Welcome to part 2 of our 3 part series on Vestibular disorders. In part 1, we discussed some of the common symptoms of vestibular disorders, and touched on the population groups that can be affected. In part 2 we are going to explore these conditions in more detail and explain how different types of treatments can help.
Benign Paroxysmal Positional Vertigo (BPPV)
Definition: BPPV is a condition where floating calcium particles are present in the inner ear canal, have become dislodged from their usual position. These crystals migrate into one of the semicircular canals of the inner ear. When the head is reoriented, the gravity-dependent movement of these particles cause abnormal fluid displacement and can impart the sensation of vertigo (spinning room sensation).
It usually affects one side, however can occasionally be bilateral which is usually associated with trauma.
Management: BPPV is managed conservatively with the Epley Manoeuvre which can be performed by a vestibular physiotherapist. If symptoms are not alleviated after two weeks, treatment with supervised balance retraining is necessary or may require further investigation by a specialist.
Definition: Vestibular Neuritis is an acute vestibular disorder that is caused by inflammation of the vestibular nerve. This inflammation disrupts the transmission of information along the vestibular nerve. It can be viral or degenerative. A head thrust test can confirm the diagnosis to rule out a stroke.
Management: Treatment consists of supervised balance retraining to assist with imbalance/unsteadiness through the concept of central compensation. Central compensation is the central nervous system’s ability to compensate for a loss in vestibular function. Timeframes vary based on the person, and the good news is many individuals have complete resolution of symptoms.
Definition: A disorder of the inner ear that relates to a build-up of fluid in the inner ear canals that can lead to swelling and pressure with dizziness, fluctuating hearing loss and tinnitus (hearing of non-present sound).
Management: Balance retraining is important to assist with central compensation and compensation strategies can be implemented for acute episodes.
Cervicogenic Dizziness (neck-related dizziness)
Definition: This consists of dizziness associated with a musculoskeletal condition of the neck. Symptoms can include neck pain and stiffness, dizziness and headaches.
Management: For best management, manual physiotherapy is recommended once other dizziness causes have been ruled out. In addition to manual treatment, a Exercise Physiology intervention for postural retraining and strengthening of the periscapular and paraspinal musculature to prevent reaggravation of the injury would be recommended.
Presbystasis (age-related balance loss)
Definition: As we age, our balance system degenerates through the three balance pathways: vestibular, visual, and somatosensory (proprioception). A reduction in lower limb muscle strength and mobility, and increase in joint pain, along with reduced brain central processing speed lead to reduced balance and unsteadiness during walking. An increase in anxiety as a result of this can reduce confidence and lead to social isolation.
Management: Medical investigations are conducted to rule out differential diagnoses and an individual’s static and dynamic balance, lower limb strength and gait are assessed by a Physiotherapist or Exercise Physiologist. The next step is then to explore walking (gait) and balance retraining, lower limb strengthening and advice regarding activities of daily living adjustments to reduce falls risk.
The goal is not to cure, but to improve quality of life and independence.
Superior Semicircular Canal Dehiscence (SCCD)
Definition: Vertigo induced by sound or pressure due to thinning of bone overlying one of the canals of the inner ear. Chronic loss of balance when walking, dizziness with severe head movements (can be from sneezing, swallowing, etc.) and the sensation that objects are moving when they aren’t.
Management: Balance retraining can assist with reducing falls risk and to enhance quality of life.
Imbalance following ear surgery or head injury
Definition: Due to change in pressure and inflammation within the inner ear, a loss of balance can occur following surgery or trauma to the head and ear.
Management: Balance retraining can assist to reduce falls risk in these acute populations. Balance retraining is supervised by an exercise physiologist and implemented initially within the clinical gym, where the progression from static, stable surface training is built towards dynamic, unstable surface exercises allows for simulation of external factors such as crowds, uneven ground and weather within a closed environment.
Part 3 of this series will demonstrate some of the common manoeuvres and exercises that these patients are prescribed for their vestibular treatment and balance retraining.