Dizziness and vertigo series: Part 1 of 2
Most people have experienced the feeling of dizziness at some point in their life. Whether in your childhood after spinning on the merry-go-round, being on a boat in rough water (seasickness), or perhaps when taking a new medication.
It’s important to understand a brief dizzy sensation caused by actual movement is normal but random bouts of dizziness unprovoked can be a condition called vertigo, which is dizziness to an extreme degree.
Dr. Brooke Pearce, a vestibular health expert and co-founder of The Dizzy and Vertigo Institute of Los Angeles, says “dizziness is an umbrella term to describe different sensations of movement. Vertigo is not a separate illness, but rather a symptom that occurs with different health conditions. It often comes along with other related symptoms, like nausea or vomiting.”
“Dizziness is a huge umbrella term,” she said. It can include:
- Vertigo (the spinning sensation)
- Imbalance
- Steadiness
- Disequilibrium
- Visual disturbance, to name a few
“Think of the vestibular system as the GPS of the body,” said Pearce. The inner workings are fascinating. The ear “houses 10 end organs (5 on each side). The brain takes in these signals and cross checks them with the additional information coming in from the muscles and eyes.”
Overall, “Think of [your] balance system as a tripod.” The brain is constantly cross-checking data from “the muscle input, vision input, and ears input.”
Your ear has a hearing part and a balance part. “The vestibular system (our personal GPS) takes in information and tells us where we are in space,” she said.
Two primary reflexes act as our delivery drivers with this information:
- Shoulders up: vestibular ocular reflex (brain taking in information from ears & eyes);
- Shoulders down: vestibular spinal reflex (brain taking in information from the ears & muscles).
“The problem a lot of times is if the ear is not doing its job, it is essentially at the core of both of those reflexes.” This is the time to seek guidance from a physician. 
Some patients may be quite familiar with the problems that ensue. “Your system starts to reweight information if the ear signals become unreliable. A lot of people become over reliant on the visual system and this is not sustainable because our world is very busy. You can become sensitive and so hyper-reactive to stimuli when the ear is not able to crosscheck the input. It becomes difficult to tolerate reading, scroll on your phone, drive in the car, or go to the grocery store,” she said.
You can also become physically over-reliant too, meaning the person is “holding onto things as the brain is needing that secondary response from the muscles. A good example of this would be at night in the dark when you get up to use the bathroom. At that point holding onto walls or furniture helps your brain get the physical input it needs if the ears and eyes are not reliable”.
The experience people go through, symptoms and life altering journey is subjective. “In the clinic we objectively use a lot of different metrics to get a scale of symptom reaction and severity of symptoms. It helps paint the entire picture. It’s important patients feel heard and understood. Having data validates the subjective experiences and assists in the diagnostic process”. You know how you feel. It is valid.
“Majority of the time the (vertigo) sensation is originating from the inner ear,” Pearce said.
Understanding the vestibular system is key. “When you view the vestibular system as the GPS of the body and your GPS is thrown off, the severity that can occur is very intense.”
Patients who experience BPPV (benign paroxysmal positional vertigo) know it is “really intense; it feels like a firework … a big bang sensation. It lasts for a few seconds, up to about a minute or so, and then it all calms down again,” Pearce said.
Dizziness can easily impact us both physically and emotionally.
- “The physicality of what’s occurring or the sensation that they are getting physically is very disturbing.”
- “The way the autonomic nervous system will respond is really intense.” We all know the fight vs. flight feeling!
If you are experiencing dizziness, see a doctor so they can “rule out conditions that are life-threatening or that need to be medically managed,” she said. There are many, many things that can be causing a person to be dizzy, that’s why appropriate diagnostic procedures are very important.
Types of tests performed
Starting with your physician, to rule out “any scary-bad concerns” is important. It is not usual for doctors to want to run a MRI, CT scan, EKG or draw blood for lab tests in order to rule out major concerns that could be occurring.
The goal in Pearce’s office is to get to the root of any inner ear involvement through “offering comprehensive diagnostic tools to look at the ear – and to definitively rule in or out the ear” as being the issue.
Her practice is comprehensive, sophisticated (diagnostics physically and in software), research-backed, and personalized to each patient. For those outside of the Los Angeles area, video-based telehealth services are available.
“Each patient needs a very different battery of tests” and that determination “has to be specific to that patient’s symptoms” she said.
Whether these symptoms have presented in your past, present, or social circles – it is good to be aware of its complexities, where to turn, and available options to minimize its negative impact on your life. The future is brighter when we open up to learning more about our health.
If you have a health related question that I can ask an expert, submit it here.
Dr. Pearce has a strong research background and is focused on being on the cutting-edge of vestibular assessments and treatments.
Watch for more from Dr. Brooke Pearce in, “Can medication make you dizzy?”
This website does not provide medical advice. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. It is for informational purposes only. Always seek the advice of a medical professional or other qualified health care provider on any health matter or question.