You are suffering with vertigo, dizziness, an “off-feeling,” imbalance, or all of the above. You may or may not know why you feel this way, but you definitely want to feel better! In addition, these sensations put you at increased risk for falls even if you are otherwise healthy and active.
But how do you know if you’re on the right track with care? Many people with vertigo end up at an urgent care or ER, are told they didn’t have a stroke, and are sent home with an anti-vertigo medication such as Meclizine, which may not be very helpful for your particular cause of vertigo.
Here are top 5 signs that you’ve found the right healthcare provider to help you with your vertigo
They treat vertigo regularly
A vestibular physical therapist is a great choice, as long as they have had advanced training. Sometimes they only need to see you for one or two visits, and other times it may take several months of care, depending on the cause of your vertigo. Bonus points if they’ve been to Emory’s Competency-Based Course (the gold standard for training) or other great courses as on this comprehensive vestibular training courses . An Ear, Nose, and Throat (ENT) doctor is another option, but be sure they specialize in vertigo and not only sinus surgery for example. Some chiropractors have specialized training in functional neurology and can help if your issues relate to neck problems. Your primary care physician (PCP) may or may not have some experience with treating vertigo but often the better choice is a specialist (PT, ENT, etc.), so ask your PCP for a referral if needed. Finally, a neurologist is a good choice if you have a diagnosis of vestibular migraine or central causes of vertigo such as stroke or multiple sclerosis.
Extra bonus points to the PCP, ENT, chiropractor, or neurologist who also refers you to a vestibular physical therapist for a team-based approach, especially if balance is an issue!
They have and use the right equipment
The research is clear: viewing eyes in room light or with Frenzel lenses (thickened glasses) is 66% less accurate than using infrared video goggles or ENG (electrodes on the face to track eye movements; Baba et al., 2004). When a clinician is examining a patient with vertigo, some of the assessment should be done with infrared video goggles in order to ensure the most accurate diagnosis and treatment. Other equipment that may be used in your ENT’s office includes a rotary chair, calorics (cold/warm water or air in the ear, with water being the more accurate of the two), and hearing test equipment. An ENT or neurologist may also order neurologic testing such as a CT or MRI of the head or neck, blood tests, or other medical tests such as an EKG. BEST practice includes the use of infrared video goggles for assessment, so don’t settle for less!
They know when to refer you for additional assessment or care, and they can be specific about who they recommend
A good ENT, PCP, or neurologist will not hesitate to refer a patient to physical therapy for ongoing follow-up for dizziness and balance treatment. They should be willing to “name names” of their favorite individual physical therapists or chiropractors with the best patient outcomes. In return, a quality physical therapist or chiropractor will definitely refer you to a trusted neurologist, psychologist (vertigo is emotionally taxing!), or ENT if you would benefit but haven’t seen one, or suggest that you get a second opinion if warranted. If you are having significant headaches from a concussion, then referral to a neuro-ophthalmologist for vision therapy may be appropriate. The best healthcare providers are ones who can point you to excellent practitioners in your area (or even further away if needed to get you to the right one) to help you get the best-available answers, testing, and treatment you deserve.
They are active in their professional development
Knowledge of the vestibular system is expanding each year and there are new discoveries almost daily. Having updated knowledge of current research and treatments is essential. Ask these questions of your providers to assess how current their knowledge is with vestibular care:
- How many years have they been treating patients with vertigo?
- When was the last time they attend a continuing education course or a conference regarding best technology and treatments for vertigo care?
- Do they teach vestibular (inner ear balance) assessment and treatment to students at a local university or provide vestibular education to colleagues?
- Is your healthcare provider a member of the Vestibular Disorders Association (VEDA)?
- Have they published peer-reviewed research on vestibular care?
- Do they mentor other vestibular practitioners?
- Do they have a specialty certification in vestibular care (Emory again is the gold standard)?
- Are they neurologic specialists (for physical therapists, this is known as an NCS or Neurologic Specialist Certification)?
- Ask what the person’s “vestibular certification” means – did they just pay money, attend a 2 day versus week-long course, take a 3 hour test and pass, or provide and document 300 hours of neurologic patient care? Not all certifications or “letters after a name” are equal, so ask the questions to make an INFORMED decision about who is the most qualified and experienced person to provide your care.
They don’t promise “magic” recovery, but they support you on your journey with available evidence-based treatments
Unfortunately, many causes of vertigo are either long-lasting issues or can recur. The best healthcare providers will be honest with you regarding current evidence-based practice (which they should be able to reference, show, and explain to you upon request). On the other hand, they will acknowledge the limits of current research and what we still don’t know yet. For example, there are numerous studies showing that those wrist bands do not reduce motion sickness (sorry folks) but very few that explore whether acupuncture can benefit those with dizziness. If traditional treatments do not help my patients, I am always open to new ideas as long as they do not cause harm or bankrupt the client. An informed discussion with an educated healthcare provider will be balanced and fair in this regard, and it should be consistent with scientific research. Most importantly, they should be caring and encouraging as you explore your own path to the wellness and a balanced life.