Can Virtual Reality (VR) cause vertigo or tinnitus?

Virtual Reality Can Cause Vertigo and Other Vestibular Symptoms

Yes, virtual reality (VR) can cause vertigo and related vestibular symptoms, including tinnitus in some cases. This phenomenon is often referred to as "cybersickness" and is a well-documented side effect of VR use 1, 2.

Mechanisms and Prevalence of VR-Related Vestibular Symptoms

• Studies show that 61% of VR users report symptoms of malaise during or after immersion, including dizziness, stomach awareness, headaches, eyestrain, and lightheadedness 2
• These symptoms can be severe enough to cause approximately 5% of users to discontinue VR use before completing a 20-minute session 2
• Disorientation is the most commonly reported symptom, followed by nausea and oculomotor disturbances 1

Why VR Causes Vestibular Symptoms

The primary mechanism behind VR-induced vertigo is sensory conflict:

• VR creates a visual perception of movement while the vestibular system detects no actual physical motion 3
• This sensory mismatch can lead to down-weighting of vestibular cues, altering how the brain processes vestibular information 3
• Research shows that even brief exposure to vection (illusory self-motion) in VR can modulate vestibular processing, as evidenced by changes in vestibular-evoked myogenic potentials (VEMPs) 3

Risk Factors and Susceptibility

Head-mounted displays are associated with more frequent side effects compared to desktop VR systems 1. Individual susceptibility varies based on:

• Age
• History of motion sickness
• Pre-existing vestibular disorders
• Duration of VR exposure

VR and Tinnitus

• While VR can potentially trigger tinnitus in susceptible individuals, it has also paradoxically been studied as a treatment for chronic tinnitus 4
• A clinical trial using VR-based interventions for chronic tinnitus showed improvement in Tinnitus Handicap Inventory scores and sleep quality after 6-8 weeks of treatment 4

Clinical Implications

For patients experiencing VR-induced vertigo or tinnitus:

1. Discontinue VR use immediately when symptoms appear
2. Avoid vestibular suppressant medications such as antihistamines and benzodiazepines as they can interfere with central compensation and delay recovery 5
3. Consider vestibular rehabilitation therapy (VRT) for persistent symptoms, which may include:
   • Gaze stability exercises
   • Balance and postural stability training
   • Habituation exercises
   • Substitution training 5

Prevention Strategies

To minimize the risk of VR-induced vertigo and tinnitus:

• Start with shorter VR sessions (5-10 minutes) and gradually increase duration
• Use VR systems with higher refresh rates and lower latency
• Take frequent breaks during VR use
• Ensure proper positioning and calibration of VR equipment
• Consider using VR in a seated position initially

Special Considerations

For patients with pre-existing vestibular disorders:

• VR exposure should be approached with caution
• VR can potentially be used therapeutically for visual vertigo symptoms under professional supervision 6
• Patients with active Ménière's disease should avoid VR during acute vertigo attacks 7

VR technology continues to evolve, but the potential for vestibular side effects remains an important clinical consideration for users and healthcare providers alike.