Common Vestibular Disorders
1. Benign Paroxysmal Positional Vertigo (BPPV)
- Dizziness is thought to be due to debris free floating within the inner ear which triggers dizziness when in certain positions.
- Symptoms of BPPV include dizziness or vertigo (sensation that the room is spinning around you), lightheadedness, imbalance, and nausea
- Symptoms are often provoked when getting out of bed, laying flat, or rolling over in bed.
- People often feel dizzy looking up or when bending down to pick up objects from the floor.
- An intermittent pattern is common.
- Diagnosis is made through history and physical exam.
- ENG testing may be utilized to look for characteristic nystagmus (jumping of eyes.)
- Treatment consists of maneuvers that are intended to move the debris out of the sensitive part of the ear into a location where the debris can dissolve.
- Treatment lasts approximately 15 minutes following diagnosis of BPPV
- The Semont maneuver involves a procedure in which a patient is quickly moved from lying on one side to lying on the other side.
- The Epley maneuver involves a series of head and body movements designed to move the debris through the inner ear canal.
- The patient will be instructed on positioning precautions to be followed after the treatment session.
- Follow-up is required one week post repositioning maneuver to assure improvement in symptoms.
2. Peripheral Vestibular Loss
- These patients report dizziness at a lightheaded and imbalance sensation that results from a deficit in the vestibular-occular reflex.
- The vestibular ocular reflex enables one to stabilize their eyes and gaze while performing head and body movements
- When the two ears detect head and body movement at a different rate, nystagmus is produced, giving one a sensation of lightheadedness or imbalance.
- Vestibular rehabilitation is an exercise approach to remediating disequilibrium and dizziness symptoms associated with peripheral vestibular pathology.
- It involves an exercise program to promote compensation of the central nervous system for the deficits within the inner ear.
- Patients are asked to perform a short exercise program at home two to three times daily.
- The patient then follows up with the physical therapist one time every week to every other week to advance the home exercise program as needed.
Treating Vestibular Disorders With Vestibular Rehabilitation Therapy (VRT)
- Patients with inner ear disorders are often referred to physical therapy for treatment of imbalance and movement related dizziness.
- Symptoms result from pathology within the vestibular system that reduces a person’s ability to move within the home and environment without imbalance or vertigo.
- Dizziness often interferes with one’s ability to perform daily activities, including household management and employment, significantly reducing one’s quality of life.
- Patients often complain of decreased balance on compliant surfaces or in the dark and often when walking in a visually distracting environment
- Dizziness is a symptom of a deficit within the peripheral or central nervous system.
- Vestibular rehabilitation is designed to decrease dizziness, increase balance function and increase general activity levels.
Unfortunately, not all individuals benefit from Vestibular Rehabilitation Therapy, including:
- People with low blood pressure
- People with medication reactions
- People who have suffered transient ischemic attack (TIA)