When you hear the word dizzy... what do you think of?

- Spinning?

- Vertigo?

- Light-headed?

- Off balance?

- Foggy?

- Nausea?

- Faint?

Interestingly, all of these words can be used to describe dizziness, however each of them can be caused by very different things. Let's focus on one of these descriptors-“VERTIGO”.

Vertigo is a type of dizziness that means a false sense of spinning or an illusion of motion. This is often caused by an inner ear problem affecting our vestibular system. Overall, vertigo from a vestibular problem accounts for a third of all dizziness and vertigo symptoms reported to health care professionals. One recent large epidemiological study estimated as many as 35% of adults aged 40 years or older- over six million Canadians- have a vestibular problem at some point in their lives. Furthermore, adults with some form of inner ear dysfunction are up to 12 times more likely to have a serious fall.

What’s even more important than these stats, however, is that when properly diagnosed, vestibular therapy can be an extremely effective treatment for many vestibular disorders. Although someone suffering from vertigo may not always appear that they are suffering, it can be very debilitating and impact every aspect of their life.

What is a vestibular disorder?

The vestibular system includes parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. If disease or injury damages any one part of this system, a vestibular disorder can result. Vestibular disorders can also result from or be worsened by genetic or environmental conditions, or occur for unknown reasons.

What are common causes?

1. BPPV

This is considered the most common vestibular disorder. It stands for:Benign (not life threatening) Paroxysmal (it comes in sudden, brief spells) Positional (triggered by certain head positions or movements) Vertigo (a false sense of rotational movement). BPPV is a mechanical problem in the inner ear and occurs when tiny calcium bicarbonate crystals dislodge from their chamber and enter into one or more of the 3 semi-circular canals (where they are not supposed to be) causing positional vertigo (ie. when laying down in bed, rolling over in bed, looking up or down).

BPPV can occur for no good reason and may be associated with age. People will often describe its occurrence as "I work up one morning and it was there." There are a few additional risk factors outside of age including migraine, inner ear infection or disease, diabetes, osteoporosis, intubation (presumably due to prolonged time lying in bed) and reduced blood flow, as well as a possible correlation with one’s preferred sleep side, however we don’t always know why one might get it over someone else.

Can this be treated?

YES! Although BPPV can spontaneously resolve on its own, treatment is often needed. Once the diagnosis is made and the ear/canal identified from the assessment, treatment is directed at moving the crystals out of the canal and repositioning them back to their chamber.

In typical cases and when treated by a trained vestibular therapist, BPPV treatment has a success rate of >95%! It is important to note that BPPV does NOT cause constant dizziness even at rest and unchanged with head movement, hearing loss, headache or other neurological signs/ symptoms (numbness/tingling, trouble speaking, coordinating movements) ** If you are experiencing any of these additional symptoms, tell your health care provider immediately.

2. Vestibular neuritis and labyrinthitis

These are disorders resulting from an infection that causes inflammation of the inner ear or the nerves connecting the inner ear to the brain. These symptoms include vertigo, dizziness, and difficulties with balance, vision, or hearing. Infections of the inner ear are usually viral but can be bacterial. Such inner ear infections are not the same as middle ear infections, and cannot be detected by a doctor simply looking into your ear (as they cannot see into the inner ear).The onset of symptoms are usually very sudden. This can be very scary and often people will end up in the emergency room or seeing their physician on the same day. Once the inflammation settles and a period of gradual recovery occurs (this may take several weeks), some people can be completely symptom free. However, others have chronic dizziness if the virus has damaged the vestibular nerve. People suffering from these chronic symptoms often become frustrated because although they may look healthy, they don’t feel well. Simple day to day activities can be challenging (ie walking in a store, using a computer, being in a crowd, standing in the shower with their eyes closed, or turning their head to talk to someone). It can affect their ability to work and concentrate, impacting their overall quality of life.

Can this be treated?

YES! Vestibular trained therapists use various tests while monitoring the eyes' response (the eyes are a window to the inner ear). Special goggles can be used to help detect abnormal eye movement that may no longer be seen in room light and which can aid in accurate diagnosis of a vestibular dysfunction. After an evaluation, a personalized vestibular rehabilitation exercise program is prescribed. Most of these exercises can be performed independently at home, although the therapist will continue to monitor and modify the exercises. The exercises may provide relief immediately, but a noticeable difference may not occur for several weeks. Many people find they must continue the exercises for years in order to maintain optimum inner ear function, while others can stop doing the exercises altogether without experiencing any further problems. A key component of successful adaptation is a dedicated effort to keep moving, despite the symptoms of dizziness and imbalance. Sitting or lying with the head still, while more comfortable, can prolong or even prevent the process of adaptation.   

Although only two possible causes of vertigo were discussed here, physical therapists with training in vestibular rehabilitation are competent in diagnosing and treating common vestibular disorders, and/or ruling out a vestibular cause to their symptoms. Treatment plans will always look to address any secondary problems that may be present related to vestibular disorders such as persistent dizziness or postural instability as part of a comprehensive care plan, as well as make appropriate referrals when needed.

At Momentum Health and Evidence Sport and Spine, we value collaboration and the importance of communicating assessment findings and a proposed treatment plan amongst the various health care providers involved in order to provide optimal patient-centred care.

Article by Tanielle Garcia, PT, MPT, BKin(Hons), Trained in Vestibular Rehabilitation, BDN, Physiotherapist at Evidence Sport and Spine