What We Offer You for Vestibular Balance Disorders
- Specialized expertise in diagnosing the underlying causes of vestibular balance disorders. Go to Conditions Treated
- Pioneering surgical and nonsurgical treatment options that require deep knowledge and skills not widely available in the Bay Area. Go to Treatments
- A collaborative approach with specialists who work together to provide comprehensive evaluations and individualized treatment plans for balance disorders. Go to Your Care Team
- Ease of access to diagnosis, treatment, and follow-up care, as well as virtual visits. Go to Connecting to Care
At Stanford Health Care, we treat a wide range of vestibular balance disorders. Your vestibular system is a set of inner-ear structures and nerves that give input to your brain on balance and spatial orientation.
Bone, cartilage, and fluid-filled canals (semicircular canals) make up the inside of your ear. As you move, the position of this fluid changes. Nerves inside your ear deliver this information to your brain. This helps form your sense of balance.
You may feel unsteady or imbalanced if you have an issue with your:
- Brain and nervous system, such as an injury, tumor, or psychiatric disorder
- Vestibular system
Stanford Health Care is a national leader in the latest research and innovative treatments for vestibular balance disorders.
Certain medications and conditions such as Meniere's disease, migraine headache, or vestibular migraine may also cause balance problems. Older adults tend to have more problems with balance.
We offer thorough diagnosis and treatment for all types of vestibular balance disorders, including:
- Acoustic neuroma (vestibular schwannomas)
- Acute vestibular syndrome (AVS), including vestibular neuritis and labyrinthitis
- Benign paroxysmal positional vertigo (BPPV)
- Central vestibular disorders
- Disequilibrium of aging
- Meniere's disease
- Persistent postural perceptual dizziness (PPPD)
- Superior canal dehiscence syndrome (SCDS)
- Vertigo
- Vestibular migraine
Treatment Options
At Stanford Health Care, we focus on nonsurgical therapies that help relieve your symptoms while letting you get back to an active life. If you need surgery for your condition, we have expertise in minimally invasive and robotic surgical options.
Balance Disorder Treatments
Stanford Health Care’s Vestibular Balance Disorders Program brings together a multispecialty team including experts in rehabilitation medicine, neurology (nervous system disorders), and otolaryngology (ear, nose, and throat conditions). Our specialists provide personalized vestibular balance disorder treatment recommendations based on your condition, symptoms, and lifestyle. We work closely with you to manage all aspects of your care, from diagnosis through individualized treatment plans and ongoing support.
INNOVATION HIGHLIGHTS
- We are one of the only medical centers in the U.S. to offer an interdisciplinary program for comprehensive testing and treatment of balance disorders.
- Our computerized dynamic posturography system combines virtual reality with moving force plates to assess sensory, balance, and vestibular functions in real time.
- Stanford Medicine’s Steenerson Lab is dedicated to studying diagnostic tools and treatments for vestibular disorders.
- We offer radiation therapy that precisely targets noncancerous tumors affecting balance using CyberKnife, a robotic delivery system invented at Stanford Medicine.
- We offer group and individual physical therapy and psychological therapy for dizziness disorders.
Screening and Diagnosis
Our specialists work together to give you a careful and comprehensive assessment. Here’s what to expect:
1. We start with a phone questionnaire with a new patient coordinator to ensure you will be seen by the correct provider. You will need to have visited a neurologist or an ear, nose, and throat (ENT) doctor for an initial assessment before coming to our clinic.
2. We then schedule you for a comprehensive vestibular assessment to check your vestibular function. Vestibular tests may include:
- Dix-Hallpike maneuver to test for BPPV by having you do a series of movements
- Electronystagmography (ENG) and videonystagmography (VNG) to look at your eye movements
- Evoked potentials to measure your brain’s responses to stimulation
- Hearing tests to check for hearing issues
- Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography scan (CT scan), to detect underlying medical conditions
- Rotary chair test to assess whether your brain or inner ear is causing dizziness
- Video head impulse tests to see if your ears are correctly picking up rotation information
3. Following testing, we make an appointment either in-person or virtually with a healthcare provider who manages inner ear and brain disorders (otoneurologist).
4. You may also see a physical therapist at the same time.
We may recommend a specialized exercise program to help you improve your balance and cope with dizziness. A physical therapist trained in vestibular rehabilitation teaches you exercises that address your specific symptoms. These exercises may include:
- Balance retraining to help you feel steadier while doing day-to-day activities
- Grounding exercises to reduce the anxiety response naturally triggered and heightened by dizziness
- Habituation exercises to reduce dizziness by repeated exposure to actions that normally cause you to feel dizzy
- Posture training to practice standing and sitting
- Stretching exercises to increase your flexibility
- Vision stability exercises to help you increase control of your eye movements
- Walking exercises to practice maintaining your balance
If you have BPPV, small calcium carbonate crystals (otoconia) in your inner ear loosen when your head moves, causing dizziness. They detach from a part of the inner ear called the utricle and move to another part of the inner ear called semicircular canals. A physical therapist can teach you exercises to reposition your head so that crystals move back to the utricle, relieving the dizzy feeling.
Our doctors may recommend changes to your lifestyle to reduce dizziness and control symptoms, including:
- Decreasing the amount of caffeine and alcohol you consume
- Eating and drinking at regular intervals
- Increasing exercise and activity levels
- Increasing fluid intake
- Getting regular and restorative sleep
- Learning how to manage stress
- Quitting smoking
- Seeking psychological therapy
- Adding handrails at home
- Getting your feet checked for nerve damage (neuropathy) or sensation problems that impact balance
- Getting your vision checked or updating glasses prescriptions
- Using a walking device
Your doctor may prescribe medications to help with dizziness, feeling like you’re spinning or moving (vertigo), or nausea. Depending on your condition and symptoms, we may also recommend medications such as:
- Antidepressants or anti-anxiety medications to treat PPPD
- Anti-inflammatory, antiviral, diuretic, and migraine medications to treat Meniere’s disease
- Antimigraine medications including antidepressants, antiseizure drugs, blood pressure medications, and others to treat vestibular migraine
- Corticosteroids and/or antivirals to treat AVS/vestibular neuritis/labyrinthitis
At Stanford Health Care, our surgeons offer the latest techniques and least invasive options to help treat balance disorders. We may recommend surgery if you have Meniere’s disease, acoustic neuroma, or SCDS.
- Endolymphatic sac operation: We surgically remove a portion of your inner ear to help you better control inner ear pressure.
- Labyrinthectomy: We surgically remove your ear’s temporal bone to relieve your symptoms, but you lose hearing in the affected ear.
- Vestibular nerve section: We surgically divide the balance nerves to your ear to relieve symptoms of dizziness while maintaining your hearing.
- Middle fossa craniotomy: We remove a small piece of bone (bone flap) from above your ear to reach and remove smaller tumors. This approach is commonly used in patients with good hearing.
- Retrosigmoid craniotomy (keyhole brain surgery): We remove a bone flap from behind your ear to reach and remove tumors near your brainstem (the bottom part of your brain that connects it to your spinal cord) and cerebellum (part of your brain in the back of your head). This approach is typically used for larger tumors and does not disturb inner ear structures.
- Translabyrinthine craniotomy: We remove a bone flap from behind your ear to reach and remove tumors in your inner ear. The surgeon must also remove small bones from the inner ear to access the tumor. Since this surgery causes total hearing loss, we only use it when you have limited or no hearing.
To treat SCDS, our surgeons plug the opening in your superior semicircular ear canal. They reach your inner ear through a bone flap above your ear (middle fossa craniotomy) or behind your ear (transmastoid repair).
We may also recommend surgery for other conditions, such as cataract surgery to improve your vision if you have disequilibrium of aging.
We use stereotactic radiosurgery to treat noncancerous tumors in the brain (acoustic neuroma) that cause balance disorders. Radiation beams target the tumor without affecting the healthy tissue around it.
Our surgeons are highly skilled in cutting-edge robotic radiosurgery techniques, including CyberKnife, which works faster and is more effective than other types of radiation treatment.
Your wellness plays a role in the success of your treatment. We offer a range of support services to assist you and your family throughout your healthcare journey. Whether it’s psychological counseling, transportation assistance, or help with your finances, we’re here for you whenever you need us.
Innovation Through Clinical Research
As a leading academic and research institution, we are always striving to find new techniques and apply the latest and best technology to your treatment. Specialists at Stanford Health Care Ear, Nose, and Throat (ENT) work with each other and with teams across the nation to spark groundbreaking research. We are committed to bringing you clinical trials that test new and better ways to diagnose, treat, and manage balance disorders. Participating in a trial may give you access to the latest therapies before they are widely available.
A diagnosis of a complex ear, nose, throat, or neck condition can disrupt your life. We are here to guide you through every challenge using our Circle of Care approach. You have a team supporting you and placing your needs at the center of every decision. Our multispecialty team works together to tailor treatments to your needs. Depending on your condition, you will be cared for by our otolaryngologists (ear, nose, and throat and head and neck surgeons) and advanced practice providers. Together, we prioritize your overall health and give you renewed hope for a better quality of life.
Through teamwork, our doctors continually advance our approach to diagnosis and treatment and improve the care experience. At weekly review meetings, experts from multiple disciplines review cases that require more complex recommendations.
Our extended care team embodies the same cooperative spirit to provide support for all your individual physical, emotional, and daily living needs. Our goal is to maximize treatment success while minimizing the impact that a balance disorder diagnosis and its treatment can have on your life.
Your Doctors
Neurologist
A neurologist is a medical doctor with specialized training in diagnosing, treating, and managing disorders of the brain and nervous system, including those affecting balance.
View All {0} Neurologists »Audiologist
Audiologists are trained, licensed, and certified health care professionals. They measure and evaluate your ability to hear, and they have unique expertise in treating hearing conditions. They also measure your inner ear function as it relates to balance and balance disorders.
View All {0} Audiologists »Advanced Practice Provider (APP)
Our skilled nurse practitioners and physician assistants specialize in diagnosing and treating balance disorders. They see patients independently and occasionally alongside your doctor. APPs can give you a thorough exam, write prescriptions, and help prevent or treat any issues. Our APPs meet weekly to discuss patient needs.
View All {0} Advanced Practice Provider Doctors »Extended Care Team
Physical Therapist
Our physical therapists are trained in vestibular rehabilitation therapy, which addresses balance and dizziness issues. They work with you on exercises including balance retraining, posture training, and stretching.
View All {0} Podiatrists »Nurses and Nurse Coordinators (RNs)
Nurses and nurse coordinators are registered nurses who coordinate your care with your vestibular balance disorders team. They guide you from your first contact through follow-up care and help you find counseling, financial, and other support services.
View All {0} Podiatrists »Care Coordinators
Care coordinators provide you with information and assistance before and during your appointment.
- Medical Assistant: Medical assistants work with our team to help provide care. They may prepare you for an examination, assist your doctor, or take your vital signs before your appointment.
- Patient Care Coordinator: Our patient care coordinators help you with scheduling appointments and accessing your lab results. They are your first line of contact before you see your provider and will guide you during your balance disorders care.
- Patient Access Representative: Patient access representatives can answer your questions about health insurance coverage, help you apply for health insurance, and refer you to our financial counselors.
Research Coordinators
Clinicians at Stanford Health Care participate in research efforts to advance the understanding of vestibular balance disorders and their treatment. Research coordinators help screen candidates for possible participation in clinical research trials.
View All {0} Podiatrists »Support Services
Your wellness is our top priority. As part of your care, we design a wellness plan to support you and your family before, during, and after treatment.
We strive to make access to care as simple as possible. We have a network of convenient locations across the Bay Area and a wide range of support services. User-friendly virtual health tools and video appointments help you stay connected with your care team from home. We accept most insurance plans and offer discounted transportation, short-stay options, and international travel and translation services. We make it easy for you to get the care you deserve. Our team guides you through each step, so you can make decisions that are right for you.
At Stanford Health Care, we make accessing care for vestibular balance disorders easy and convenient. We make every effort to coordinate your appointments so that you can see multiple providers, as needed, during a single visit.
For Referring Physicians
PHYSICIAN HELPLINE
Phone: 1-866-742-4811
Fax: 650-320-9443
Monday – Friday, 8 a.m. – 5 p.m.
Stanford Health Care provides comprehensive services to refer and track patients, as well as the latest information and news for physicians and office staff. For help with all referral needs and questions, visit Referring Physicians.
HOW TO REFER
Email or fax a vestibular balance disorders referral form with supporting documentation to ReferralCenter@stanfordhealthcare.org or 650-320-9443.
Vestibular Balance Disorders Program