Vestibular/Balance and Dizziness
Benign Paroxysmal Positional Vertigo
Benign Paroxysmal Positional Vertigo (BPPV) is characterized by spells of vertigo (the perception of spinning or moving when your body is still), lasting less than one (1) minute that occurs when the patient moves the head into particular positions. Typically this occurs with looking up, lying down or rolling over in bed. This particular type of vertigo is caused by a problem with the balance system of the inner ear (the labyrinth).
It has been thought that debris (called otoconia or “ear rocks”) break off due to a jarring of the inner ear and subsequently collects in the inner ear – thus causing significant dizziness. We now know there are many different potential reasons for these otoconia to get dislodged and your physical therapist should be able to identify these with a careful and detailed assessment. Vertigo or dizziness may be triggered by numerous conditions such as medicine, hypotension, viruses, or neurologic conditions. Other vertigo, imbalance, or dizzy conditions involving a dysfunction in the vestibular system may also benefit from physical therapy and vestibular rehabilitation and habituation exercises.
How is BPPV diagnosed?
The physical therapist performs a history, physical assessment and balance tests. Special tests, such as the Dix-Hallpike test are performed to determine the side of involvement (confirmed by the observation of oscillating eye movements). If indicated, further diagnostic testing can be ordered – such as an EMG or MRI.
How is BPPV treated in Physical Therapy?
Certain exercises may be helpful with some people. Various kinds of physical maneuvers have proved helpful, such as Canalith repositioning maneuvers. Lastly, it is important to perform a complete assessment of the cervical and cranial base regions to identify any joint or soft-tissue dysfunctions that may be contributing to the patient’s symptoms.
Are there any risks with BPPV treatment?
A few patients may experience nausea while the canaliths are being repositioned. It is possible that short term dizziness may occur right after the treatment, but there is usually immediate relief from the “spinning” sensations.
Vestibular Neuritis and Labyrinthitis
Vestibular neuritis affects about 15% of all complaints of vertigo and is the second most common cause of vertigo, it seems to be viral in cause; the symptoms of vertigo are usually preceded of up to 2 weeks prior, by a viral infection affecting the respiratory or gastro intestinal systems. The infection causes damage or neuritis, usually to one of the two vestibular nerves; these are the nerves that supply the inner ear. It can also be caused by damage to the brainstems vestibular nucleus.
Symptoms of both vestibular neuritis and Labyrinthitis include dizziness, vertigo, sometimes prolonged rotational vertigo, and a feeling of imbalance and nausea. Symptoms maybe acute and constant initially and as symptoms become established become that of a hypo or decreased function of the vestibular system. Rapid head movements can trigger symptoms but is not as consistent a pattern of triggers as with BPPV.
Often symptoms of motion sensitivity and hypo-function remain with rapid eye and head movements to the affected side with symptoms of vertigo and imbalance. Recovery from these conditions is from central nervous system compensation which will be aided with a program of vestibular rehabilitation.
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