Vertigo is the sensation of spinning—even when you're perfectly still, you might feel like you're moving or that the room is moving around you. Most causes of vertigo involve the inner ear ("vestibular system"). Often times people feel like they have to take a couple of minutes to focus before they can resume their activity. In most cases dizziness worsens with positional changes. Vestibular disorders can result in difficulty with hearing or seeing and may even result in falls. In more severe cases people may have difficulty with going into crowded areas where lots of movement and noises are occurring and normal activities of daily living such as driving, reading, changing positions, walking, and stairs become challenging.
Problems within the vestibular system can occur at any age and is becoming increasingly frequent in children as a result of concussions and post- traumatic head injury. It is more common in middle aged and older adults from immune system dysfunction, common colds, infections, fluid buildup within the ear, neuritis. It also frequently occurs in patients with MS, post stroke, and other central or brain related injury.
One of the most common forms of vertigo is benign paroxysmal positional vertigo (BPPV), an inner-ear problem that causes short periods of a spinning sensation when your head is moved in certain positions.
So what is Vertigo?
What is the vestibular system and how is it related to balance?
Balance is dependent on 3 systems within the body.
Visual (eyes- input to the brain about what we see)
Vestibular (inner ear- input to the brain about the movement that we are performing, spacial orientation, and equilibrium)
Proprioception (receptors found within joints that send information to the brain about positioning)
These three systems combined allow us to move with balance and coordination. Any dysfunction in one of these systems will result in decreased balance and a higher risk of falls. Many people struggle with balance and dizziness every day because of decreased input from the ears about our orientation in space and equilibrium with movement.
Causes of Vertigo
Some of the most common causes include:
BPPV (benign paroxysmal positional vertigo) occurs when tiny calcium particles (canaliths) clump up in canals of the inner ear. This blocks the inner ear from sending signals to the brain about head and body movements relative to gravity. Without these signals, your brain is unable to help you keep your balance.
BPPV can occur for no known reason and may be associated with age.
Meniere's disease is an inner ear disorder thought to be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss.
Vestibular neuritis or labyrinthitis is an inner ear problem usually related to infection (usually viral). The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance
Less often vertigo may be associated with:
- Head or neck injury
- Brain problems such as stroke or tumor
- Certain medications that cause ear damage
- Migraine headaches
How can Physical Therapy help?
Physical therapy is the leading way to correct vertigo and peripheral vestibular dysfunction. Physical Therapy has been shown to decrease dizziness and increase balance for patients that have vestibular dysfunction. Medication has been shown to decrease dizziness but has not shown to improve balance and coordination.
During your initial exam we can:
- Identify where the dysfunction is occurring within the inner ear
- Improve the integrity of the signals that are being sent back to the brain through observation of eye movement
- Work to alleviate your symptoms with re-alignment of the rocks within the canals.
- Address the amount of stimulus that is being sent from your ears to the eyes also called the VOR reflex.
Your comprehensive evaluation may include several tests to determine the best treatment options for your vertigo. These test may include: Dix-Hallpike test, Supine Roll test, Shaking head tests, etc.
Once the affected side and canal are diagnosed, we can then select an appropriate canal positioning maneuver. The most common canal affected is the posterior canal. We may use an Epley Maneuver or a Semont Maneuver if this canal is affected. When the horizontal canal is affected, Lempert maneuver or barbecue roll may be used to reposition the otoconia back into the uticle and saccule.
Once your otoconia are housed where they are intended to be (in the uticle and saccule) your therapist will work with you on a variety of specialized exercises to help you re-establish your dynamic stability, postural stability, and gaze stability to help you get back to normal day to day activities.