From the Guidelines
Vestibular dysfunction typically presents with vertigo, dizziness, imbalance, and difficulty walking, often accompanied by nausea, vomiting, and visual disturbances, as noted in the 2020 clinical practice guideline on Ménière's disease 1. The signs and symptoms of vestibular dysfunction can vary depending on the underlying cause, but common symptoms include:
- Vertigo, which is a spinning sensation, often described as a false sensation of self-motion or a false sensation that the visual surroundings are spinning or flowing 1
- Dizziness, which is a sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion, as defined by the Barany Society 1
- Imbalance and difficulty walking, which can increase the risk of falls and injuries
- Nausea and vomiting, especially during vertigo episodes
- Visual disturbances, including blurred vision, difficulty focusing, and nystagmus (involuntary eye movements)
- Spatial disorientation, feeling unsteady or floating, and trouble determining position in relation to gravity
- Hearing changes, such as tinnitus (ringing in the ears) or hearing loss, particularly in conditions like Ménière's disease
- Cognitive effects, such as brain fog, difficulty concentrating, and memory problems, due to the brain's increased effort to maintain balance These symptoms can worsen with head movements, in busy visual environments, or when changing positions, and can significantly impact a person's quality of life, as noted in the 2017 clinical practice guideline on benign paroxysmal positional vertigo (BPPV) 1. It is essential to evaluate patients with suspected vestibular dysfunction for other potential causes of vertigo and dizziness, including neurologic, otologic, oncologic, inflammatory, or infectious causes, and to consider the clinical presentation, differentiation, and distinguishing features of various conditions, as outlined in Table 5 of the 2020 guideline on Ménière's disease 1.
From the Research
Signs and Symptoms of Vestibular Dysfunction
The signs and symptoms of vestibular dysfunction can be characterized by a combination of phenomena involving:
- Perceptual manifestations
- Ocular motor manifestations
- Postural manifestations
- Autonomic manifestations Specific symptoms include:
- Vertigo/dizziness
- Nystagmus
- Ataxia
- Nausea These manifestations correlate with different aspects of vestibular function and emanate from different sites within the central nervous system 2.
Classification of Vestibular Dysfunction
Vestibular syndromes can be categorized into 9 categories, including:
- Dizziness and lightheadedness
- Single or recurrent attacks of vertigo
- Sustained vertigo
- Positional/positioning vertigo
- Oscillopsia
- Vertigo associated with auditory dysfunction
- Vertigo associated with brainstem or cerebellar symptoms
- Vertigo associated with headache
- Dizziness or to-and-fro vertigo with postural imbalance A careful and systematic neuro-ophthalmological and neuro-otological examination is necessary to differentiate between central and peripheral vestibular disorders 2.
Diagnosis and Treatment
Diagnosis of vestibular dysfunction can be established through a combination of clinical history, diagnostic maneuvers, and laboratory examinations 2, 3, 4. Treatment options include vestibular rehabilitation, canalith repositioning procedure, and surgical intervention for intractable cases 5, 3, 6. Vestibular rehabilitation can improve balance control, promote visual stabilization, and reduce the unpleasantness of vertigo symptoms 5.