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Vertigo can throw your whole world upside down

Updated: Sep 26, 2022

The following information is intended for patients who suffer from or have been diagnosed with conditions affecting the vestibular system.



Why physiotherapy?

Physiotherapy plays a important role in the treatment and management of acute and chronic vestibular conditions. This is done through individualized treatment plans including visual and proprioceptive training and exercises. The treatment plans focus on the head, body and eyes to reduce symptoms associated with vestibular dysfunction. Vestibular rehabilitation is focused on returning you to your normal life without the disabling symptoms that vestibular dysfunction can cause. However, not all physiotherapist have been trained in this specialized field which requires further studies and practical hands-on experience. Make sure your physiotherapist has a special interest in the treatment of vestibular disorders and has furthered their education to ensure you get the best treatment.


The following are some common symptoms of vestibular issues:

Dizziness (a feeling of lightheadedness and imbalance which might be accompanied by visual disturbances)

Vertigo (The awful feeling of a turning motion when you’re perfectly still)

Imbalance (The state of being out of equilibrium)

Extreme nausea,

Difficulty in walking,

Poor coordination.


Vestibular issues can arise from a number of different causes such as. Let us briefly discuss the most common vestibular diagnosis we come across in the practice.

1. BPPV (Benign Paroxysmal Positional Vertigo)

3. Labyrinthitis

4. Vestibular neuritis

5. Vestibular migraines


Most episodes of vertigo occur spontaneously and can be triggered by something as benign as rolling over in bed (a very common description by clients). It is often accompanied by involuntary eye movements called nystagmus.


1. Benign Paroxysmal Positional Vertigo or BPPV is the most common cause of vertigo or the false sensation of movement.

Benign – it is not life-threatening

Paroxysmal – it comes in sudden, brief spells

Positional – it gets triggered by certain head positions or movements

Vertigo – a false sense of rotational movement



Who is affected?

It is most often occurs spontaneously between the ages of 50 and 70. In younger individuals, it is usually due to impact to the head, ie. Bumping your head or as a result of a fall or motor vehicle accident.


What happens in the ear causing BPPV?

Your inner ear is a complex labyrinth of compartments and canals that contain fluid called endolymph. The inner ear canals sense movement of the head through the movement of the fluid and help you balance your head and focus your eyes on moving objects. Small particles (Otoconia) in your inner ear are being dislodged due to the head trauma or it can occur spontaneously. When the small partcles become dislodged they move through the fluid causing the sensation of movement whilst you are at rest. The vestibular system also has input from the nerves of your eyes – this is why BPPV causes involuntary jerking of the eyes called nystagmus.


Should you seek help if I have these symptoms?

Yes!

Although most episodes of vertigo are benign, it is important to rule out other causes of vertigo or dizziness like neurological disorders, stroke, inner ear infection. It is also important to know that BPPV will not give you constant vertigo or dizziness that isn’t affected by movement. Vertigo due to BPPV is triggered by certain movements and once you stop moving, after a short period the vertigo will stop.

Your general practitioner or ER physician may be able to assess and treat vertigo due to BPPV, however, they usually refer on to someone that specializes in the assessment and treatment of vestibular problems. This can be a physiotherapist and/or audiologist, trained in VRT (Vestibular Rehabilitation Therapy), neurologist or Ear Nose and Throat specialist.


Physiotherapy treatment for BPPV

The treatment of choice depending on the canal that is affected is the Canalith Repositioning Procedure (Epley maneuver). The Dix Hallpike Maneuver is frequently used to diagnose the affected inner ear canal. Your treatment will also be accompanied by balance exercises and oculomotor (eye muscle and head movement) exercises if needed.

It is important to understand that repositioning procedures and exercises will challenge your vestibular system and could initially elicit symptoms. The symptoms will decrease as your progress with the exercises.


How many treatments do I need?

The amount of treatment sessions are dependent on each individual’s reaction to treatment. It usually takes 4 – 6 treatments using the repositioning maneuver for the symptoms to subside. Once you have had BPPV, there is always a greater chance that the ear stones will become dislodged causing symptoms again. However, many clients never have a recurrence after treatment is finished. Should your symptoms recur, it is best to seek the guidance of a health care professional trained in vestibular disorders for an assessment .


If you need more information regarding the assessment and treatment of vertigo as a result of BPPV contact our physiotherapist trained in vestibular rehabilitation at 0646617764 or book online at physioXpert.co.za with Toy van Rensburg.


2. Meniere’s disease

This is not a very common pathology and the symptoms are very complex and include spontaneous episodic attacks of Vertigo, fluctuating hearing loss, tinnitus and a feeling of fullness of the ear.

Physiotherapy is not indicated


3. Vestibular neuritis

This condition is caused due to a viral infection the herpes virus affecting the nerve to the inner ear. Vestibular neuritis typically presents with sudden vertigo, dizziness, extreme nausea and vomiting. The dizziness usually last for days with gradual improvement, dizziness caused by head movement could last for months. BPPV may also be present vestibular neuritis. This condition is not accompanied by hearing loss.

Physiotherapy Treatment is indicated if BPPV is present, and when the Vertigo settles down a rehabilitation program to help the patient retraining their balance.


4. Labyrinthitis

This condition is caused due Labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear. As per Vestibular neuritis, Labyrinthitis typically presents with sudden vertigo, dizziness, extreme nausea and vomiting. The dizziness usually last for days with gradual improvement, dizziness caused by head movement could last for months. BPPV may also be present vestibular neuritis. This condition is accompanied by hearing loss, differentiating it from vestibular neuritis.

Physiotherapy Treatment is indicated if BPPV is present, and when the Vertigo settles down a rehabilitation program to help the patient retraining their balance.


5. Vestibular migraines

Vertigo (dizziness), usually lasting minutes to hours, but sometimes days.

Symptoms include unsteadiness and loss of balance.

Patients are sensitive to motion.

Treatment: Migraine medication (physiotherapy not indicated for vertigo, only if the patient needs balance rehabilitation).

This might be present without a headache.

Our Physiotherapists are trained to address vestibular or balance conditions by implementing specific movements and exercises after an in-depth assessment.


Watch the following video to learn more about Vertigo:




If you are suffering from any of the above-mentioned conditions, book an appointment so we can help you. You can book online www.physioxpert.co.za or you can give us a call on 0646617764.



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