TREATING VERTIGO AND VESTIBULAR DISORDERS

What is Vertigo?

Vertigo is the feeling as if you or the world around you is spinning. It may be accompanied by nausea, headache, or loss of balance. Sometimes these symptoms are barely noticeable, and at other times they can affect your ability to function or perform your activities of daily living. There are many possible triggers for dizziness; often it occurs following dental work or a hair appointment. Other possible causes include an injury, illness, or disease process that is affecting the inner ear or the vestibular nerve. Fortunately, many causes of dizziness and imbalance can be successfully treated with physical therapy.

What Causes Vertigo?

Inside your ear are three semicircular canals and two small otolith organs that are filled with fluid, lined with small hairs, and contain calcium carbonate crystals. When you move your head and body, the fluid in your inner ear shifts the small hairs, sending signals to your brain about where you are in space. These vestibular signals work together with what your eyes see to help you maintain your balance. When debris, injury, or disease affects the small hairs or changes the movement of the crystals, it sends a spinning signal to your brain—that’s vertigo.

What is BPPV?

The most common type of vestibular disorder is Benign Paroxysmal Positional Vertigo (BPPV). It causes a sense of spinning when a person’s head changes position in relation to gravity. Often, people experience episodes of spinning when rolling over in bed, washing their hair, looking up, or turning their head quickly to look at something. BPPV is triggered by displacement of the crystals in the inner ear. BPPV often occurs without an apparent cause, or it can occur after a head trauma (including concussion). Read more about BPPV here. BPPV is diagnosed and treated with a simple positioning maneuver that is done in the clinic. Here is a video of Andrea Myers, PT, DPT, performing this maneuver, called the Dix-Hallpike Maneuver:

Could Something Else Be Making Me Dizzy?

Vestibular disorders can be caused peripherally, by something affecting your inner ear, or centrally, by something affecting your brain or brain stem. Other possible causes of dizziness and vertigo include:

  • Migraines or Vestibular Migraines
  • Cervicogenic dizziness
  • Concussion or head injury
  • Inner ear infection: labyrinthitis, vestibular neuritis
  • Inflammation or impingement of the vestibulocochlear nerve
  • Medications
  • Postural hypotension
  • Meniere’s Disease
  • Stroke
  • Secondary endolymphatic hydrops
  • Perilymph fistula
  • Tumors, acoustic neuroma
  • Superior canal dehiscence
  • Ototoxicity
  • Demyelinating disease, like Multiple Sclerosis
  • Grinding your teeth
  • Stress, anxiety, or trauma

For more information, check out the Vestibular Disorders Association’s (VEDA’s) website.

How Can Physical Therapy Help You?

Vestibular rehabilitation uses specific maneuvers and exercises to help you recover from your symptoms. One example is the Epley Maneuver, or canalith repositioning, for symptoms of BPPV. Your therapist guides you through a sequence of specifically timed head and body turning movements. These movements reposition those tiny crystals in your ear. When the crystals fall back into place, the dizziness stops. Evidence shows that vestibular physical therapy is the gold standard and most effective form of treatment for relieving symptoms of BPPV.

Other vestibular physical therapy treatments include Habituation Exercises, Liberatory or Semont Maneuver, Lempert Maneuver, Gufoni Maneuver, Cawthorne-Cooksey Exercises, Brandt-Daroff Exercises, and other vestibular exercises customized by your therapist for you. These exercises are typically a series of specific eye movements and head movements in different positions and with different activities. The exercises work by stimulating the brain to adapt to the imbalance between your inner ears.

After a careful evaluation and assessment, your specialized physical therapist will work with you to develop a comprehensive physical therapy program customized to meet your goals. Schedule an appointment with one of our vestibular therapists today!

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