The etiology of dizziness and balance problems is very broad, making the diagnosis and treatment difficult.  The inner ear (vestibular system) helps to control our balance in conjunction with our brain, eyes and musculoskeletal system.  Vertigo is the sense of movement of either ones self or the surrounding environment and must be differentiated from imbalance that is less often related to inner ear pathology.  Common causes of inner ear vertigo are benign paroxysmal positional vertigo (BBPV), viral labyrinthitis, Meniere's disease and less common tumors of the vestibular system.  Central causes of vertigo must also be excluded such as migraine associated vertigo, cerebellar stroke, multiple sclerosis and vertebrobasilar insufficiency.

Assessment of balance disorders typically begins with a thorough history and physical exam including a detailed neurologic exam.  Most inner ear balance disorders can be identified by history alone.  Additional testing to diagnose vestibular problems often involves a hearing test (audiogram) and occasionally electronystagmography (ENG).  An MRI scan is ordered if there is question of a brain tumor, stroke or if other central findings are recognized.