Vestibular Rehab Series #1: Can Vertigo Be Treated?

Dizziness

Dizziness is often used as an umbrella term to describe a variety of sensations including:

• light-headedness
• fogginess
• unsteadiness
• room spinning (vertigo)

Vertigo is a specific type of dizziness sensation described as the sense of you spinning or of the room around you spinning.  The term “vertigo” itself is a symptom, the causes/diagnosis for the symptom can vary.

If you’re experiencing vertigo symptom, a physiotherapist who has received training in vestibular rehab can assist you in the diagnosis and treatment of your vertigo.

Why do I get dizzy?

The vestibular system is part of the inner ear. When we change our head position or move our heads, the vestibular system detects the change and helps us to balance, orient ourselves and still be able to see clearly when we’re in motion. Watch the video here

When the system is not working properly, different conditions may develop. One of the conditions may be benign paroxysmal position vertigo, or BPPV.

What is BPPV?

BPPV is the most common cause of vertigo. Out of all the patients seen for vertigo, BPPV accounts for 20-30% of the cases. And the incidence in the general population is ~ 2.5%.

Let’s break the name down a bit more before we go into the details.

• Benign suggests the condition is not harmful in nature.
• Paroxysmal means that the symptoms comes and goes.
• Positional means the symptoms are provoked by position changes of the head, most commonly by looking up, lying down flat quickly, bending forward, and rolling in bed. Each BPPV episode should last no longer than one minute.

If you have had experiences such as “every time I look up to change a light bulb I get vertigo” or “I get vertigo when I quickly lie down on my couch”, keep reading and you’re very likely going to find out how to get your symptoms treated!

What causes BPPV?

Although the exact cause of BPPV still remains unknown, we do see a strong correlation between the onset of BPPV and people who fall into the following categories:

• over the age of 50
• experienced head trauma (concussion, car accident)
• experienced inner ear trauma (ear surgery)

And we have a well-developed explanation for the mechanism behind it!

To understand the mechanism, we first need to understand the anatomy and function of the inner ear. So, let’s take a look at the picture below:

Figure 1. Inner ear anatomy

There are three loopy tubes in our inner ear called semicircular canals (posterior, superior, and horizontal). The tubes are filled with a fluid that has motion sensors in it. These tubes are in charge of detecting rotational head movements (turning head side to side).

The structures next to the 3 tubes, utricle and saccule, contain crystals called otoconia. Those crystals also have motion sensors that detect linear head movements (looking up and down). Normally, when we move our heads, the motion sensors in those structures detect the movement and send signals to our brain, and our brain coordinates our body parts, eyes, and ears accordingly, so we feel steady when we move.

BPPV happens when the crystals are displaced and float into one of the three tubes. The motion sensors in the inner ear are now sending inaccurate signals to the brain, so the brain is coordinating inaccurately as well. It results in vertigo (sense of spinning), nystagmus (repetitive movement of your eyes), and sometimes nausea.

How is vertigo diagnosed?

Vertigo can be diagnosed by a physiotherapist trained in special assessment techniques.  When I see you in the clinic, I will ask you a few questions about the history of your vertigo:

• Have you had any head or inner ear trauma?
• Do you experience vertigo when you change your head position (turning in bed, looking up, etc.)?
• How long does each episode typically last?
• Does anyone notice that your eyes move repetitively (nystagmus) during the vertigo episode? Such as in this video
• Do you have a history of neck pain or migraine? (This may indicate there’s something more to your vertigo than BPPV, and I will assess with additional tests and and treat it differently depending on the diagnosis)

During the physical examination, a few special tests will be performed in order to help me understand which tube is involved. During this process, a positive test will reproduce your typical vertigo symptoms.

Once we determine the involved structure, we can go directly into performing a repositioning technique that will put the crystals back. The vertigo usually is resolved within 3 repetitions of the technique. The course of the treatment for BPPV generally takes a few visits.

 Other causes of dizziness

When your symptoms and the findings of the physical examination does not indicate BPPV, we will look into other potential diagnosis such as:

• Vestibular neuritis
• Labyrinthitis
• Migraine associated vertigo
• Meniere’s disease
• Etc.

Treatment strategies for those diagnoses are different from those of BPPV, and you can often still benefit from physiotherapy treatments.

Can vertigo be treated?

If you suspect that your vertigo is BPPV, or are unsure of the diagnosis, contact me, Tiffany Shi, Registered Physiotherapist,  at tshi@orthophysio.com, or simply call us at 416-925-4687 to book a vestibular assessment.