Why Dizziness is So Hard To Solve (and What You Can Do About It)

Dizziness, vertigo, and balance problems are more than just inner ear issues - so why does our medical system keep getting it wrong?

In this eye-opening episode, vestibular specialist Dr. Jeffrey Guild exposes the fundamental misconception behind how dizziness and vertigo are evaluated, and why so many people are misdiagnosed, over-medicated, or sent down the wrong referral path.

📉 The Problem:Most doctors still treat the vestibular system as just an “inner ear issue,” when it’s actually a complex neurological network - connected to your eyes, brainstem, cerebellum, and even cognition.This misunderstanding leads to missed diagnoses, ineffective medications, unnecessary surgeries, and long-term suffering for patients.

✅ In this episode, you’ll learn:
• Why the vestibular system is neurological, not just ENT-related
• The real cause of positional vertigo and how it’s commonly mismanaged
• How vestibular disorders affect cognition, memory, and even dementia risk
• When ENT, neurology, or vestibular rehab should be part of your care
• Why movement - not medication - is usually the solution
• How to identify a true vestibular rehab specialist (and why one visit may not be enough)

🧠 Whether you're suffering from balance issues, unexplained dizziness, or you're a provider trying to understand vestibular conditions more deeply - this is the video the medical algorithm won’t show you.

🧭 Quick Tips from the Episode:
1. Don’t assume it’s “just the inner ear”
2. Vestibular rehab (not ENT) is often the right first step
3. Be cautious about medications that suppress symptoms without solving the root problem
4. Movement is medicine - especially head and eye movement
5. One vestibular provider not helping? Seek another. Training varies widely.

💬 Questions, disagreements, or clinical insights? Drop them in the comments - we’re building a smarter community together.
👥 Know someone struggling with dizziness or vertigo? Send this to them now.
🔔 Subscribe for real answers to balance and vestibular health - without the medical runaround.

#vertigo #dizziness #vestibularrehab #BPPV #cognition #misdiagnosis #DrJeffreyGuild #vestibularmigraine #balanceproblems #movementismedicine

Our medical system has this wrong. The medical algorithm has the referral pathway wrong. And it is because of the misconception of the vestibular system being an inner ear system versus a neurological system. On this episode, we're going to talk about the system that usually is the cause of dizziness, the system that is affected when people are dizzy. And we're going to give some powerful and even tactical and high level strategic information about how to address dizziness and balance problems, especially if it is the system that is affected. And for those of you who don't know me, I'm Doctor Jeffrey Guild, physical therapist. I've been a vestibular specialist for over 12 years, and I work with these sorts of problems dizziness and vertigo and balance disorders every single day. Of course, it's not the only reason. And if you have these problems, especially vertigo, consult a healthcare provider. Consult your doctor because you also want to make sure that this is not anything life threatening. But the vast majority of the time, the problem, the dizziness is caused by something wrong with the vestibular system. And this is where the misconception comes about. Usually people think including the medical community and the medical algorithms that govern who you see. And this is why we're going over this information. Most people view our main central balance system, the vestibular system, as an inner ear balance system. And the reality is it is a neurological system. It is not just an inner ear balance system. And that's one of the reasons why people can get symptoms that are more cardiovascular or GI related. And this is an all encompassing neurological system. And we need to think about this very holistically. So when you have problems with balance and dizziness it can create symptoms all throughout your body. And this is common when people have vestibular disorders. We'll start with the deep inner ear that people tend to be most familiar with. And that is the part of our vestibular system where you have the snail looking thing, if you will. This is the part that you learned about in elementary school. They tell our brain about head rotation. And the way that it does this is the loops are filled with thick fluid that stimulates some hair cells. And then that sends signals to the brain and tells our brain about head rotation. In fact, it has two goiters on its neck. And within these two goiters are basically full of rocks, specifically calcium carbonate crystals called otoconia. And what happens when people get positional vertigo? And this is where when you roll over in bed and the room spins or you bend down the room spins is the most common symptom. When people get this, these otoconia, these calcium carbonate crystals get dislodged from these goiters and they go into the tubes that are coming off of the snail's head. And that is what causes positional vertigo, because those crystals are not supposed to be in the tubes. The tubes are there just to tell our brain about head rotation. And it's not supposed to have those crystals in there, but when the crystals get in there, it sends false signals to our brain. And so then we get the perception of rotational spinning in certain positions. And of course, it depends on what position you are in. It depends on which, tube that the crystals go into. And so it can vary. It's the second most common behind vestibular migraine. That's a whole nother story. And that's why we get positional vertigo. The tubes are there to tell our brain about head rotation. But what about the goiters? And why are those calcium carbonate crystals there? You may wonder, and how do I get rid of them? And basically the answer to that is those crystals are supposed to be there. They tell our brain about acceleration and change of direction, which is of course acceleration as well, but it's basically those crystals move in relation to any change of movement. So they're supposed to be there but they are not supposed to be in the tubes. And of course, when it's not acting properly, when a wrench gets thrown into it, people can be either subtly impaired or severely impaired. But what about the rest of the vestibular system? So the relay system in the brainstem, the brainstem is the part of the brain that deals with telling our basically heart rhythm, breathing rhythm. If the brainstem is affected, then basic living abilities become very impaired. we don't want to have problems in the brainstem. The vestibular system will go to a relay system in the brainstem and also will go to the cerebellum, the cauliflower part in the back of the brain. This the cerebellum deals with more fine tuning. when you reach out and grab a cup of water, your hand is not shaking. It's able to go in a smooth way to the cup. The cerebellum does the same thing with our vestibular system as well. We need a part of the brain that helps us with fine tuning of our vestibular system, and that's what the cerebellum does. From there, we have projections that go to the middle part of the brain, and even to areas of the hippocampus and other areas of the brain that deal with cognition. And that's why more and more research is coming out now about how much cognition, our thinking and problem solving abilities can become impaired if we have a vestibular disorder. solving vestibular disorders becomes very, very important. And there's even a look at the possibility of increased risk of dementia when people have vestibular disorders for a length of time. you don't want to just allow these problems to persist. If you have dizziness balance, vertigo problems, you want to get these problems solved because they can affect your cognition. They might contribute to increased risk of dementia. And by the way, there's a couple of great studies that have come out that have shown the increased risk with both Méniere's disease, vestibular migraine and positional vertigo, and cognitive problems that have nothing to do with the hearing component of these disorders. Because hearing is well known to be associated with increased risk of dementia and cognitive decline, untreated hearing loss puts the person at increased risk for these problems. But these studies had ruled out untreated hearing loss as a part of the problem. independent of the hearing loss, these vestibular problems contribute to cognitive decline and even the possibility of increased risk of dementia. But all this is brand new evidence and a lot more is coming out. the main point here is the vestibular system is not just an inner ear system. It is an all encompassing neurological system. And that is where the problems in the health care system start. It starts with where do you go to get help for these problems. And I want you to think about what normal balance is, being able to walk across the street while turning your head side to side, looking for cars, while having a conversation with someone, while avoiding a pothole and about to step up on a curb, all while walking in a straight line and being able to take in all this visual information and to be able to do this while walking a straight line fast without getting dizzy, without having problems, without getting overwhelmed, So this is an incredible system. Unless if a wrench gets thrown into it or if it becomes weak. that is where the problems arise. So you can imagine how people can become extremely impaired if they have a problem with their vestibular system, and if they don't get the right help, if they go to the wrong specialist, or if our medical system sends them down to an ear, nose and throat doctor who is looking at this from an ear, nose and throat perspective rather than a neurological perspective. And I say this because this is a very common problem with vestibular disorders. As I say this. Our medical system has this wrong. The medical algorithm has the referral pathway wrong. And it is because of the misconception of the vestibular system being an inner ear system versus a neurological system. And the medical community just hasn't corrected this yet. So it's important to know this. a common path is from your primary care doctor to an ear, nose and throat doctor. Now from there they might send you on to a neurologist, perhaps. And a lot of times people will bounce around from specialist to specialist to specialist, and not being able to get the help that they need. And sometimes they'll even get medical procedures and medications that they don't need that make them worse. And in the very worst case scenario, they can get procedures that can cause lifelong damages to their vestibular system and ablations and all sorts of things that are meant to suppress their symptoms. But the problem is it causes lifelong balance problems because the vestibular system is destroyed. And that's why it's so important to do your research, question your health care providers on this, and understand that the medical community does not have vestibular disorders well established yet. This is a system that is very poorly understood in the health care system. And usually people are sent to the wrong specialists. sometimes it can be a team of specialists that need to be part of the solution. It's not always just one person. It's not always just a rehab professional. Sometimes it might be a collaboration between a rehab professional and a neurologist, or, yes, a rehab professional and an ear, nose and throat doctor. It depends on what the diagnosis or the problem is, but often it might take a couple of different specialists to solve these sorts of problems. as you can see, we're talking about this in a way that you may not have heard before. that's why we're getting this information out to you. So tip one to do is ask questions to your healthcare provider. And you might need to see a vestibular specialist instead of an ear, nose and throat doctor. If you're just being sent to an ear, nose and throat doctor. Now there are certain diagnoses where yes, an ear, nose and throat doctor is the person that you want to see. There's a diagnosis called the vestibular dehiscence. if there is an acoustic neuroma, that is another reason to see an ear, nose and throat doctor. But the vast majority of the time with vestibular disorders, you want to see a vestibular rehab professional. Now, this person can be a physical therapist. They can be an occupational therapist. Sometimes chiropractors, sometimes physicians can be very specialized in this area, but oftentimes they are rehab professionals from their the rehab professional can bring in the medical professional if something else is needed. And by the way, vestibular migraine is now, as we understand, the most common vestibular disorder. that's another reason why we need to get more information out to people about these conditions to people that we know is true. That is not a part of the traditional medical establishment, because under the traditional medical establishment, people are not getting treated for these disorders the way that they need to be. And the medical community is well aware of this. Vestibular disorders, dizziness and vertigo problems are a major problem and a very common cause of reasons why people see their doctor. this is something we need to address much better. So step one see a vestibular specialist. Not necessarily just an ENT. And you know you can go ahead and see the ear, nose and throat doctor, but also seek out a vestibular rehab specialist in your area and they will be able to more likely have a better idea of what's going on and treat the problem. And there's a lot of evidence now that talks about the over prescription of benzodiazepines and Valium and, um, basically what we call neurological and vestibular suppressants, the medications that suppress the vestibular system. And the reason that these medications are being prescribed to people is because they suppress the neurological system, the vestibular system, and it might help people feel less dizzy. Although what we often, experience is people don't feel less dizzy, they just tend to experience the side effects of these medications, but they don't really feel a whole lot better when it comes to their dizziness. It's because in anything past the initial flare up of the condition. What the person actually needs is usually to stimulate their vestibular system. They need to be moving. Their vestibular system needs to be stimulated in order to get better. And these medications will often suppress the symptoms or will suppress the system in general and will delay appropriate recovery and treatment. you want to be questioning if you're being prescribed a bunch of medications for vestibular disorders. Now migraine is a whole nother story. But if the idea is to suppress the symptoms and just to make you feel better and to just make you less dizzy, these medications can be problematic and can actually delay appropriate recovery and treatment, and we'll do more content about this later on, showing the specific evidence for this and the guidelines by, for instance, the Journal of Otolaryngology and Head and Neck Surgery, did a great, publication about positional vertigo in 2017 that was basically screaming at the top of its lungs, stop prescribing Valium and stop prescribing neurological suppressants when people have positional vertigo. But of course, like anything else, there's a gap between the research and the specialist side of things and the common clinical practice. that's why we get more information out to people. So step one Look for a vestibular rehab professional. And step two, understand that if you're being recommended, surgical intervention or, you know, medications, make sure you understand why and look for a different opinion, especially if it's a surgical intervention. Make sure you really understand why, that is being recommended to you and, maybe even seek a second opinion. sometimes it can be appropriate, especially in the case of an acoustic neuroma. But the vast majority of the time, if it's a surgical intervention for a vestibular disorder, you really want to understand why don't just take it at face value. And third tip movement is The vast majority of the time, the solution for vestibular disorders and very specifically head movement and movement in general. getting up and walking and getting back to normal life, getting back to normal movement. Oftentimes people will change the way that they move. When they get vestibular disorders, they will change the way that they sleep. They will change all sorts of things. And oftentimes our job is to get people to get back to their normal movement in their life. Sleeping in a normal way, to move in a normal way. To not move in a rigid fashion. To move your head again. And this does a couple things. One, you become more desensitized to the dizziness and vertigo, and your body can recover, even without specific treatment for these conditions, you will begin to do better if you are moving more. The people who do worse when they have a vestibular disorders are the people who move less, especially when they lie down and put themselves in the bed, which is a very normal response and an understandable response when you feel this way. But if you spend your time lying down, and if you restrict your movement, if you do less, then your dizziness or vertigo or balance problems will get worse. you want to do more. You want to keep on moving and you do want to move your head. Of course, be safe. Don't be a fall risk. If you need to add a walker, add a walker. But that's also why you need to get to a Vestibular rehab professional who can help you with these problems, or at least get to a physical therapist who can help you with with an assistive device such as a walker, or help you determine whether you need a walker in the first place, or whether you can keep walking with dizziness, with balance problems without a walker. And that's that's based on the individual professional guidance of a physical therapist. But the main thing to understand is more movement is better than less movement, head movement. It specifically is the key to the vestibular system. Now, we had talked about the other parts of the vestibular system. And now that I'm talking about head movement, one of the key important areas of the vestibular system is our eyes and our vision. And how closely the vestibular system connects with our vision, it can be very hard to separate the vestibular system from our vision. In fact, I would put the vision as part of the vestibular system. And the reason is we need to be able to view the world in front of us, and our eyes need to be able to take in all this visual information while our head is moving, while other objects are moving in subtle ways or not so subtle ways in our field of vision. And our brain needs to be able to take in all this visual information. And if it can't do so appropriately, then we're going to have problems we can even get dizzy with just objects moving directly in front of us that can make us dizzy or make us feel poorly. our vision is a very important part of our vestibular system. One of the main and the fastest reflexes in our body is actually in the vestibular system that is connected with our eyes, because we need to be able to make sense of the world when we are walking and moving our head. And the world needs to be able to move, in front of us fast, And if we cannot do that, then we can become very impaired. vision is the other very important component to the vestibular system. So quick recap. First make sure that you are seeing a vestibular rehab professional. If you think you have a vestibular problem, question who you're being sent to. As far as healthcare providers, make sure you understand why you're being sent to see those people and see a vestibular rehab professional. If you are being prescribed medications or surgery, make sure you understand why. Because oftentimes those may not be the best solutions for you. They can be, but make sure you fully understand why, if those are being recommended or prescribed to you, and understand that movement is one of the key solutions to dizziness, balance and vertigo problems. If you have a vestibular disorder and a vestibular rehab professional would be the one to guide you specifically through that process. Because what you do need is very specialized individual treatment for this condition, and to be very systematically progressed through the rehab process in a way that is safe, that you do not get overstimulated and that you will get better over time. And a little bonus tip if you go to a vestibular rehab professional and let's say you're worse. You're not getting better. There is a wide range of training with vestibular rehab professionals. And just because you go to one, it doesn't work out. Seek out another one, because sometimes these individuals get their training from a weekend course or a week long course, and some of them have gotten mentoring and training over a series of years. So there can be a wide range of knowledge and understanding with each vestibular rehab professional. And the most common mistake that vestibular rehab professionals will make is Overstimulating their patients. if you get overstimulated one time is understandable. If they keep overstimulating you and you keep getting worse you just need to find a different vestibular rehab professional who understands the importance of going at an appropriate pace, and who knows how to progress the vestibular system appropriately Now, the length of treatment, it might be one and done, or these conditions can take 6 to 7 months. Sometimes in more rare situations it can be more of a lifelong journey. But the outcomes are incredible for vestibular rehabilitation. hopefully this information was helpful and impactful for you or someone you care about if it was. Subscribe to our channel. Share this someone that you care about and we'll look forward to seeing you on the next one.