Vertigo - General Information
What is Vertigo?
Vertigo is the sensation that the room is spinning. It it a symptom, not a diagnosis
What is Dizziness?
Dizziness is described more as feeling lightheaded, floating, or feeling "off".
What causes Dizziness?
Dizziness can be caused by a number of things such as changes with your:
- Brain
- Heart
- Vision
- Medications
- Diabetes
- Blood Pressure
What causes Vertigo?
Vertigo can be caused by changes with your brain, a clogging of the large arteries in your neck, migraines, concussion, or a reaction to certain medications. Very commonly, vertigo can be caused by a problem with your vestibular (inner ear) system.
Is there treatment for Dizziness and Vertigo?
YES!!! With dizziness, the true cause needs to be addressed by your family doctor (or specialist) first. With vertigo, the treatment depends on the specific diagnosis causing it. You may need the help of an Ear Nose and Throat Specialist, or a Neurologist for a diagnosis. A Vestibular Therapist may be able to help you with a diagnosis.
What are some of the common inner ear disorders that cause Vertigo?
BPPV:
This stands for Benign Paroxysmal Positional Vertigo.
- Benign – not life threatening
- Paroxysmal – sudden attacks, commonly with no cause
- Positional – triggered by head position changes
- Vertigo – spinning sensation
What is it?
We have naturally forming calcium crystals in our inner ears – they are so tiny you can’t even see them on an MRI! Their job is to tell our brain where our head is in space when we move it side to side or up and down. With BPPV, the crystals have come out of place and moved from their sacs into one of the 3 canals above them. They then start to send incorrect signals to the brain, causing us to feel like we’re spinning with slight movements.
What causes it?
For people aged 50 or younger, the most common cause of BPPV is a head injury. It also happens frequently after a whiplash injury. For people over the age of 65, the most common cause is that there is no cause! You just wake up one morning and there it is!
What are the symptoms?
People with BPPV describe short intermittent episodes of vertigo when moving their head in certain positions. They feel like the room is spinning when they look up or down, lay flat in bed, or roll to their right or left while laying in bed. The spinning is short lived – though it often doesn’t feel like it at the time! It tends to last less than a minute at a time but can come on with each head movement. Sometimes, people with BPPV feel dizzy for a while afterwards and the episodes can cause nausea, vomiting, and a loss of balance.
What is the treatment?
Your trained medical practitioner will do what is called a “crystal repositioning maneuver” to move the crystals back into their rightful spot. There are different maneuvers depending on which canal the crystals have snuck into. Most commonly, the crystals are in the back canal and an “Epley” maneuver is done to put them back into place.
Is it curable?
Most of the time, yes. When done correctly, the Epley maneuver works 90-98% of the time to put the crystals back into place. Often, only one treatment is needed but sometimes 3 or 4 maneuvers are required. Occasionally, the crystals are not moveable in which case gaze stability, adaptation, and balance exercises are the treatment. Sometimes, the body recovers on its own and the crystals reposition themselves!
Meniere’s Disease (also known as Primary Endolymphatic Hydrops):
What is it?
It is a disorder where there is an abnormal buildup of fluid in the inner ear. Sometimes, the inner ear temporarily fills up with fluid from a cold, ear infection, or allergies. This is called “Secondary Endolymphatic Hydrops”.
What causes it?
It is not known for sure what causes Meniere’s Disease. There are theories that it is a circulatory problem, an autoimmune disorder, or possibly genetic.
What are the symptoms?
People with Meniere’s Disease tend to experience constant vertigo for hours at a time. They feel nauseas, sometimes vomit, lose their balance, and feel dizzy. They often feel a heaviness or pressure sensation in their ear and hear a ringing sensation, called tinnitus. Hearing loss is common – especially low frequency.
What is the treatment?
People with Meniere’s Disease are often given medications to help them through their episodes. Vestibular suppressants (medication that calms the signals from the inner ear to the brain) such as Serc or Betahistine are used during an acute episode to help reduce nausea and dizziness. Some doctors put their patients on diuretics (medication that helps the body to get rid of fluid) as well. People with Meniere’s often have to avoid foods that can cause fluid buildup or changes such as salt, sugar, caffeine, and alcohol. When the spinning subsides and an acute attack is over, Vestibular Therapy can help. We retrain the brain to understand the signals coming from the inner ear, we retrain your gaze stability, and we help you with balance exercises. Much of your therapy can be done at home independently.
Is it curable?
Unfortunately, no. The medications can help in the short term and the exercises can help in the long term but at present there is no cure for Meniere’s Disease.
Labrynthitis:
This can also be called a Neuritis or Neuronitis. It is the second most common vestibular disorder.
What is it?
Labrynthitis is an inflammation of the vestibular and cochlear nerves that supply the inner ear. A Neuritis or Neuronitis occurs when only the vestibular nerve is affected.
What causes it?
It is usually caused by a viral or bacterial infection.
What are the symptoms?
People with Labrynthitis can experience constant vertigo for days. They are severely nauseated, vomit, dizzy, and lose their balance. They often feel like they are being “pulled” towards their good side and complain of tinnitus and hearing loss on one side. People with Neuritis typically experience less severe attacks and do not have hearing loss.
What is the treatment?
In the acute phase, doctors will often prescribe vestibular suppressants (medications that calm the signals from the inner ear and the brain) to help reduce the symptoms. If it is caused by a bacterial infection, antibiotics may also be prescribed. Once the attack subsides, Vestibular Therapy can help. We retrain the brain to adapt and compensate, we retrain your gaze stability, and we help you with balance exercises. Much of your therapy can be done at home independently.
Is it curable?
Sometimes the symptoms of a Neuritis can completely resolve once the infection is treated or runs its course. In more severe cases of Neuritis or Labrynthitis, there is some permanent damage to hearing or the vestibular system. Vestibular exercises can help with the dizziness, nausea, difficulty focussing, and loss of balance.
I don’t have a diagnosis!!
You are not alone. Many people with inner ear conditions do not have a diagnosis. It can be very difficult to diagnose what is causing the problem in the inner ear and many people get a general diagnosis such as “Vestibulopathy”. This simply means that there is a problem with the vestibular (inner ear) system. Your Vestibular Therapist can help guide you along the process of treating your disorder and if unable to diagnose your condition, make recommendations regarding which medical practitioners may be able to provide a potential diagnosis.
For more information on these conditions or other vestibular conditions please visit www.vestibular.org for the Vestibular Disorders Association (VEDA) website.
What should I expect at my first appointment?
- Your vestibular therapist will explain everything in detail before doing any testing.
- The appointment starts with a history taking where we ask you questions regarding your symptoms.
- We then test your eye focussing ability, some of your reflexes, your coordination, and your balance.
- When we get to the testing of BPPV, we do a maneuver that involves leaning backwards that can sometime set off your symptoms. If this happens, it is usually brief but patients sometimes feel off for a while afterwards. If we do not think you are experiencing BPPV, this testing can be deferred.
- Plan for at least an hour of one-on-one time with the therapist. Time allowing, your treatments will begin at your first appointment.
How do I prepare for my first appointment?
- A doctors referral is not required by us; however, your insurance company may ask for one for reimbursement purposes.
- We ask that you bring in a list of medications you are currently taking.
- You will need to have someone drive you home afterwards as sometimes people feel “off” with some of the testing we do.
- You may not feel up to going to work right away so plan accordingly.
- If we have treated you for BPPV, we ask that you avoid laying flat for 8 hours afterwards. You may need to avoid booking any dentist or hairdresser appointments the day you see us.
How many appointments will I need?
- This all depends on your diagnosis.
- If you are suffering from BPPV, sometimes only one treatment is needed.
- If you have Meniere’s, Labrynthitis, or another vestibular disorder it is a longer process.
- Many of the exercises we give can be performed independently at home and we are here to monitor, adapt, and advance your exercises as necessary.