Common Vestibular Conditions

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a very common biomechanical dysfunction of the semicircular canals of the inner ear which most commonly occurs insidiously but can be associated with head trauma, previous infections, prolonged bed rest, or sometimes results following dental work.  Symptoms arise when calcium carbonate crystals (otoconia) located within the utricle dislodge into one or more of the canals, sending false and conflicting signals of movement to the brain.  This results in transient episodes (less than 1 minute) of severe vertigo (the world spinning) when the head is turned or when there is a change in position or posture (eg. rolling in bed, getting out of bed in the morning or bending forwards).

The severity of symptoms may subside over time but are likely to persist if untreated.  A Vestibular physiotherapist can assess and identify where the crystals are located and subsequently treat the condition with a tailored Canal Re-positioning Techniques in order to effectively resolve your symptoms.

Vestibular Neuritis (Neuronitis) & Labyrinthitis

Vestibular neuritis and labyrinthitis are conditions arising due to inflammation of the vestibulocochlear nerve, which connects the inner ear to the brain. Inflammation most commonly arises from a viral infection (such as influenza or herpes) localised to one ear and affects the nerve’s ability to transmit both hearing and balance information from the vestibulocochlear apparatus. This often results in an abrupt onset of varied symptoms such as constant vertigo, nausea, vomiting, severe balance disturbance, difficulty with visual tracking and hearing changes or ringing.  Symptoms often mimic more concerning causes such as stroke, and therefore many people tend to present to the Emergency Department when such symptoms arise.  Diagnosis is often via a process of elimination of more sinister causes. Vestibular rehabilitation exercises can be an effective treatment and should be commenced as soon as possible. Often a short course of steroids can also be beneficial and may be administered by a medical practitioner.

Meniere's Disease (Endolymphatic Hydrops)

Meniere's Disease is a chronic disorder characterized by unpredictable transient attacks of vertigo with associated tinnitus and hearing loss.  It is thought that symptoms evolve from an abnormal accumulation of excessive fluid (endolymph) within the inner ear.  It is currently unclear as to what exactly triggers acute attacks, but too much salt, excessive stress and fatigue may have an impact. The condition can develop at any stage of life, and both symptoms and attacks can vary in severity, duration and frequency throughout the course of the disease.  Treatments currently are limited but recommendations consist of low sodium and water diets, medication targeting vertigo and nausea, and vestibular rehabilitation therapy to improve balance.

Acoustic Neuroma (Vestibular Schwannoma)

An Acoustic Neuroma is a benign tumour which grows on the Vestibulocochlear Nerve - the nerve that gives us hearing and inner-ear-related balance. The tumour gradually grows, causing worsening balance, dizziness, hearing loss, and tinnitus (ringing in the ear). If it grows large enough it can also affect the Trigeminal and Facial nerves, causing pain, numbness or even paralysis on one side of the face. If tumours grow large enough they can become life-threatening.

Surgery is commonly recommended to remove the tumour (and in some cases, the entire nerve), but it is common to continue to struggle with symptoms afterwards. In certain cases, other interventions or a “watch-and-wait” approach may be recommended. Vestibular rehab is important in each of these cases to help to optimise a patient’s balance and dizziness symptoms. Even if the nerve is badly damaged or surgically removed, the brain can be trained to compensate somewhat, which improves symptoms significantly.

Vestibular Migraine

Migraine is a very common condition with varying symptoms, severity and degrees of disruption to people’s lives. The “vanilla” version involves headache with throbbing or pounding, sensitivity to noise or light, motion sickness, and nausea/vomiting. In reality, migraines do not always have a headache, which is one reason why approximately 50% of migraines are never properly diagnosed. Migraine symptoms can also change over the course of a person’s life. A Vestibular Migraine (VM) is a migraine that involves dizziness, vertigo (a false sense of motion), loss of balance, or sensitivity to movement of the eyes, head or neck. It may be idiopathic (no known cause) but is also more common in people with other inner-ear disorders.

VM is usually managed with a combination of: (1) identifying and minimising an individuals’ triggers. (2) medication, usually prescribed by a neurologist. (3) vestibular rehabilitation exercises, aimed at improving balance and retraining the brain to better-cope with movement. It is common for VM sufferers to have neck pain, and there is often a “chicken-and-egg” relationship between VM and neck pain. Therefore, rehab also may include hands-on treatment to the neck, as well as exercises for improve flexibility, strength and control.