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Rocking

Timothy C. Hain, MD, Most recent save: July 21, 2016

Introduction:

Rocking vertigo means that one has a sensation of movement such as on a boat. Practically, there may be a sensation of periodic rotation, or a sensation of sway. The rocking sensation is rarely accompanied by true vertigo (i.e. spinning). Sometimes these patients are called "rockers".

Causes:

Little is know about the cause of rocking sensation. In theory, it might be due to disturbance in the vertical semicircular canals of the inner ear (see figure above), due to a disturbance in the sensors for linear acceleration, the otoliths, or a disturbance in the central connections of these structures. As presently our ability to test these structures is very limited, it is difficult to be sure. In this regard, considerable recent progress have been made in assessing the otoliths (VEMP testing).

Considering known causes,

Rocking, like most types of dizziness, is usually worse when individuals are under stress.

rocking1
Diffusion image showing low blood flow in parietal operculum, associated with rocking symptom.

 

Diagnosis:

Persons with rocking should be examined by a physician with expertise in inner ear disorders as well as neurological disorders. An example is the practice associated with the author of this page (Chicago Dizziness and Hearing). Most very large cities in the US have a medical practice of this type.

Testing that may be recommended can include:

  1. ENG test
  2. ECOG
  3. Hearing test
  4. VEMP of the brain test (where available, including both SCM and ocular type)
  5. MRI scan
  6. Blood tests including FTA, Sed-rate, anti-thyroglobulin and TPO antibodies, ANA

Additional testing may be suitable for individuals in which Meniere's disease is a strong possibility.

Treatment:

Treatment is usually symptomatic. Benzodiazepines, such as klonopin usually are very effective, but of course are also addictive. SSRI (such as paroxitine) or SNRI type antidepressants (such as venlafaxine) are also often worth considering, in very low doses. Vestibular rehabilitation therapy should also be tried.

References:

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Copyright August 3, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on August 3, 2016