DIZZINESS / VESTIBULAR PROBLEMS
As a child, spinning until you were dizzy was great fun. But otherwise, finding the room spinning when you get out of bed isn't pleasant at all.
The word "dizzy" is used to describe everything from feeling faint or light-headed to feeling weak or unsteady. Dizziness that creates the sense that you or your surroundings are spinning or moving is called vertigo. There are a few disorders that may produce this symptom that your physiotherapist is able to help you with.
Keeping your sense of balance depends on your brain processing a variety of information from your eyes, your nervous system and your inner ears. However, if your brain can't process signals from all of these locations, if the messages are contradictory, or if your sensory systems aren't functioning properly, you may experience dizziness and loss of balance.
Dizziness is one of the most common reasons older adults visit their doctors. Aging increases the risk of developing any of several conditions that may cause dizziness. Although it may be disabling and incapacitating, dizziness rarely signals a serious, life-threatening condition. Treatment of dizziness depends on the cause and your symptoms.
Signs and symptoms
Characteristics of dizziness may include:
- A sense that you or your surroundings are spinning or moving (vertigo)
- A loss of balance
- Difficulty concentrating
- Blurred vision after quick head movements
Top of page
Under normal circumstances, your sense of balance is controlled by a number of signals that your brain receives from several locations. They include your eyes that determine where your body is in space and how it is moving, your sensory nerves that send messages to your brain about your body movements and positions and lastly your inner ear. The vestibular labyrinth is your organ of balance in the inner ear that has many canals including: the semicircular canals; the utricle; and the saccule, that are filled with fluid and fine, hair-like structures that sense and monitor all movements of your head.
Good balance depends on at least two of these three sensory systems working well. For instance, closing your eyes while washing your hair in the shower doesn't mean you'll lose your balance. Signals from your inner ear and sensory nerves help keep you upright.
However, if your central nervous system can't process signals from all of these locations, if the messages are contradictory, or if the sensory systems aren't functioning properly, you may experience loss of balance.
Top of page
Dizziness may have a number of potential causes. These may include:
- Vertigo - the false sense of motion or spinning - is the most common symptom of dizziness. Sitting up, moving around or looking up may make it worse. Sometimes vertigo is severe enough to cause nausea and vomiting.
- Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in your inner ear (vestibular system), which sense movement and changes in your head position. Abnormal rhythmic eye movements (nystagmus) almost always accompany vertigo. Causes of vertigo may include:
- Benign paroxysmal positional vertigo (BPPV). BPPV involves intense, brief episodes of vertigo associated with a change in the position of your head, often when you turn over in bed, sit up in the morning or look up to the ceiling. It occurs when normal calcium carbonate crystals (otoconia) break loose and fall into the wrong part of the canals in your inner ear. When these particles are moved when your head is moved, they stimulate sensors in your ear, producing an episode of vertigo. Health professionals are not exactly aware of what causes BPPV, but it may be a natural result of aging and can also be caused by trauma to the head. For treatment see treatment section.
- Inflammation in the inner ear. An acute infection in the inner ear, either the vestibular nerve or the labyrinth (acute vestibular neuronitis or labyrinthitis) can produce inflammation that will result in a sudden, intense vertigo that may persist for several days, with nausea and vomiting. It can also cause acute hearing loss in one ear. It can be incapacitating, requiring bed rest for 1-2 days to minimize the signs and symptoms. However, as soon as you are able to move around without vomiting, then movement is BENEFICIAL. Fortunately, vestibular neuronitis generally subsides and clears up on its own. Recovery time may be shorter with vestibular rehabilitation exercises that your physiotherapist can assist you with. Although the cause of this condition is unknown, it may be a viral infection.
- Meniere's disease. This disease involves the excessive build-up of fluid in your inner ear. It may affect adults at any age and is characterised by sudden episodes of vertigo lasting 30 minutes to an hour or longer. Other signs and symptoms include the feeling of fullness in your ear, buzzing or ringing in your ear (tinnitus), and fluctuating hearing loss. The cause of Meniere's disease is unknown.
- Vestibular migraine. People who experience a vestibular migraine are very sensitive to motion. Dizziness and vertigo caused by a vestibular migraine may be triggered by turning your head quickly, being in a crowded or confusing place, driving or riding in a vehicle, or even watching movement on TV. A vestibular migraine may cause feelings of imbalance or unsteadiness, hearing loss, "muffled" hearing, or ringing in your ears (tinnitus). Attacks of migrainous vertigo can last from a few minutes to several days.
- Chronic Neck Pain. Chronic neck pain sufferers who have had very limited movement of their neck over an extended period of time can occasionally develop vertigo when their neck movement is increased with treatment of their neck. Symptoms are generally experienced when moving their head into the new movement that has been gained through therapy. This may be due to the adaptability of the vestibular system. The vestibular system adapts to the limited movement of the head over time when there is neck pain, so when the neck movement is improved, the vestibular system occasionally needs to adapt once again. Vestibular rehabilitation exercises shown to you by a physiotherapist can help this system to adapt faster and therefore reduce symptoms.
- Acoustic neuroma. An acoustic neuroma (schwannoma) is a non-cancerous or benign growth on the acoustic nerve, which connects the inner ear to your brain. Signs and symptoms of an acoustic neuroma may include dizziness, loss of balance, hearing loss and tinnitus.
- Rapid changes in motion. Riding on roller coasters or in boats, cars or even airplanes may on occasion make you dizzy.
- Other causes. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke, brain hemorrhage or multiple sclerosis.
If you experience any of these symptoms please visit your health care professional for an in-depth assessment of your problem to ensure that you get the correct treatment for you condition.
Top of page
Feeling of faintness (presyncope)
"Presyncope" is the medical term for feeling faint and light-headed without losing consciousness. Sometimes nausea, pale skin and a sense of dizziness accompany a feeling of faintness. Causes of presyncope include:
- Drop in blood pressure (orthostatic hypotension). A dramatic drop in your systolic blood pressure â€” the higher number in your blood pressure reading â€” may result in light-headedness or a feeling of faintness. It can occur after sitting up or standing too quickly.
- Inadequate output of blood from the heart. Conditions such as partially blocked arteries, dissected arteries, disease of the heart muscle, abnormal heart rhythm or a decrease in blood volume may cause inadequate blood flow from your heart.
Loss of balance (disequilibrium)
Disequilibrium is the loss of balance or the feeling of unsteadiness when you walk. Causes may include:
- Inner ear (vestibular) problems. Abnormalities with your inner ear can cause you to feel like you are floating, have a heavy head or are unsteady in the dark.
- Sensory disorders. Failing vision and nerve damage in your legs (peripheral neuropathy) are common in older adultsand may result in difficulty maintaining your balance.
- Joint and muscle problems. Muscle weakness and osteoarthritis - the type of arthritis that involves wear and tear of your joints - can contribute to loss of balance when it involves your weight-bearing joints. This is increased when pain is involved as this causes the muscles around the painful joints to weaken and therefore add to the feeling of loss of balance.
- Medications. Loss of balance can be a side effect of certain medications, such as anti-seizure drugs, sedatives and tranquillisers.
Top of page
When to seek medical advice
See your doctor if you experience any unexplained, recurrent or severe dizziness. Although it's uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:
- A new, different or severe headache
- Blurred vision
- Hearing loss
- Speech impairment
- Leg or arm weakness
- Loss of consciousness
- Falling or difficulty walking
- Numbness or tingling
- Chest pain or rapid or slow heart rate
Doctors can usually determine the cause of dizziness. Doing so may require a consultation with an ear, nose and throat (ENT) specialist or a neurologist. But even if no cause is found or if your dizziness persists, prescription drugs and other physiotherapy treatment may make your symptoms more manageable.
Top of page
Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident. You may also experience long-term consequences if an existing health condition that may be causing your dizziness goes untreated.
Health professionals base treatment of dizziness on the cause and your symptoms.
- BPPV. Treatment of BPPV is with canalith repositioning, a simple procedure that involves your doctor or physiotherapist manoeuvring the position of your head. The goal is to move the loosened particles in your ear to a place within your ear where they won't cause dizziness and will be reabsorbed into your body's fluids. The success rate of this procedure may be as high as 90 percent. You may need to have the procedure repeated.
- Inner ear conditions. Balance retraining exercises (vestibular rehabilitation) are used to treat acute vestibular neuronitis or labyrinthitis. These are exercises you learn from a physiotherapist and then do at home. This rehabilitation involves movements of your head and body to correct loss of balance.
- Meniere's disease. Treatment of Meniere's disease involves reducing your body's retention of fluids through diuretics or dietary changes, such as a low-salt diet. Occasionally, surgery is an option.
- Vestibular migraine. To combat vertigo associated with a vestibular migraine, your doctor will likely try to help you determine and avoid the triggers for your attacks. He or she may suggest that you avoid certain foods, reduce stress in your life, develop a regular sleep pattern and practice aerobic exercise. You may also be taught specific rehabilitation exercises by your physiotherapist to help make your balance system less sensitive to motion. Certain medicines may help prevent attacks of migrainous vertigo or make them less uncomfortable by providing relief for nausea and vomiting.
- Anxiety disorders. Your doctor may suggest counselling to help you deal with your anxiety and manage your dizziness.
- Other contributing health conditions. Your doctor will recommend treatment of an existing disease or disorder that may be causing or contributing to your dizziness, such as ear infection, stroke, heart problems or multiple sclerosis.
Top of page
Vestibular Rehabilitation - Why is therapy needed?
If the brain cannot rely on the information it receives from the vestibular system, a person's ability to maintain posture and co-ordinate balance can become overly dependent on vision or on the information received from the muscles and joints (proprioception).
This can lead to developing new patterns of movement to compensate for the change and to avoid head movements that are apt to create symptoms of dizziness and nausea. For example, a person might swivel the entire body rather than just the head in turning to look at something, or might always look down at the floor to avoid what appears as a confusing swirl of activity.
Unfortunately, these types of adaptation can result in headache, neck pain, muscle stiffness, general fatigue, and a decrease in the ability to retrain the brain to adjust to the vestibular problem, hence making the symptoms much worse.
The goal of Vestibular physiotherapy rehabilitation is to retrain the brain to recognize and process signals from the vestibular system in coordination with information from vision and proprioception. This often involves desensitizing the balance system to movements that provoke symptoms.
What happens during vestibular therapy?
A qualified physiotherapist will first perform a thorough evaluation. This includes observing posture, balance, movement, and compensatory strategies.
Using the result of this evaluation, the therapist will develop an individualized treatment plan that will include exercises to be performed both in the therapy department and at home and that combine specific head and body movements with eye exercises. Many times, treatment may also include increasing activities and exercise in order to strengthen muscles and increase tolerance for certain stimuli.
Some of the exercise and activities may at first cause an increase in symptoms, as the body and brain attempt to sort out the new pattern of movements. But with time and consistent work, the coordination signals from the eyes, proprioception, and vestibular system will occur.
How does therapy help?
In most cases, balance improves if the exercises are correctly and faithfully performed. Muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease or disappear. Many times, vestibular physiotherapy is so successful that no other treatment is required.
If surgery is required to correct an inner ear problem, therapy will also be an important part of treatment. A physiotherapist may perform a vestibular evaluation before surgery, make visits during the hospital stay to help with the temporary increase in balance problems that often accompanies surgery, and may provide a series of simple exercises to do for home care after discharge from the hospital. Often, physiotherapists provide further therapy after a person has recovered from the surgery.
Top of page
If you experience dizziness, consider these tips:
- Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
- Sit or lie down immediately when you feel dizzy.
- Avoid driving a car or operating heavy machinery if you experience frequent dizziness.
- Use good lighting if you get out of bed at night.
- Walk with a cane for stability.
- Avoid using caffeine, alcohol and tobacco. Excessive use of these substances can restrict your blood vessels and worsen your signs and symptoms.
- Work closely with your doctor and physiotherapist to manage your symptoms effectively.
Top of page