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Vestibular Paroxysmia (VP)

What Is Vestibular Paroxysmia (VP)?

Vestibular Paroxysmia (VP) is a rare balance disorder. It causes sudden, brief attacks of vertigo or dizziness. Attacks often last only a few seconds and are usually shorter than one minute. Some people have many attacks in one day.

Attacks often happen without warning. In some people, certain head movements may trigger them. VP may continue for months or years if it is not treated. It is sometimes called microvascular compression syndrome.

What is Happening in My Body?

VP is thought to be caused by irritation of the eighth cranial nerve. This nerve is also called the vestibulocochlear nerve. It carries hearing and balance signals between the inner ear and the brain.

A nearby blood vessel may touch or press against the nerve. However, this type of contact can also be seen in people without VP. The exact cause is not fully understood.

Think of the nerve like an electrical wire. When the wire becomes irritated, it may send quick bursts of incorrect signals. These signals can cause brief attacks of vertigo, imbalance, or ear symptoms.

Because of this, you may have:

  • Sudden, brief attacks of spinning or dizziness
  • Many attacks during the day
  • Unsteadiness during an attack
  • Ringing in one ear
  • A change in hearing during an attack
  • A feeling of fullness or pressure in one ear

Hearing symptoms do not occur in everyone.

It is important to know:

  • Your symptoms are real.
  • VP is rare but treatable.
  • Other disorders can cause similar symptoms.
  • Many people have fewer attacks with the right medicine.

How is Vestibular Paroxysmia Diagnosed?

There is no single test that can prove you have VP. Diagnosis is mainly based on the pattern of your attacks and how you respond to treatment.

For a diagnosis of VP, a person usually has:

  • At least 10 similar attacks
  • Attacks lasting less than one minute
  • Spinning or non-spinning dizziness
  • Improvement with certain nerve-calming medicines
  • No other condition that better explains the symptoms

A provider may consider “probable VP” when a person has at least five similar attacks that last less than five minutes.

Your provider may also order:

An MRI may show a blood vessel touching the nerve. However, this finding does not prove that you have VP because it can also be found in people without symptoms. MRI is helpful for checking for other possible causes, such as a tumor or another nerve problem.

What Your Provider May Ask

To learn more about your symptoms your provider may ask questions like the ones below. Before your appointment it may be helpful to think about, or even write down, your answers to these questions.

  • What symptoms are you having?
  • How long does each attack last?
  • How many attacks do you have each day or week?
  • Do your attacks feel the same each time?
  • Do head movements trigger your symptoms?
  • Do you notice ringing or hearing changes?
  • Which ear seems affected?
  • Do you feel unsteady during an attack?
  • What medicines are you taking?

How is Vestibular Paroxysmia Treated?

Medicine is usually the first treatment. Medicines such as carbamazepine or oxcarbazepine are often used. In VP, they help calm abnormal electrical signals from the irritated nerve. They do not treat inflammation.

Your provider will choose the medicine and dose that are safest for you. You may need blood tests to check for side effects. Do not start, stop, or change these medicines without talking to your provider.

Surgery is rarely used. It may be considered only when symptoms are severe, medicine does not work or causes serious side effects, and testing shows a clear cause that surgery may correct.

What Can I Expect Over Time?

Will I Get Better?
Many people have fewer and milder attacks after starting medicine. However, each person responds differently. Your provider may need to adjust the medicine or dose.

How Long Will It Take?
Some people improve soon after starting medicine. Others need more time or a change in treatment. Some people need treatment for months or years.

Can I Live a Normal Life?
Most people can return to their usual activities when their attacks are controlled. Until then, use care when driving, climbing, or doing other activities where a sudden attack could cause a fall.

When Should I Call My Provider?

Contact a healthcare provider right away if:

  • You have sudden hearing loss
  • Your vertigo becomes constant
  • Your symptoms are quickly getting worse
  • Your attacks are causing falls

These symptoms are not typical of VP and may be signs of another medical problem.

When Should I Get Urgent Medical Care?

Call 911 or seek emergency care if you have:

  • New weakness or numbness, especially on one side
  • Trouble speaking
  • New trouble walking
  • Double vision
  • Fainting
  • Chest pain
  • A sudden, severe headache
  • Repeated vomiting that prevents you from drinking
  • A fall with a head injury

Questions to Ask Your Provider

It may be helpful to ask your provider questions, like the ones below, to learn more about your symptoms and any possible treatments.

You can ask:

  • What may be causing my symptoms?
  • Could another condition be causing these attacks?
  • Do I need an MRI, hearing test, or balance test?
  • Would medicine be helpful?
  • What side effects should I watch for?
  • Will I need blood tests while taking the medicine?
  • Is it safe for me to drive?
  • What should I do if my symptoms change?

Key Points to Remember

  • Vestibular Paroxysmia is a rare but treatable balance disorder.
  • It causes frequent, brief attacks of vertigo or dizziness.
  • Attacks often last less than one minute.
  • It may be caused by irritation of the hearing and balance nerve.
  • Diagnosis is based mostly on your symptoms and response to medicine.
  • MRI can help rule out other problems, but MRI alone cannot diagnose VP.
  • Nerve-calming medicine is usually the first treatment.

Additional Resources