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Article Summary

While vestibular disorders can affect anyone, military personnel are exposed to unique risk factors for inner ear damage. Possible causes of vestibular disorders that may be prevalent in military settings include traumatic brain injury and neurotoxic vestibulopathy, particularly from certain prescribed antimalarials. The path to diagnosis for military personnel and veterans generally goes through your primary care physician (PCP). However, not all PCPs are trained to recognize vestibular disorders. You may find it helpful to educate yourself about the symptoms of a vestibular disorder so you can communicate this clearly with your PCP.

Vestibular Impairment & Military Service

While vestibular disorders can affect individuals of any age, background, or profession, military personnel are exposed to unique circumstances that can put them at risk for certain types of inner ear damage.

Symptoms of a Vestibular Disorder

The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. If the system is damaged by disease, aging, or injury, vestibular disorders can result. Common symptoms include:

  • Vertigo and dizziness
  • Imbalance and spatial disorientation
  • Vision disturbance
  • Hearing loss and tinnitus
  • Cognitive and/or psychological changes
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Tinnitus

Tinnitus is a ringing, hissing, whistling, buzzing, or clicking sound and can vary in pitch from a low roar to a high squeal. Most cases are associated with damage to the auditory (hearing) system, although it can also be associated with other events or factors, such as jaw, head, or neck injury; exposure to certain drugs; nerve damage; or vascular (blood-flow) problems. Prior to receiving any treatment, it is important for a person to have a thorough examination that includes an evaluation by a physician and audiological testing.

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Symptom Tool

To help point you in the direction of some possible causes for your symptoms, you can use an online tool like the Isabel Symptom Checker, a medical knowledge system that takes a set of symptoms and presents you with a list of possible diagnoses that could be the cause of those symptoms. Each diagnosis is linked to knowledge resources to help you read up on the disease and learn more about it so you can discuss it with your healthcare professional.

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For Your Doctor Visit

To get the most out of your doctor’s visit it is helpful to assess and record your symptoms and your medical history. VeDA makes it easy by providing you with tips and tools you can download, including:

– Medical History Form
– Questions for Your Doctor
– How to Choose a Vestibular Healthcare Specialist

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Common Causes of Vestibular Dysfunction in Soldiers & Veterans

Possible causes of vestibular disorders that may be prevalent in military settings include traumatic brain injury, BPPV, and neurotoxic vestibulopathy, particularly from certain prescribed antimalarials. Symptoms of posttraumatic stress disorder (PTSD) may also confound the diagnosis of vestibular disorders.

TBI

The risk of blast exposure to deployed US military service members is significant. Traumatic brain injury (TBI) is a frequent consequence of blast exposure. Dizziness is a common clinical finding in people with blast-induced TBI.

Many US military service members who have been exposed to blasts in Iraq and Afghanistan complain of symptoms consistent with peripheral vestibular pathology such as vertigo, gaze instability, and motion intolerance.

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BPPV

Benign Paroxysmal Positional Vertigo (BPPV) occurs when tiny calcium carbonate crystals in the inner ear become loose and move into one of three semi-circular canals, which can happen as a result of a hit to the head or for other reasons. The primary symptom of BPPV is vertigo, often reported as a spinning sensation, which is triggered by movement and changes in position. BPPV can be effectively treated with the appropriate mechanical maneuvers performed by a qualified healthcare professional.

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Antimalarials

Neurotoxic vestibulopathy is a common but under recognized outcome following use of the neurotoxic antimalarial drug, mefloquine (also known as Lariam). In 2013, the FDA cautioned that neurological effects from mefloquine, to include dizziness, loss of balance, or ringing in the ears, could be permanent. Other possible impacts include fatigue and cognitive problems. Mefloquine has been widely used by U.S. military personnel since its introduction in the 1980s, such as during operations in Somalia in the early 1990s, during Operations Iraqi Freedom (OIF) beginning in 2003 among personnel deployed to Iraq and Kuwait, and during Operation Enduring Freedom beginning in 2001 among personnel deployed in Afghanistan, and in related operations in Africa and Southeast Asia. As documentation of mefloquine prescribing was often poor, many military personnel will not have evidence of the drug in their medical record. A history of exposure to mefloquine should be assumed if the military service member reports taking a once-weekly tablet that is white slightly smaller than dime-sized, for prevention of malaria.

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PTSD & Vestibular Disorders

PTSD and vestibular disorders share many common symptoms, such as anxiety, headaches, difficulty concentrating, and social withdrawal. Soldiers diagnosed with PTSD may also have an underlying vestibular disorder.

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Psychological Resources

Anxiety, depression, brain fog, and fatigue are common complaints among people with vestibular dysfunction. You are not alone. Learn more about the mind-body connection and tools that can help you calm your nervous system so you feel more in control of your thoughts and actions.

Peer-Support

You are not alone. Living with a vestibular disorder can sometimes make you feel like your life is upside-down, literally and figuratively. It can be overwhelming to know where to start on the road to recovery. Support groups provide space for you to ask questions and learn in a non-judgmental and safe environment. Participants know that everyone attending the meeting understands and has compassion for the functional difficulties of getting through each day. Online support groups allow you to connect with others regardless of your physical location.

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What to do if you suspect your vestibular system is damaged

The path to diagnosis for military personnel and veterans generally goes through your primary care physician (PCP). However, not all PCPs are trained to recognize vestibular disorders. You may find it helpful to educate yourself about the symptoms of a vestibular disorder so you can communicate this clearly with your PCP. Becoming an advocate for your own healthcare can greatly improve your chances of receiving an accurate diagnosis during the early stages of your condition.

  1. Educate yourself about vestibular symptoms and diagnosis.
  2. Download a dizziness and balance medical history questionnaire; fill it out and bring it with you to your PCP appointment.
  3. Ask your PCP for a referral to a medical facility that can perform comprehensive vestibular testing (see below for a list of military hospitals with vestibular testing capabilities). You may also request a referral to a civilian balance center (see VeDA's provider directory).
  4. Visit your local Veterans Service Office to engage the help of a Veteran Service Officer (VSO), who can represent you should you request disability status from the VA.

Resources for military personnel & veterans

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References

  1. Scherer, MR, Schubert MC. Traumatic brain injury and vestibular pathology as a comorbidity after blast exposure. Phsy Ther. 2009; 89:980-992.

  2. Defense Centers of Excellence Clinical Recommendation for Assessment and Management of Dizziness Associated with Mild TBI, September 2012.

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