Dizziness, Vertigo and Disequilibrium

The importance of balance 

Our brain’s balance and equilibrium system is one of the most important systems in the human body. This system integrates sensory input from the eyes, ears, muscles and joints. It allows us to feel grounded, oriented and physically engaged with the environment around us.  So, when there is a disruption in this process, dizziness, vertigo and balance disorders are often the result.

Our approach

Our approach begins with a detailed health history and comprehensive neurological examination, followed by on-site diagnostic testing to objectively evaluate your visual, vestibular and somatosensory systems. This allows us to understand how your brain is processing information from your environment and how it relates to your sense of balance and movement. Additional laboratory testing may also be provided to screen for underlying health conditions and physiological imbalances which can also cause symptoms of dizziness. With this information we will be able to identify where your symptoms are coming from and be able to customize a treatment plan that is specific to your needs. Click HERE to learn more about diagnostic testing for balance and dizziness disorders.

Dr Rachman Chung offers cutting edge dizziness treatment in San Francisco, CA


Each year, 2.5% of all ER admissions in the US are due to dizziness. Dizziness itself is a unspecific term which can mean different things to different people. Some may feel faint and unsteady on their feet, while others may have the sensation of floating or being on a boat. Some may even experience an unexplained anxiety or fear related to riding in cars or navigating crowded environments in places such as grocery stores or restaurants.

Before we dive into the story of "dizziness symptoms,“ there’s one more thing; although the information below will help you clarify and understand the symptoms you may be experiencing, it is not a replacement for a health professional exam. So, please don't try to diagnose and treat yourself without the guidance of an expert.

In general, dizziness symptoms can include the following:

  • unsteadiness

  • poor balance

  • disorientation

  • visual tracking issues

  • gaze stability issues

  • light-headedness

  • tinnitus

  • hearing loss

  • brain fog

  • nausea

  • confusion

  • illusion of motion

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Causes of dizziness, vertigo and disequilibrium.

The cause of vestibular disorders can be due to a problem within the peripheral or central part of the brain. The peripheral meaning the inner ear. And the central meaning the neural networks within the brain which process sensory information.

Click HERE to learn more.


Vertigo is defined as an illusion of spinning. Some patients report that it feels like their body is rotating
in the space, while others describe it feels like the “outer world“ is rotating around their body. Remember that feeling after the merry go round? That’s vertigo! Vertigo may be accompanied by other symptoms such as nausea, vomiting, tinnitus, fullness in the ear, loss of balance, headache, or others.

Imbalance (disequilibrium)

Imbalance is often described as a difficulty or inability to walk straight. Some patients describe it as
a sensation of an impending fall or if their body is tilted to the ground. Sometimes the symptom can be very subtle. For example, some people have no problems with balance except when it’s completely dark, and they have nothing to hold to.

Falls can be the direct result of dizziness, balance issues or a lack of sensory input from the skin, muscles and joints. While they are the are the leading cause of death and disability in the senior population, falls are also the number one cause of injury across all age ranges.


Faintness is the feeling as if you may pass out or lose consciousness at any moment. Others describe it as
“lightheadedness.” This can occur due to insufficient blood supply to the brain. There are many conditions which can
cause faintness, some of them are benign while others require immediate medical attention.

Fall-Risk Screening

Fall-risk screening is important at every age when one is experiencing symptoms of dizziness or balance problems due to the increased risk of fall related injuries. It is especially true for elderly individuals to receive regular screening in order to prevent falls and to provide early detection of neurological conditions or other chronic health conditions which can impair one’s balance and equilibrium. Click HERE to learn about Fall-Risk Screening.

If you're dizzy-consult an expert

Studies estimate 10-20% of the US population have symptoms of dizziness. Unfortunately, despite how prevalent these symptoms are, only 50% of patients receive a diagnosis when they visit their doctor. And this is not because physicians don’t care. It’s because dizziness and balance problems can be caused by numerous conditions.  Also, additional delays in diagnosis and treatment can occur when patients are not referred out to receive diagnostic tests which are more specific for evaluating the balance and equilibrium systems. These tests include audiometry, computerized posturography and videonystagmography.


Medications for acute symptom management and vestibular rehabilitation is the standard course of care. With that said, make sure you receive a physical and neurological examination, blood work and diagnostic testing to ensure that you are taking the right medication for the right reasons. Even if you do take medications, vestibular rehabilitation should be performed to assist with improving your balance and motor skills and to ensure the best recovery. 

Anti-nausea, motion-sickness medications and benzodiazapenes can be helpful for managing acute symptoms of dizziness, vertigo or vomiting. However, since most medications act as suppressants to the vestibular system and can prevent the brain’s ability to recover--these should only be used when necessary.

If your symptoms are caused by conditions which require pharmaceutical medications, Dr. Chung will referral you to the appropriate specialist for this care.

Vestibular Rehabilitation (VRT)

Is a therapeutic exercise model which incorporates specific movements and sensory-motor therapies involving the head, eyes and body. The types of movements prescribed will be based on the cause of your symptoms and the functional imbalances which were identified throughout your exam and testing.  VRT has been shown to improve the symptoms caused by peripheral and central vestibular disorders by promoting central mechanisms of adaptation, habituation and compensation.

Vestibular rehabilitation aims to achieve the following goals:

(list by Emedicine: Vestibular Rehabilitation)

  • Improve balance

  • Minimize falls

  • Decrease subjective sensations of dizziness

  • Improve stability during locomotion

  • Reduce over dependence on visual and somatosensory inputs

  • Improve neuromuscular coordination

  • Decrease anxiety and somatization due to vestibular disorientation

The exercises prescribed are customized to your functional deficits, activities of daily living and athletic performance goals. They should be challenging and progress in level of difficulty and complexity your function improves. The initial phase of treatment begins with in office visits and home-based exercises which should be performed at least 3 times per day in order to promote neural plasticity within the brain and body. Follow up testing and symptom questionnaires will be provided to monitor progress and to further modify and improve your therapeutic goals.