Dizziness and Driving

It is not unusual for patients to ask about their ability to drive after being diagnosed with a vestibular disorder. It is a reasonable and responsible concern without a clear answer. Our litigious society dampens our ability to clear a patient when we feel that they have adequately compensated from a chronic vestibular injury, or when BPPV symptoms have resolved. 

Accidents can happen for a number of reasons with a vestibular disorder being just one.  If we clear the patient for driving and they go out and cause an accident, can we be held responsible?

Is it Safe to Drive After Dizziness Episode?

I typically deal with these questions by pointing out the above, that whatever I may think, I cannot be the one to clear them for driving. I also share my personal experience. When I experienced a vestibular neuritis two years ago, I did not drive for a month.

Even now, I still have some difficulty with visual stability when reading signs while the car is moving while also keeping my eyes on the traffic.

On the other hand, I have no problem with telling a patient when I think they are not ready to be driving. Most are accepting of this recommendation, but some are overconfident and resistant to this advice. In these cases, I make my point by writing down my cell phone number, handing it to them, and asking them to call me before they get in the car so I can make sure I am safely off the road. We both get a laugh, but they get the point.

All this sounds rather anecdotal and unscientific.  What do we know about vestibular disorders, driving, and the legal ramifications of mixing the two?  

A 2018 study based on the 2016 National Health Interview Survey found that of those respondents that identified themselves as having “vestibular vertigo” in the prior 12 months, there was a threefold increase in reported accidents when compared to similar respondents without “vestibular vertigo.”

A more recent 2019 study out of Germany, through review of insurance records, found that people with a diagnosis of Meniere’s disease or vestibular neuritis had a higher incidence of accidents than a control group. Interestingly, they did not see that the accident rate for those study patients increased in the years after diagnosis compared to the five years prior to diagnosis.  This could be interpreted a number of ways. One view may be that the vestibular disorder did not increase those individuals likelihood of having an accident. Another might be that they already had some level of vestibular disorder prior to diagnosis.

Fitness to Drive: Are There Laws on Driving While Dizzy?

A review of associated laws finds that, like most laws, there are geographic variations.  There is considerable literature from and about “fitness to drive” in Europe and European literature.

For example, in the United Kingdom, it is mandatory that any disability that might impact driving safety be reported to the DVLA (Driver and Vehicle Licensing Agency). There is a significant potential fine (over $1,000.00) if you have an accident as a result of an unreported medical condition such as “sudden, disabling or recurrent” dizziness. The DVLA site lists a number of “notifiable conditions” that must be reported when applying for a drivers’ license.

The closest thing I found to a consensus statement regarding dizziness and driving in the United States is a 1997 report of a survey of members of the American Neurotology  Society. The census indicated that there is (was?) very little support for mandatory reporting, and infrequent occurrences of reporting concern about driving to officials.