Vestibular Conditions

Common Dizziness/Tinnitus Conditions: Learn about it!

What is my diagnosis?

I work with many vestibular, autoimmune and neurological conditions. Here is a list of some common conditions that my ROCK STEADY clients experience. You may or may not yet have a diagnosis and that is fine. I recommend that you seek medical clearance from your doctor and hold your diagnosis lightly. Our research showed that participants symptoms improved regardless of their diagnosis, age, gender and time since onset of symptoms.

What is vertigo and tinnitus?

Vertigo is a sensation of movement (or ‘dizziness’) unrelated to the external environment. It can be worse with sudden head movements due the inner ear and brain signals getting confused; or it may be worse while still because the brain has not yet created new steadiness templates at rest.

Tinnitus is a sound that we hear within our ears, head or body that is also unrelated to the external environment. You can watch my Tinnitus Channel on YouTube to learn more!

Both vertigo and tinnitus are reversible with neuroplasticity. You can support your brain to change how it processes these vertigo or tinnitus ‘error signals’ and you can rebuild new normal neural pathways that feel normal again. (I discuss this in detail in my book!)

In our community around 49% of people report tinnitus, 51% report a vestibular condition without tinnitus, 28% of people report both symptoms of vertigo and tinnitus, and 21% of people report only tinnitus.

Read the article: ‘5 Common Misunderstandings About Vertigo’ here.

Persistent Postural Perceptual Dizziness (PPPD)
Listen to the audio here

Key points: This is a condition with persistent sensations of dizziness inside the body (rocking, swaying, unsteadiness or uneasiness) that last for longer than 3-months. There is no nystagmus (eye-flickering) as seen in classical vertigo, but rather the dizziness can be described as in the head or whole body. People often report sensitivity to visual stimuli (crowds, computers). It may be worse when standing or sitting upright and can be exacerbated by head movements. PPPD is often non-responsive to physiotherapy or generic treatment for vertigo. It may be preceded by an acute vestibular incident such as BPPV or an ear infection but not always. PPPD clients express a debilitating concern and a strong self-judgment toward any dizziness or NQR sensations

What is it?

PPPD is a form of chronic dizziness that is not explained by injury to the inner ears. With this condition all medical test results can be normal. This can feel very frustrating when you feel ‘abnormal’ but it can’t be explained through the investigation process. Many people are told misleading comments like it’s all in your head. Yet this is a complex condition and a simple statement like that doesn’t help anyone to heal.

For PPPD there is no evidence of any physical damage to the brain or inner ear, so the diagnostic process is one of ruling out other conditions. Doctors will first investigate for Meniere’s, infections, migraines or BPPV etc.

In many cases, PPPD is triggered by an initial incident of true vertigo (with BPPV for example). However, once this initial vertigo is resolved the persistent dizziness remains. It is as the brain filters can’t reset and return to normal after the initial shock.

People with this condition describe their symptoms as persistent (present at least 50% of the time) or constant, 24/7 dizziness. It is upsetting for them and they feel uncomfortable on a daily basis. Some people will begin to avoid daily activities such as driving or housework because they feel so unsafe inside of their body. This truly is an invisible and debilitating condition if it goes unrecognised or undiagnosed. I have met many clients who felt like they were going crazy given that nobody could describe or explain their condition to them. This is very common for anyone with PPPD.

The PPPD form of dizziness may temporarily disappear while performing an engaging task or becoming focused elsewhere. However, when returning to normal tasks or stillness, the persistent dizziness sensations return. This phenomena is described as being context dependent. The dizziness is like a constant background fuzz that when noticed is ever-present and distressing. At worst, it can lead to avoidance behaviours, isolation and an ongoing cycle of maladaptive behaviours that reinforce the dizziness.

This condition and its diagnostic process can feel debilitating, frustrating and disappointing. Clients often report waking up in the morning with dread asking themselves: Is the dizziness still there? Has it gone yet? Am I still dizzy today? They describe living in fear of their symptoms and feelings of being a failure. Why aren’t I better? How come other people can recover but I can’t? The doctors and physiotherapists said I should be over it by now- what is wrong with me? These thoughts reflect a belief as though they have somehow failed at being normal. This is of course untrue and a total misunderstanding. PPPD is infact a series of normal misunderstandings between the ears, spinal chord, eyes and brain. The signals have been mislead and misfired. It is all reversible.

For this condition there is a strong link with anxiety and a subconscious underlying fear of the dizziness itself. The body sensations are perceived with a ‘fright’. The brain then responds with its normal and natural anxiety response exacerbating symptoms resulting in a loop of feeling dizzy-anxious-dizzy. The fear of dizziness and associated anxiety is quite natural and not psychiatric condition. Almost everyone who feels dizzy experiences the associated shock and anxiety. It is appropriate anxiety within the circumstances. However, if left unmanaged it can delay the natural recovery process as anxiety inhibits neuroplasticity. Overtime it can lead to increased anxiety and avoidance behaviours that perpetuate the PPPD condition.

For some of you reading this might be thinking ‘this is me! This is what I feel’. Gaining this knowledge and understanding about your body and the PPPD diagnosis can be very useful for helping you to move toward your healing. Sometimes we are handicapped by the diagnostic search for understanding and validation. This can impeded us from actually starting our daily neuroplasticity practice. So I urge you to get the best diagnosis you can, get medical clearance, and start to focus on your daily program. Start healing. Start retraining your brain to feel normal again. You will need to learn how to self-soothe the natural anxiety mechanisms and use neuroplasticity to reset normal sensations. It is likely that you have some strong belief systems that are subconsciously impacting your neural settings and these will need to be updated too. Your old beliefs can keep you stuck in the PPPD cycle. The emotional and ‘spiritual’ layers of healing are essential for preventing relapse of PPPD. By spiritual I refer to your capacity to believe in yourself and to have faith in your body (this is not at all related to religion).

Many clients are prescribed medications for depression and anxiety during the diagnosis process. Some people never receive a diagnosis at all. It is important that you listen to your body and work with medical professionals who you trust. You need to feel safe and able to move on from your uncertainty. If you are always chasing a diagnosis, you may never heal. In order to heal, you need medical clearance- not an exact understanding of your symptoms or diagnosis. For some people they never fully understand their diagnosis or symptoms. But they still learn how to heal it.

In summary, people with PPPD are feeling dizziness sensations (that may have started spontaneously with an ear infection for example) but the dizziness never resolves. This creates a normal emotional response of anxiety that impedes the neural repair process. So the initial dizziness resolves (the ear infection heals) but the remaining neural signals for dizziness sensations continue to fire. This results in persistent postural perceptual dizziness.

The more we focus upon these sensations, the more the brain re-fires them. So if we were to wake up each day and think “Am I dizzy? Is the dizziness still here? Has it gone yet? Will I be able to drive today?”, we are further stimulating the distress associated with the dizziness neural pathways in our brain and body. Thus, throughout the day the brain is putting a large amount of attention upon the dizzy circuits and it is being placed in the front of our attention so that it is in effect perceived as always there. Despite normal test results, the dizziness is there inside the brain firing along healthy neural pathways. It is a neural dizziness rather than an inner ear injury. It is like error signals or mistakes occurring within the neural templates of the brain.

Wherever we focus, we fire neurons. When we look for dizziness, we can find it. This is because the mapping of that sensation lives in our brain and we can activate it at any time. Similar to being in a dark room full of objects, we can only see what we shine the torch light upon. It is always there, but if it is in darkness we don’t notice it. Our attention becomes the source of our struggles and our solutions. For PPPD our attention is like the torch shining our attention on the dizziness and keeping it at the front of our awareness.

The dizziness signals are there in the background bouncing around your brain, ears, eyes and spinal chord. You don’t need to get rid of them or cure it. They are useless and harmless. A different way toward healing is to build stronger neural pathways that feel normal to you. For example you could learn how to put your attention and focus upon your desire to feel calm, steady or at ease. You can do this while feeling dizzy as these pathways are adjacent and can co-occur. Eventually the stronger pathways will override the dizzy ones so that you no longer notice them there. Your brain will learn that the dizziness signal are not important or dangerous and they will become filtered out of your awareness. My clients who learn to do this incrementally notice that their dizzy signals become weaker and weaker. They return to normal.

People with PPPD often feel that they are going crazy because their symptoms are not validated by medial testing. They often report that they feel that others don’t believe them. These clients can end up with referral to see psychiatrists or psychologists and they may be medicated with anti-anxiety or anti-depression medications to help numb the unwanted distress or panic that is within them daily. Please note that PPPD is not a psychiatric condition (read this article). As with any condition, PPPD can occur alongside any other diagnosis. This is known as a comorbidity and can further complicate the medical investigation process. Anyone with persistent dizziness is likely to experience a normal reaction of anxiety and depression. It is understandable and not abnormal.

People with PPPD become stuck in a cycle of worrying about dizziness, focusing upon dizziness, being anxious about dizziness and then refiring the neural pathways creating the dizziness. This is the maladaptive cycle I referred to earlier. The best way to heal this form of dizziness is to learn about how to break your cycle of worry by addressing your beliefs. You need to go deep into your inner world and shine a light on your personal belief system. There are many skills and tools you use to help you do this. You can learn to trust your body again. Practising the body scan with curiosity to what you feel is a good way to start. Consciously focus on areas of your body that feel at ease. The body needs to learn how to feel safe and steady again. This is not something that your logical brain can fix. You can’t tell yourself I am safe. Get over it. The anxiety parts of our brain don’t work in logic and they don’t speak English!

The ‘steady’ neural pathways can be activated by feeling them and focusing upon them. This is a very important skill that can be learnt at home. The ROCK STEADY Module 1 exercises begin here and guide people through this process. You can try the exercise below. It is recommended that you start with simple standing, sitting or lying exercises using wall and floor supports. Do not focus upon dizziness or ask yourself is it there? Instead, you are now focused upon feeling your centre and finding steadiness. Give yourself a new point of focus and make your brain work hard to achieve this focus. Your brain will then become occupied with the neural pathways for steadiness and this will become your felt experience. In other words, you can retrain yourself to feel steady. You literally learn to feel steady again and to strengthen those neural pathways within your body and your brain by practising it on your own. You can close your eyes in any position and try it now. Practise finding steadiness in your body using the exercise in this chapter below. Feel steady so that you can rebuild more steady neural pathways.

What to do

First, be gentle with yourself. This has been a long process of diagnosis and you are most likely exhausted. Give yourself lots of rest, get support and take time to learn about healing with neuroplasticity. Remove any guilt or shame you are feeling about PPPD. It is not your fault. You have done your best. You are normal despite having this diagnosis. You are you. Healing is a process that you cannot force or push through. You need to be patient and invest time into it. Try the standing scan in the Free Starter Kit or use the full ROCK STEADY PROGRAM.

As you do this standing scan, remind yourself that of course the dizziness signals are still there in the background. You don’t need to look for them or focus upon them- they are there and that is not going to help you or hurt you. Leave them be. The dizziness sensations are strong neural circuits that are firing throughout your body and brain. They are real and you are not imagining them! It is normal to be afraid of dizziness and you don’t need to judge yourself or get rid of it.

Shift your focus to your touch sensations in your skin. Feel the floor, your clothing or the wall if you are touching it. Stand with your feet wide and hands on your hips if that assists you to cultivate steadiness. Find it. Feel it. Focus on your real felt sense of steadiness. This lives inside of you too.

Steadiness is an antidote to the dizzy sensation. Practice utilising your touch system so that you can literally feel your steadiness and safety in your skin. Acknowledge the dizziness signals are in the background of your mind and allow it to dissolve out of your awareness. When we remove our focus from the dizziness, it becomes less important and has less neural firing. We want to now redistribute your attention, brain flow and focus toward your hidden physical and emotional sensations of steadiness. You can do this by shifting your focus to feel it in your skin. Your steadiness is already there (beside the dizzy signals). You don’t need to work hard for it. But you do need to find it!

Keep looking for steadiness sensations until you find them. You create these sensations in your body and your mind. As your steadiness neurons fire together, the steadiness neural pathways become stronger. As you do this more often, it becomes easier and more normalised so that you can feel steady 24/7 instead of dizzy, 24/7. You can see why self-belief is so essential. If you don’t believe in your body or your ability to practice finding steadiness, it is unlikely you ever will. Ask yourself: do I believe that I can retrain my brain?

If you think why didn’t I learn this years ago? remind yourself that these skills take time and professional guidance. If someone could have taught you this, they would have. Our knowledge and understanding of the mind-body connection has evolved over the years and many of your doctors or health professionals will not have had training in this healing process. I know many clients who had doctors say to them just don’t worry about it but the doctors didn’t know how to teach people to implement that advice.

Rewiring your neural pathways is something that you have to learn to do within yourself. Reading this book won’t create neural patterns for you, but by practising the exercises that you read and feeling your body with openness, you will begin to fire neurons differently. When you feel your body without fear or judgment, you can create new pathways. You can choose where you focus and how you speak to yourself. You are in control of your choices and your focus. This self-study process gives your more and more capacity to choose feeling normal again. Until you learn how to do it, the option never exists.

Keep going. Believe in yourself. If you tell yourself that you can’t feel or can’t find steadiness- you won’t. You are powerful and your mindset is powerful. Speak to yourself with kindness and be open-minded as you try new things. Feel your way from your feet up. Nobody else can do it for you. Only you can change your neural templates and you can do it whenever you feel ready.

Hot tip: Most dizzy sensations (but not all) are located in the head where we have so many bouncing neurons and emotional centres. It can feel overwhelming or distracting to focus on what you feel in the upper parts of your body- especially when you are first learning. Many people also feel strain or symptomatic behind their eyes. To start with, really bring your focus into your feet, legs and hips. Focus on your lower body. Feel your skin and muscles. Cultivate connection to your feet or legs by feeling the chair or the ground. Reconnect into your lower body and help get your attention away from the dizziness of the head.

Take your time. Stay safe. If this exacerbates feelings of anxiety for you to do it alone at home, you might want to consider getting private therapy to support you through this learning process. You don’t have to do it alone and it is not your fault- it just is. Find someone to help you rewire your neural pathways and use the ROCK STEADY program to offer you extra self-study guidance if you feel stuck.


The vast majority of my private clients have PPPD. Their symptoms may have started with BPPV, vestibular migraine, MdD, or Meniere’s, but for whatever reason, it evolved into persistent perceptual dizziness. Between their vertigo episodes they report feeling constant rocking, pushing, pulling, dizziness.

These clients have often tried everything from everyone to help them feel better. They have seen multiple doctors, specialists, natural therapists, alternative health options and spiritual healers! They have tried it all but then they find me on YouTube.

The process of healing that I take them through gives them their power back. I teach them how to listen to their body and how to respond the changing needs of their body, mind and soul. In this process I strongly urge them to stop looking outside for solutions because their symptoms are not something that another person can resolve.

Ellen was short with me when we first met. She was sceptical that what I offered would work and she openly said that she had lost faith in her doctors and local natural therapists. I validated her fears and told her that I could not get rid of her symptoms for her, but that I could teach her how to feel normal in her body again using neuroplasticity. I could teach her how to rewire her own brain and body. She was willing to give it a go. She was willing to start a daily practice. She was willing to feel her sensations. She was willing to feel her emotions. She was willing to ask for support. She was willing to take on a 6 month program for intensive support.

Ellen couldn’t drive anymore but she wanted to. She loved animals and wanted to be able to take care of them without fear of her dizziness preventing her from doing more strenuous farm work or chores. She wanted to travel again and dreamed of going on overseas adventures in Europe with her husband. Ellen hated what she felt in her body and she was both depressed and anxious about it but seeing a psychologist hadn’t helped. Medication hadn’t helped. She was at her wits end and not ready to give in to it.

Once Ellen established her dreams, her goals, her values, her inspirations, and her desired feelings, we could create a daily practice for her. She committed 15 minutes a day to her practice, searching for her desired feelings and cultivating the neural pathways that she wanted to feel. She got better with practice and she began to feel better. I gave her skills and tools for working with her persistent doubts and sabotaging thoughts. She did written exercises to identify her limiting beliefs and she began to overcome them. She learnt about her balance system, her mind and emotions.

Ellen developed trust in herself, and built confidence in her capacity to heal by building non-judgmental skills, self-awareness, curiosity and by literally feeling her progress. After three months of private therapy her dizziness had resolved. She no longer had constant rocking sensations. She felt steady and tall in her body. She had faith in herself again and she had stopped looking for external fixes or cures. She was driving again and tending to her animals after years of being too afraid. Ellen was starting to choose new activities each week that she could add to her ‘can do’ list.

With time Ellen could do everything she wanted to do. She had returned to normal and booked a holiday. She now understood her fears, her panic, her avoidance, her anxiety, and her solutions to overcome it all. She had figured it out by listening to her body. She had reset her vestibular system and she now had excellent proprioceptive (touch) function to help feel at ease in daily life. Ellen took her power back and I encouraged her to set boundaries for herself physically, mentally, emotionally and spiritually to prevent relapse. Ellen used the ROCK STEADY process to learn about her healing.

Benign Paroxysmal Positional Vertigo (BPPV)
Listen (7 minutes)

Key points: non-harmful, intermittent, positional, brief spinning, treatable. You can treat this at home safely and effectively with the BPPV Video Kit found in ROCK STEADY. Contact a local vestibular expert to help you diagnose and treat this condition if it persists.

What is it?

BPPV is a commonly seen form of dizziness. It is a condition of dislodged calcium carbonate particles inside the inner ear. The particles belong in neighbouring areas of the inner ear and are important for detecting acceleration movements such as starting and stopping. However, in this condition, some particles fall out of the area they belong to and cause annoyance in adjacent areas of the inner ear. BPPV can affect anyone, at any age. It is more common than we think. In our University of Melbourne office, 4 out of 16 people have had BPPV.

The situation:

The particles have moved into one of the semicircular canals of the inner ear where they do not belong. This is a problem because now when we move our head, such as rolling over in bed, the particles create a strong sensation of vertigo. As the head rolls in bed, the particles also move within the balance canal creating a vertigo response until they can resettle themselves somewhere less annoying. The vertigo will be triggered each time we make a head movement that shifts the crystals around the semicircular canal.

What might it feel like?

You will see the world spin around distorting your vision when you move your head in a certain position (e.g. rolling over. bending down or looking up). This spinning is a brief form of vertigo and may occur with a lingering sense of nausea or shock. Symptoms are transient and generally pass in less than a minute.

What can I do about it?

Particle repositioning treatments are simple and straightforward. These can be done at home, however if you are anxious about symptoms please seek treatment from a specialist. Ask your vestibular audiologist, physiotherapist or General Practitioner if they know how to do the treatment. Find a vestibular specialist to assess your ‘nystagmus’ eye movement.

If you live remotely, or cannot find someone locally- use the BPPV Video Kit in ROCK STEADY. We can take you through the BPPV treatment steps remotely with video demonstrations. You don’t need to do it alone 😉 Finding a local person to support you would be preferable (but not always possible, we understand).

The Epley manoeuvre is most commonly performed to treat this condition, and has a success rate of around 80%. Treatment can be repeated twice daily until the condition resolves. BPPV may be intermittent and may recur for no known reason. Excessive treatments can further dislodge particles and create ongoing symptoms. The Brandt-Daroff exercises can make the BPPV more difficult to treat!

BUT … Why do I have persistent BPPV?

Most commonly, BPPV comes from loose particles in the posterior semicircular canal. When the particles are free-floating, this is called canalithiasis and is usually treated effectively. However, there are exceptions and some BPPV can persist or be difficult to treat.

This can occur when:

Both ears are affected
The calcium carbonate particles become adhered to the inner part of a balance canal, making it difficult to reposition them (referred to as cupulolithiasis BPPV)
Or the particles are found in one of the less common semicircular canals
These rare types of BPPV may require treatments other than The Epley. You can learn more about treating difficult BPPV in ROCK STEADY. It is best to only treat one ear at a time, so repeat treatments about one week apart may be required until symptoms resolve in each ear.

I have seen patients who have had BPPV for over 20 years without treatment (not all doctors or health professionals are trained in this treatment process.) Since effective BPPV treatment in clinic, they are now completely free of their vertigo.

Try the ROCK STEADY Program for access to FULL BPPV video demonstrations and further information about preventing ongoing vertigo, dizziness or anxiety.

Labyrinthitis (inner ear infection) or Vestibular Neuronitis
Listen (3 minutes)

Key points: It is not recurrent, usually only in one ear, vertigo is severe at onset and gradually improves over the following months, hearing loss or tinnitus noises may also occur, medical advice recommended.

What is it?

Labyrinthitis is a viral or bacterial bug that causes disruption inside the inner ear. If it is contained to the balance organs alone, then vertigo will be the main concern. If the infection spreads to the hearing organs then hearing loss and new noises (tinnitus) within the ear/s may also be noticed.

When only one ear is affected we call this a unilateral condition. If both ears are damaged we call it a bilateral vestibular loss. ROCK STEADY has the tools for healing either situation.

If you have been diagnosed with a form of vestibular neuritis this means the nerve carrying information from your inner ear has been inflamed or disturbed. Healing this is the same process as for any unilateral vestibular condition.

The situation:

The infection can cause trauma to the inner ear structures resulting in permanent damage to the fragile architecture of the inner ear. Luckily, we have two ears, so if one ear is damaged we can still use the balance and hearing functions on the other side. The recovery process is different for each person. The body and brain need to re-learn how to balance and hear with only one ear. This can be confusing, frustrating, and tedious.

With ROCK STEADY support tools and home exercises, recovery can be a smooth process.

Vestibular Migraine
Listen (7 minutes)

Key points: Pressure, fullness or pain in the skull (not specifically in the ears), light/sound sensitivity, motion sickness, episodic vertigo for more than a few minutes, nausea, medical advice recommended.

What is it?

Vestibular migraine (VM) is not an ordinary migraine. It is a condition that is characterised by a cluster of symptoms that may or may not include headache! Symptoms may include vertigo, tinnitus, hearing distortions, visual distortions, motion sickness, sensitivity to light/sound, headache and brain fog. Or put quite simply, people with VM often report that they feel not-quite-right. VM symptoms can vary as time goes on, people can ‘grow out of it’ or it may grow with you changing each year.

The situation:

The rhyme and reason of vestibular migraine is not entirely understood. There are some ideas, symptoms may be related to a variable supply of oxygen and blood sugars due to either an excess of blood flow around the brain and inner ears (like a tap running with a full stream of water flow) or due to a restriction of blood flow around these regions (like a tap with a slow and thin stream of flow). Either way, the ears and the brain prefer to have a STEADY stream of oxygen and blood sugar supply, so neither are optimal and could result in distorted sensations. Another explanation is that the neural communication fibres connecting the limbs, ears, eyes, and all of our body parts to the brain are in a state of confusion, as though there is a big traffic jam slowing down the information as it travels from one place in the body and brain to the next.

There is no clear explanation. VM may be partly environmental and partly genetic. It may be triggered by stress, fatigue, emotional upsets, allergies, life changes, traumas, hormonal changes or other factors. Each person has a different VM story to tell. Many people with VM report anxiety and lingering symptoms of feeling not-quite-right between attacks despite normal hearing and balance function.

It is really useful to have support tools and strategies for preventing overwhelm. I have seen many VM patients who, after having been medicated for this conditions for decades, are now symptom-free and able to manage their early warning signs without medications. They have returned to confidence. Everyone has a different road to recovery. Awareness of your changing “needs” is key. Explore what your body is asking for to help it recover.

Consider physical, mental, emotional, and spiritual aspects of your life. Try the ROCK STEADY 12-week online support program. Support all of you.

Remember, if it were ‘easy’ to understand, we would have it all sorted out by now. Give yourself time and kindness to explore this at your own pace. You can feel better.

Brain Fog, Fuzziness, Idiopathic Dizziness
Listen (3 minutes)

Key points: It can feel like a jetlag that doesn’t end.

What is it?

This is a cluster of symptoms that do not quite fit into any other category. Patients report feeling off-kilter or they report lingering sensory distortions. There are no known triggers. Patients often note reduced concentration, visual blur or brief dizzy spells. The sensory distortions can occur when the pathways to and from the brain are a little muddled. With medical clearance, there is a great possibility that these symptoms will mend with time and understanding of what our body is telling us. The symptoms often make sense once we really listen in, with openness and curiosity. We lean in.

The body is always seeking its own symmetry, homoeostasis and equilibrium. It can take time and it can be frustrating.

Many patients with these symptoms make subtle changes to their priorities and look for ways to recharge their batteries. In other words, when all else fails, look to self-care strategies and find out what works for you… the options are endless. We have seen people recover (& thrive) time and time again.

You know it… Being overworked, under-slept and spending lots of time in front of a screen or on the run can exacerbate brain fog, fuzziness and idiopathic dizziness. Worry about symptoms can also prolong recovery.

The 12-week ROCK STEADY Program that you can use in your daily life to boost your steadiness and clarity. There are plenty of tools to choose from in the Seeking Balance Online Programs.

Superior Canal Dehiscence (SCD)

Listen (3 minutes)

Key Points: Medical treatment available, dizziness triggered by loud noise or vibrations, brief vertigo, not positional, bodily sounds become more noticeable, hearing distortion.

What is it?

SCD is a thinning of the protective bony layer of the superior semicircular canal. This canal is a part of the balance system. As the fluid moves around the canal and responds to sound or movement vibrations, the thinning bone acts like a trampoline and bounces more than usual. In a normal ear we only have two moving trampoline like windows located near the middle ear. These regulate the pressure waves moving through our inner ear fluid. In SCD, people now have a third moving ‘window’ and this creates exaggerated sound and balance vibrations to pass through the inner ear system. It results in sound sensitivity and vertigo with loud sounds.

The third moving ‘window’ causes vertigo (nystagmus eye movements) when exposed to sudden, sharp or loud sounds. This can also occur with large tapping vibrations placed anywhere on the body. This can be frightening for people with SCD who are unsure what is going on in their body at the time. It is experienced as a short flurry of visual/sound distortion and is different to light/sound sensitivity as seen in migraine. This is a mechanical change within the inner ear and associated with clear triggers such as sneezing, blowing the nose, laughing, talking loudly etc.

With the thinning bone on the superior canal, there is more fluid movement and therefore increased balance signals passing through the vestibular organs. This can draw sound vibration away from the hearing organs and result in unusual sound distortions or tinnitus. Body functions (such as our heart beat or chewing sounds) can be heard as louder sound vibrations and become distressing or distracting for people with SCD. Hearing body noises more loudly is common for people with SCD and is called ‘autophony’.

Treatment involves plugging up the affected canal surgically to stop the excessive fluid movement or blocking one of our moving ‘windows’ that sits closer to the middle ear. There are risks associated with surgery and it is not performed in all cases.

Many people with SCD benefit from learning about managing the associated anxiety and emotional impact of these intermittent symptoms. With time and understanding, symptoms can be minimised. Listen here to in an interview about treating SCD surgically.

Learn more about holistic recovery using ROCK STEADY. You can learn to better understand your symptoms and how to feel confident in your body again.

Acoustic Neuroma/Vestibular Schwannoma
Listen (6 minutes)

Key points: Gradual onset of symptoms, usually in one ear only with symptoms such as tinnitus, fullness and sound distortions in that ear, intermittent dizziness and vertigo, medical investigation is required.

What is it?

An acoustic neuroma/vestibular schwannoma is a type of tumour that occurs along the eighth nerve (the balance and hearing nerve). Most commonly, it occurs along the vestibular nerve in the schwann cells. This nerve pathway takes information from the inner ears toward the brainstem. Ordinarily, the schwann cells provide a protective insulation layer for the hearing and balance nerve. In the case of vestibular schwannoma, the schwann cells grow excessively and form a growth along this nerve. This can lead to hearing loss, vertigo and unusual sound distortions as the growth can compress the eighth nerve and reduce the efficacy of hearing and balance information passed along this pathway.

The tumour cells are usually benign. If the schwannoma is identified to be small in size, then the specialist may opt to monitor the growth annually rather than surgically remove it. This is called a conservative treatment approach. There is a chance that the schwannoma will remain small in size and not require medical intervention.

If surgery is indicated, the specialist will talk with you about the risks of surgery and the intended surgical approach. You may be at risk of further hearing loss and imbalance post-operatively but usually, patients understand that this is a worthwhile compromise. If left unmonitored a vestibular schwannoma could compress upon other cranial nerves and lead to serious health complications. Ear, Nose and Throat (ENT) surgeons will monitor the growth of the schwannoma over time with repeat MRI scans. As regrowth can occur following surgical removal, MRI scan monitoring each 1-5 years is generally recommended.

Following surgery, patients benefit from ROCK STEADY home exercises to help their balance system rebuild and strengthen new pathways. Emotional support tools will also useful throughout this treatment process.

Mal Debarquement Disorder
Listen (3 minutes)

Key Points: Cause unknown, often triggered by an event of travel such as a boat trip, or may be triggered by stress. Symptoms often described as constant rocking or push/pull sensations, symptoms may be reduced when in motion such as swimming/ driving, medical investigation recommended to rule out other cause.

What is it?

Mal Debarquement may be considered as a variant of vestibular migraine. There are suggestions that the rocking sensations occur due to confusion within the balance-brain. This part of our brain is important for prioritising information. In other words, it acts like a bouncer at the door of a nightclub who allows people entry under the condition that they are over 18, they are not intoxicated, and that the club is not already full. This job is important to maintain harmony within the nightclub.

Equally important is the job of the balance-brain. If the brain is confused and allowing all forms of stimuli (vibration, light, sound, emotion and touch etc.) entry into our experience, then it is no wonder that we might feel a constant swimming or rocking sensation. There is too much information to process and not enough selective order! Treatment takes a similar approach to vestibular migraine. Stress and anxiety reduction strategies will help the brain to optimise its efficiency. Being rushed, overworked, anxious or lacking sleep can exacerbate symptoms.

Get support tools from the ROCK STEADY 12-week Program to help re-set the balance brain and to feel like yourself again!

Meniere’s Disease or Endolymphatic Hydrops
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Key points: Episodic vertigo, spinning for longer than 20 minutes, fluctuating hearing loss/ tinnitus/ aural (ear) fullness, usually only one ear is affected, medical investigation recommended.

What is it?

Meniere’s disease is thought to be a combination of environmental and genetic factors. It is not something that we can predict, prevent or control, but we can support healthy recovery and prevent ongoing stressors. Meniere’s episodes can result in permanent damage to the inner ear structures resulting in balance symptoms and permanent hearing loss in that affected ear.

The situation:

For Meniere’s patients, the inner ear makes too much special inner-ear-fluid (known as endolymph). In fact, it can make so much fluid that the inner ear no longer has enough space to store it. Part of the inner ear membranes may then rupture causing a mix of inner ear fluids. The mix of fluids can damage the balance and the hearing organs.

The body and brain then need to rebuild membranes and balance and hearing pathways during the recovery process. This can be a very tender and sensitive time. Patients may report feeling sensitive to both sound and movement. It can be a confusing and exhausting process over months, or it may recover in just a few days.

The amount of fluid produced, stored, and used by the inner ear is not effectively controlled by medicine. Meniere’s attacks can be very unpredictable. Each person has a different experience of vertigo/hearing loss and the uncertainty of symptoms can feel quite debilitating. Having tools and strategies for strengthening steadiness can be very useful.

It is helpful to have ROCK STEADY support tools and action plans for effective recovery. Ongoing stressors and persistent worry can exacerbate the vertigo. Our body can recover its balance function following a Meniere’s attack – stay supported.

BUT … Why Do I Have Persistent Dizziness?
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Persistent dizziness may linger for any condition if the ears/brain have a hard time recalibrating and re-learning balance control. If the balance brain is unable to recover itself, you may not feel ‘yourself’ for a little while. Using appropriate support tools and balance exercises, you will get there.

Let’s go through a list and see if any of these sound true for you:

  • Are you anxious about the dizziness and thinking about it a lot?
  • Are you overly cautious and protective of yourself in order to prevent dizziness?
  • Are worried about triggering dizziness?
  • Do you have BPPV that is untreated?
  • Do you have enough support to help you recover optimally?
  • Are you scared of the vertigo attacks or sick with worry about it?
  • Have you learnt tools and exercises to enable your body to recover?

Learn more support tools and become the expert in your recovery process with the Seeking Balance ROCK STEADY Program. Choose the support tools that best fit your needs. You can take control of your recovery and nobody else can do it for you. Start ROCK STEADY and feel like you again.

Read the article: ‘5 Common Misunderstandings About Vertigo’ here.