CAUSES

Meniere’s disease

It is a disorder of the inner ear, which is characterized by episodes of hearing loss and fullness in one ear, tinnitus, and vertigo. Meniere’s disease is caused by increased pressure of the inner ear fluid. If not treated timely, Meniere’s disease can lead to progressive hearing loss. Meniere’s disease usually affects one ear, but it may be bilateral in 15% of cases.

 

Vestibular Neuritis

Vestibular Neuritis is caused by a viral infection leading to inflammation of the vestibular nerve. The inflammation disturbs the balance function and causes dizziness. The dizziness symptom is accompanied by blurred vision, nausea, vomiting, and difficulty in focusing during head movement. Vestibular Rehabilitation should be started at the earliest to help attain rapid recovery.

 

Otolithic Disorders

Damage to the otolith organs (utricle and saccule) causes disequilibrium of the body and affects visual stability. Until recently, there was no precise method to check the impairment of otolith organs. But now Otolith disorders can be diagnosed with the Subjective Visual Vertical test and VEMP. Otolith stimulation through vestibular rehabilitation therapy works well in treating the disorder.

 

Vestibular Migraine

10% of the population is affected by a migraine, most of them are women. The most common presentation of a migraine is headaches. But in a vestibular migraine, the patient has dizziness which may be associated with headaches. A severe headache coupled with dizziness indicates a vestibular migraine. Along with the spinning sensation associated with headaches, motion sickness and hypersensitivity to light and sound prominently show up in the patient. A vestibular migraine is controlled with diet and lifestyle modifications. In cases of frequent dizzy spells, migraine prophylaxis is prescribed.

 

BPPV

The unusual movements of carbonate crystals from their chamber into fluid-filled semicircular canals disturb the way the balance nerve senses gravity and adjusts its movement. The result is vertigo or the sensation of spinning. BPPV is a common cause of vertigo. It is seen more frequently in the older population, after an ear infection, head injury, surgery, or after prolonged rest. But often the trigger is unknown. Thecanalith repositioning exercises are the best method to cure dizziness caused by BPPV in which the offending particles are repositioned according to the type of BPPV by maneuvers like EpleyManoeuvre, SemontManoeuvre, etc.

 

Labyrinthitis

The infection causes labyrinthitis in the labyrinth of the inner ear leading to vertigo, hearing loss, and tinnitus. The difference between labyrinthitis and vestibular neuritis is; in labyrinthitis both vestibular and cochlear nerves are affected and cause dizziness, ringing in the ear, and hearing loss. While in Vestibular neuritis only the vestibular nerve is affected leading to vertigo but the hearing ability is not affected. Labyrinthitis causes severe dizziness bouts that may last for days! Vestibular suppressants may be prescribed by doctors to treat dizziness and its associated symptoms, for a very short duration of 3 to 5 days. Vestibular rehabilitation should be started at the earliest to ensure rapid recovery.

 

Perilymph Fistula

Dizziness, fullness in the ear, vertigo spells are the symptoms of perilymph fistula. A small tear in the fluid-filled inner ear causes fluid to leak into the middle ear. This leakage disturbs the equilibrium and leads to vertigo spells, especially when the patient does straining activities or coughs vigorously. This condition may also lead to tinnitus and hearing loss. Videonystagmography (VNG) and vestibular examination help diagnose the presence of the perilymph fistula.

 

Vestibular Paroxysmia

The compression of the vestibular nerve due to an inflamed blood vessel, radiation, surgery, or vestibular neuritis may cause vestibular paroxysmia. Microvascular compression is the most common reason for vestibular paroxysmia. The patient may have frequent short spells of vertigo episodes recurring throughout the day. VNG/ ENG and MRI scanning are recommended to diagnose Vestibular paroxysmia.

 

Superior Semicircular Canal Dehiscence (SSCD)

A rare condition of SSCD may occur as a result of thinning, or damage to the bony part of the labyrinth. It affects the patient’s hearing ability too. Natural coughing or sneezing can trigger dizziness in this condition. These patients have an extreme sensitivity to loud sounds. VNG guided Valsalva maneuver, VEMP and CT scan of the temporal bone confirms SSCD. The treatment for SSCD is to avoid actions that aggravate dizziness. Surgical repair of the bony dehiscence is advocated for lasting results.

 

Acoustic Neuroma / Vestibular Schwannoma

Acoustic neuroma is a noncancerous growth on the balance nerve which causes unsteadiness, dizziness, facial numbness or tingling sensation, change in taste, etc. A tumor grows slowly, and hence the patient often does not notice the symptoms. However, it may prove life-threatening if a tumor grows big enough to press on the brain stem. Surgery and radiation are widely used methods to treat acoustic neuroma.

 

Multiple Sclerosis

Multiple sclerosis is an autoimmune disorder in which the protective myelin shield of the nerve cells gets damaged hampering signal transmission to the brain. Difficulty in focusing, visual problems, vertigo spells, and unsteadiness are some of the symptoms of multiple sclerosis. Spinal tap, VNG, and MRI brain are advised in the evaluation to confirm multiple sclerosis.

 

SYMPTOMS

• Spinning (You or the room around you)
• Tilting or Swaying
• Feeling off balance
• Vomiting or feeling nauseous
• Having a headache and/or intolerance to bright light and noise
• Double vision, having trouble speaking or swallowing, or feeling weak
• Feeling short of breath or sweaty, having a racing heartbeat

 

COMPREHENSIVE DIAGNOSTIC EVALUATION

• Video Nystagmography (VNG)
• Vestibular Evoked Myogenic Potential (C-Vemp/O-Vemp))
• Electrocochleography (E-CochG)
• Video Head Impulse Test (vHIT)

TREATMENT OF VERTIGO

MEDICATIONS

 

Water Pills If you have Meniere’s disease, your doctor may prescribe a water pill (diuretic). This along with a low-salt diet may help reduce how often you have dizziness episodes.

 

Medications that relieve dizziness and nausea. Your doctor may prescribe drugs to provide immediate relief from vertigo, dizziness, and nausea, including prescription antihistamines and anticholergenics. Many of these drugs cause drowsiness.

 

Anti-anxiety medications. Diazepam (Valium) and alprazolam (Xanax) are in a class of drugs called benzodiazepines, which may cause addiction. They may also cause drowsiness.

 

Preventive medicine for migraines. Certain medicines may help prevent migraine attacks.

THERAPY

 

Head Position Maneuvers

A technique called canalith repositioning (or Epley maneuver) usually helps resolve benign paroxysmal positional vertigo more quickly than simply waiting for your dizziness to go away. It can be done by your doctor, an audiologist, or a physical therapist and involves manoeuvring the position of your head. It’s usually effective after one or two treatments. Before undergoing this procedure, tell your care provider if you have a neck or back condition, a detached retina, or blood vessel problems.

 

Balance Therapy

You may learn specific exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.

 

Psychotherapy

This type of therapy may help people whose dizziness is caused by anxiety disorders.

Surgical or other procedures

 

Injections

Your doctor may inject your inner ear with the antibiotic gentamicin to disable the balance function. The unaffected ear takes over that function.

 

Removal of the inner ear sense organ.

A procedure that’s rarely used is called labyrinthectomy. It disables the vestibular labyrinth in the affected ear. The other ear takes over the balance function. This technique may be used if you have serious hearing loss and your dizziness hasn’t responded to other treatments.

 

Vestibular Rehabilitation

Vestibular rehabilitation is an exercise-based program, designed by a specialty-trained vestibular physical therapist, to improve balance and reduce problems related to dizziness.

 

Who benefits from vestibular rehabilitation?

Patients typically referred for vestibular rehabilitation therapy are those diagnosed with dizziness, imbalance, vertigo, Meniere’s syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness, and migraines. Other candidates are patients who have had a stroke or brain injury or who frequently fall.

Common symptoms that can be helped with vestibular rehabilitation include:

• Dizziness or blurry vision with head movements
• Neck tightness, stiffness, and/or pain
• Imbalance or the need to hold onto objects when walking
• Headaches
• Frequent falls
• Generalized “dizziness, wooziness and foggy head” feelings
• Vertigo/spinning

At your appointment, our clinician will evaluate your symptoms and review your medical history. Your assessment will include all or part of the following areas:

• Balance and/or leg strength/flexibility
• Gait (how you walk)
• Visual stability and mobility
• Neck mobility and neck and arm strength
• Positional testing, including an inner ear exam

Based on the findings, a plan of care is developed. The goal of your treatment plan is to improve any deficits that were identified. This, in turn, will improve your ability to function in activities of everyday living, reduce your risk for falling and ultimately, improve your quality of life.