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.
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.
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.