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Jose L. Ruiz, M.D.
Dizziness and Vertigo is no laughing matter.  With proper diagnosis and treatment dizziness can be a thing of the past.  To learn more click the link below.











Testing and diagnosis can be performed at our Kissimmee , Florida location. Please Contact Us to schedule your appointment.

​Balance problems are extremely common, particularly in senior citizens. Falls are among the leading causes of fatal and non-fatal injuries in the elderly.  To learn more click the link below.

Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases it is not a serious problem, but rather a nuisance that eventually resolves.  To learn more click the link below.

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Or call 407-518-1810

"Falling is no laughing matter.  Now that I have been treated, I feel confident when I am walking around."
Dizziness and Balance Center                                                              Jose L. Ruiz, M.D.

What is “dizziness”? 
Dizziness is a term often used by patients to relate a disturbance in their equilibrium. The term is very general and can include a wide array of symptoms such as fatigue, visual disturbance, lightheadedness, confusion, vertigo, and many others. 

It is often difficult for the patient to adequately describe the symptoms. One of the goals of the physician specializing in dizziness is to gain an understanding as to what type of “dizziness” the patient has been experiencing. 

What is “vertigo”? 
Vertigo is a symptom, not a diagnosis. Vertigo is defined as the hallucination of motion. These motions can be “objective” — the patient perceives movement of the environment, or “subjective” — the patient perceives an internal sense of motion. 

Objective vertigo is nearly always related to problems of the inner ear or the ear’s complex connections to the central nervous system. Subjective vertigo can be ear-related as well but can also have numerous other causes.

What are some of the common diagnoses that can cause vertigo?

Meniere’s disease/Endolymphatic hydrops 

Meniere’s disease involves the combination of ear pressure, tinnitus, hearing loss, and vertigo, and is the result of excess pressure of endolymphatic fluid in the inner ear. However, atypical forms of Meniere’s disease may result in virtually any combination of the above symptoms. The disease typically persists for several months, and may then go into remission. The condition may then re-emerge after periods of stress, dehydration, or high salt intake. Both the hearing and balance function may diminish with such recurrences.

Meniere’s disease usually occurs in only one ear, but may involve both ears in 10% of patients.
The first stage of treatment for Meniere’s disease involves diuretics, salt restriction, oral steroids, aggressive oral hydration, allergy treatment, and avoidance of caffeine, alcohol, and stress.

The second stage of treatment involves injections of steroids or gentamicin into the ear, the minimally invasive Meniett device, or endolymphatic sac-mastoid shunt surgery.

The third stage of treatment involves such measures as a labyrinthectomy or vestibular nerve section. Fortunately, the third stage of treatment is rarely necessary.

Of note, there is considerable overlap in symptoms between migraine-associated dizziness and Meniere’s disease, and the former should be considered in patients for whom treatments for presumed Meniere’s disease prove ineffective.

Benign Paroxysmal Positional Vertigo (“BPPV”)
Occasionally, particles form or settle in one of the semicircular canals of the inner ear. The particles tend to sink to the lowest point of the canal. Certain positional changes, such as rolling to one’s side in bed, can result in reorientation of the canal in space, causing the particles to sink to the new “bottom.” This typically results in a sensation of “room spinning” that lasts for less than one minute.

Inflammation in the inner ear can result from bacterial middle ear infections or, more commonly, from viral infections. Labyrinthitis can cause rapid progression of vertigo and possibly hearing loss. The term “labyrinthitis” is also occasionally used in a generic way — to indicate that a patient’s symptoms appear to be on the basis of an unspecified inner ear disorder. 

Vestibular Neuronitis
Viral infection of the vestibular (balance) nerve can result in vertigo lasting for several days, followed by more prolonged imbalance. 

There are many less common causes of vertigo, some ear-related and some neurologic. 

What can be done about my vertigo? 

1. Diagnosis 
The first step to solving the problem of vertigo is obtaining the correct diagnosis. This is often a complicated process. The history and physical examination remain the most important elements of the evaluation. Additionally, nearly all patients should undergo hearing testing to help evaluate inner ear function. Some patients may also require other audiological testing such as brainstem auditory evoked response testing (BAER), otoacoustic emissions (OAEs), electrocochleography (ECoG) and electro-or videonystagmography (ENG or VNG). Occasionally, radiological studies such as CT or MRI may be requested as well. Not every patient requires every test. 

The specialist analyzes the information gathered from the history and physical examination as well as the various diagnostic studies in order to determine the diagnosis. 

2. Treatment 
The treatment options vary greatly with the specific diagnosis. Some available treatments include: dietary changes, oral medications, instillation of medication into the middle ear, positional maneuvers, vestibular rehabilitation (specialized physical therapy), and surgery. 


Balance problems are extremely common, particularly in senior citizens. Falls are among the leading causes of fatal and non-fatal injuries in the elderly. 

Our balance depends mostly on the function of 3 systems: 

1. Vision
Our eyes give us important information in reference to our orientation, position, and movement relative to our environment. 

2. Proprioception (position sense)
Provides information regarding our orientation relative to gravity. When a person leans, he should be able to feel the shift in pressure of his feet against the floor. Similarly, there should be some detection of leaning in the muscles of the trunk. 

3. Vestibular
The inner ear balance system is responsible for maintaining balance and equilibrium, particularly during motion. 
In general, if there is weakness in one of these systems, the remaining 2 systems should allow the individual to compensate and to maintain balance under most conditions. If the weakness in one system is overwhelming, or if there is weakness in more than one system, imbalance may result. There are numerous other health, fitness and environmental factors that can that can contribute to balance disorders. 

The primary goals of the balance evaluation are to determine which of these systems is contributing to the imbalance and to determine if there is an underlying disorder that requires treatment. 
In nearly all cases, measures can be taken to help improve balance and to reduce the risks of falls and injury.

Acoustic Neuroma/Vestibular Schwannoma

Acoustic neuromas or, more properly, vestibular schwannomas are benign growths of the balance nerves from the inner ear. They typically grow quite slowly, on the order of 1-2mm per year, and damage both hearing and balance as they do so. An MRI of the internal auditory canals and brain with and without contrast is required for definitive diagnosis.

Smaller, less symptomatic tumors may often be observed with serial MRI scans, especially in patients with limited life expectancy. Otherwise, vestibular schwannomas are treated with either stereotactic radiosurgery or formal surgical removal. The likelihoods of tumor control, facial nerve injury, hearing preservation, and functional balance vary considerably with the size and location of the individual tumor, as well as the treatment approach, and so should be discussed with a qualified neurotologist or skull base surgeon.


Terms related to Ringing in Ears:
 Ear Ringing 
 Noise, Ear 

Together with other abnormal ear noises, ear ringing is medically called tinnitus. Buzzing, roaring, and pulsitile sounds are sometimes perceived when no sound is present in persons with tinnitus. 
Tinnitus can arise in any of the four sections of the ear: the outer ear, the middle ear, the inner ear, and the brain. Tinnitus is often accompanied by hearing loss. 


What is tinnitus?
Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases it is not a serious problem, but rather a nuisance that eventually resolves. 

It is not a single disease, but a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder. In almost all cases, only the patient can hear the noise. 

What causes tinnitus?
Tinnitus can arise in any of the following areas: the outer ear, the middle ear, the inner ear, or by abnormailities in the brain. Some tinnitus or head noise is normal. If one goes into a sound proof booth and normal outside noise is diminished, one becomes aware of these normal sounds. We are usually not aware of these normal body sounds, because outside noise masks them. Anything, such as wax or a foreign body in the external ear, that blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently tinnitus. Today, loud noise exposure is a very common cause of tinnitus, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise, firearms, and high intensity music. Some medications (for example, aspirin) and other diseases of the inner ear (Meniere's syndrome) can cause tinnitus. Tinnitus can in very rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (acoustic tumor).

How is tinnitus evaluated?
A medical history, physical examination, and a series of special tests can help determine precisely where the tinnitus is originating. It is helpful for the doctor to know if the tinnitus is constant, intermittent or pulsating (synchronous with the heart beat), or is it associated with hearing loss or loss of balance (vertigo). All patients with persisting unexplained tinnitus need a hearing test (audiogram). Patterns of hearing loss may lead the doctor to the diagnosis.

Other tests, such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography scan (CT scan) or, magnetic resonance imaging (MRI scan) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus. 

What is the treatment of tinnitus?
After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is your own understanding of the tinnitus (what has caused it, and your options for treatment).

In many cases, there is no specific treatment for tinnitus. It may simply go away on its own, or it may be a permanent disability that the patient will have to "live with." Some otolaryngologists have recommended niacin to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may cause problems with skin flushing.

Causes of Ringing in Ears
 Meniere's Disease 
 Ear infection 
 Fluid in the ears 
 Medications (both Prescription and Non-prescription, notably aspirin and other nonsteroidal antiinflammatory
drugs (NSAIDs) 
 Aging (Presbycusis) 
 Ear trauma (such as from the noise of planes, firearms, or loud music) 
 Rarely, aneurysm or an acoustic neuroma (a benign tumor on the acoustic nerve). 

NOTE: The information provided on this web site is not intended to take the place of consultation with your physician. You should always consult a physician whenever you require diagnosis or treatment. All information on this site is subject to change without notice. Although the site is updated regularly, it may not yet include the most recent changes. Copyright ©2009. All rights reserved.



DESCRIPTION: ENT Doctor in Kissimmee and Orlando, FL treating Dizziness, Vertigo, Ringing in Ears, Tinnitus and Balance Disorders.

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