystals become dislodged from the membrane and are free floating in the inner ear, which wreaks havoc on the overall balance system, especially when you are moving your head. BPPV can be debilitating in severe cases, but even in mild cases, it can result in disruption of activities and an increased risk of falls.


Dizziness is often treatable. Although BPPV can spontaneously recover, just as it spontaneously occurs, it can last for weeks, months, or even years, and can reoccur multiple times over a lifetime. Additionally, there is simply no reason to wait for BPPV to recover. BPPV is easily identifiable by well-trained health care providers. There are simple tests, which confirm the presence of the free-floating crystals and their position within the inner ear.

Once the presence of the free-floating crystals and their location is confirmed, the treatment is a simple as maneuvering the person’s head to put the crystals back where they belong. In most cases, the symptoms of BPPV can be completely relieved in one treatment session.

It is important find a health care provider who is well trained and has experience in treating dizziness and inner ear dysfunction. These professionals often are audiologists, physical therapists, primary care physicians or otolaryngologists. However, not all of these providers will have the training and experience necessary to identify and treat these problems. Ask your providers if they have experience with dizziness and inner ear problems, or if they know other providers in the area who do.

Steven M. Doettl, AuD, CCC-A, is an audiologist, associate professor, and coordinator of the Dizziness Clinic in the Department of Audiology and Speech Pathology in the College of Health Professions at the University of Tennessee Health Science Center. The department is located on the campus of the University of Tennessee in Knoxville, offering graduate education in audiology and speech-language pathology and emphasizing excellence in clinical practice and advanced research.

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