Vertigo is a sudden sensation that your surrounding is spinning or that you feel unsteady. Most common description used by patient is "feeling dizzy" or walking "wobbly". Depending of the cause, vertigo is characterized by brief to persistent episodes of mild to intense dizziness mostly associated with changes in head positions. In a number of cases, dizziness is accompanied by nausea, light headedness and unsteadiness.
Vertigo is commonly associated with problems in the inner ear. The inner ear, aside from its function of hearing, contains our vestibular apparatus which monitors movements/rotation of your head and your head's position in space. It's also responsible for our equilibrium or sense of balance. The inner ear also helps you to stabilize your gaze at an object while your head is moving. Each ear has its own vestibular apparatus that works in unison with one another, and disruption of one, causes mismatch of signals to brain, creating disequilibrium and vertigo. Vertigo can also arise from problems in your brain such as stroke or injury.
Benign Paroxysmal Positional Vertigo (BPPV) is the most common disorder that can cause vertigo. It is characterized by short episodes of dizziness lasting not more than 30 seconds often experienced after changing position of your head. It commonly occurs when you move your head in certain direction, lie down from upright position, turning over in bed, bending over, turning head or sitting up in bed in the morning. You may also feel out of balance when standing or walking. Our inner ear contains 3 loop-shaped structures called semicircular canal that contains fluid and hair-like sensors that monitors rotation of your head. Also, it contains otolith organs that contain crystals making you sensitive to movements. For various reasons, these crystals can be dislodged and move into one of the semicircular canals, making the semicircular canal sensitive to head position changes it would not normally respond to. As a result you become dizzy. Other causes of vertigo includes: minor to severe blow to the head, injury to the nerve that goes into the inner ear, inner ear infection, tumor (acoustic neuroma), antibiotic toxicity, poor circulation and natural aging process. Vertigo is occurs most often in people age 60 or older.
Sign and Symptoms of BPPV include dizziness, sense of spinning, lightheadedness, unsteadiness, loss of balance, nausea and vomiting. These symptoms come and go and usually last only for less than a minute. Episodes of BPPV and other forms of vertigo can disappear for some time and then come back. Abnormal rhythmic eye movements called nystagmus usually accompany the symptoms of BPPV. It is often hard to observe nystgamus by just looking at the eyes. The physician may ask you to wear special goggles to observe for nystagmus. The direction of the nystagmus will help your physician determine which ear has the BPPV.
During the initial onset of vertigo, you may feel extremely dizzy, nauseated and out of balance, that you may want to go to the hospital. Physicians can sometimes determine the cause of BPPV or other forms of vertigo, It may require a consultation with an ear, nose and throat (ENT) specialist or a neurologist (specializes in brain and nervous system). But commonly, no specific cause of BPPV can be determined. Your doctor may do a series of test to determine the cause of your dizziness. If the cause of your vertigo is hard to diagnose through physical examination, your doctor may order additional testing such as Magnetic Resonance Imaging (MRI), Electronystagmography (ENG) or Videonystagmography (VNG). The latter two is used to determine any abnormal eye movements. Vertigo is treated by medications that control the dizziness and you may be referred to physical therapy for vestibular rehabilitation.
What Physical Therapy can do for you
To help relieve BPPV, the physical therapist may treat you with a series of movements known as the canalith repositioning maneuvers. These consist of several simple maneuvers for positioning your head. Each position is maintained for 30 seconds or until the symptoms subside. The goal is move the dislodged crystals from the semi-circular canal back to the vestibule that contains the otolith organs, where these crystals do not cause problems. After the procedure, you must avoid lying flat or putting your head in extreme bent position. The therapist will provide you with home instructions, as well, as home exercises. You will be taught how to perform the procedure to yourself so you can do it several times before seeing your therapist again.
Balance training is also part of the physical therapy treatment. The physical therapist will provide you with various activities that put challenge to your balance system, consequently improving it. Activities will be initially very simple, and as your balance improves, activities will be more difficult and complicated. You may begin balance training while standing and then progressed to walking; you start with your eyes open and then closed, and initially with feet far apart then close together. Early in the training, you will be in a flat stable surface like the floor but eventually, you will be progressed to unstable surface such as foam or tilt boars.
Joann Duka, PT |
