Health providers that might specialize in BPPV include physical therapists, occupational therapists, physicians, physician’s assistants, or audiologists. Those are the top professions that might choose to specialize in vestibular problems, but most healthcare providers in general are not comfortable with detailed evaluation to determine the root cause of dizziness or vertigo. Instead medications are commonly prescribed for symptom relief.
Below is a possible explanation of why it is so unusual to find a physician who is competent to assess and treat BPPV, which is the most common vestibular disorder.
In order for a doctor to become a neurologist or an ear, nose, and throat doctor (ENT), the individual has to go through years of medical school after college and then specialize in either neurology or ear, nose, and throat, which require extra years of specialty training.
Beyond that, the vestibular specialty is considered a “sub-specialty” within both Neurology and ENT medical practice, which means that these individuals would require additional sub-specialty training to become experts in assessing and treating vestibular problems.
Not all neurologists are comfortable assessing the vestibular system. Typically the neurologist would have to be trained as a sub-specialist called an “otoneurologist,” which means an inner ear neurologist.
Not all ENTs are comfortable assessing the vestibular system. The ENT doctor would have to be trained as a sub-specialist called a “neurotologist,” which means a neurological ear, nose, and throat doctor.
You can see why, within medicine, there are so many providers that do not have the skillset of how to evaluate and treat vestibular problems. This is because it is literally a specialty within a specialty for doctors and a lot of patients never get past their primary care doctor to the correct type of sub-specialist.
A lot of times, a patient will go to their primary care doctor and say “I’m dizzy.” The primary care doctor will do some testing evaluate and screen out the most serious causes, like send the patient for an MRI to make sure they didn’t have a stroke and send them to cardiac testing to make sure they didn’t have a heart attack. However, usually a primary care doctor does not know how to do a comprehensive physical exam for root cause of dizziness.
Once the primary care doctor determines that there is no serious life-threatening issue going on, they may prescribe medication that reduces the uncomfortable symptoms of dizziness or vertigo, but does not address or resolve the underlying cause of the problem.
Even if the primary care doctor makes a referral to neurology or ENT for further evaluation, it still may not be extremely helpful unless that provider has a sub-specialty in vestibular health problems.
So, in a nutshell, the reason why your doctor may not know you have a vestibular problem is because most doctors do not specialize in this highly specific field. It may be wise to do a root cause evaluation with an experienced vestibular doctor to evaluate and address any vestibular problems.
To find a vertigo doctor in your area, click here.
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
I can’t find a ENT Dr. or PTD or anyone who can tell me anything about my vestibular problems and why it happened and got worse, and worse over the years! I have tinnitus now as well as No vestibular function in either ear. Know one can tell me why or what I can do except to do balance training again. That’s it. Now how, why, or anything, and the tinnitus is so bad it’s driving me insane!!
I am sorry to hear about how difficult this is for you!
I definitely would suggest trying to find an Oto-Neurologist or Neuro-Otologist, and a Vestibular expert physical therapist, to help you understand what is going on and to coach you through this difficult time.
Vestibular damage can be a result of certain medications that cause bilateral vestibular loss, and tinnitus can also be a medication side effect. That might be worth exploring with your medical care team.
Some examples of other conditions that cause vestibular problems to get worse and worse over the years include diabetes, high blood pressure, high cholesterol, unchecked viral activity, and auto-immune problems, to name a few.
I have some information on tinnitus in this blog.
Some people need mental health support to deal with the type of chronic issues you described.
It is not a sign of weakness to seek mental and emotional support to deal with the stress of having these chronic problems. A social worker or licensed therapist may be able to help you cope with the stress you are under.
If you are able to make the trip to California to work with me in person, I would be happy to work with you.
I wish you all the best!
Kim Bell, DPT
Kathy may have Meniere’s Disease in both of her ears. I have it in my right ear. My tinnitus is not too bad yet, but this is a progressive disease, and she just may have had it longer than I. I haven’t found any specialist either as they are really scant in my area. Start with a basic ENT, and good luck.
I have been dealing with this problem for several years now, and have followed up with many different doctors, including Neurologist, brain scans, physical therapy, and still no diagnosis, and it seems to be getting worse! I try to hide my walking from people, so as they don’t think I’m drinking. I will continue to seek for help.
I have constant vertigo and dizziness I went to the neurologist and he said that there is no big problem in your brain and gave me temporary pill for vertigo so you can tell me where should i go for my dizziness plz prefer a doctor
That is good news to learn that there is no big problem in your brain!
I suggest you search for a vestibular physical therapist in your area.
You can use this blog to search for a provider.
This blog has home remedies that may help.
Kim Bell, DPT
Dear Dr Kim Bell,
I suffered vertigo 3.5 months, and having gone to PCP, ENT and neurologist was futile.
Online research then show it to go to a physical therapy for vestibular rehab, which finally helped.
I want to tell you that your excellent video from UC finally popped up after I stopped searching for the word vertigo on google.
Thank you for posting your YouTube lecture out there it’s very helpful to understand it.