in Physical Therapy Education

Explaining Vertigo and the Vestibular System

Vestibular disorders are quite prevalent in the population and are one of the biggest reasons that someone goes to the ER.   The vestibular system is located in the inner ear and is responsible for balance and knowing where the body is in space.  If the vestibular system is not fully intact then quite often patients will complain of dizziness and possibly room spinning.   Patients may also complain of difficulty balancing while walking or going up stairs and can have symptoms of nausea.

One of the most frequent causes of dizziness is called BPPV, or benign paroxysmal positional vertigo.  In the vestibular system in the inner ear there is a small organ called the utricle.  There are normally crystals located inside the utricle.  The problem is when the calcium crystals travel out of the utricle and fall into one of the semi-circular canals.  These canals sense movement and rotation such as when you turn your head, or lay down.  When the crystals travel into the canal they give the body the sense that it is spinning or moving.   Sometimes this recovers on its own, however frequently a physical therapist or physician can provide a treatment which helps moves the crystals back where they should be in the utricle.



Diagnosis and treatment of BPPV is very quick and generally with several tests a PT can tell if the crystals are in one of the semicircular canals.  Depending on the direction of eye movements we can tell specifically which canal the crystals are in.  Diagnosis is provided by performing a Dix-Hallpike maneuver which consists of a patient lying down and letting their head sink off the table, with their head slightly turned.  If it is BPPV the patient will feel room spinning dizziness, which generally lasts 10-45 seconds.    If it is positive we go right into the treatment which frequently is the Epley maneuver.  While the head is kept down against the table, the head is slowly turned to the other side.  Then the patient will roll on their side and tuck their chin to their sternum.  Finally we sit up.  All of the movements are very slow and controlled with the therapist controlling the patients head the entire time.  So all the patient needs to do is relax!

The good news is, if the diagnosis is BPPV these treatment techniques are very highly successful!  The literature states that greater than 90% of patients within 2-3 treatment sessions will be cleared of the BPPV.   Sometimes this completely fixes the problem, and the patient isn’t dizzy anymore.  Other times, especially if the patient has had BPPV for a while, they may require some exercises to “retrain and tune up” the vestibular system.

Frequently patients will ask me, what causes this?  That’s a great question!  There are some factors that make BPPV more likely to occur than others.  The common ones are being dehydrated, having low Vitamin D levels, uncontrolled hypertension or diabetes, and finally a blow to the head such as a car accident or fall.  More common than not however there is an unknown cause and it just happened.  I also get asked, so what can I do to prevent this from happening again, or do I need to avoid any certain movements?  The answer is no, from several research studies there is no benefit to avoid laying on that side, going to the hairdresser and laying back, or restricting motions.  So I always tell patients, just live your life, don’t limit yourself because you are trying to avoid it from happening again.  Patients will ask if they should avoid taking anti-vertigo medications on that day.   If it is BPPV, anti-vertigo medication will not impair our ability to make our diagnosis and will not eliminate dizziness, but it may suppress nausea and make the treatment more comfortable so I recommend if patients are nauseous to take the medication before coming in.

At Rose Physical Therapy we frequently treat patients for symptoms of dizziness or vertigo, including treating for BPPV.  Feel free to contact us if you have any questions or if you have any symptoms of dizziness that you would like us to evaluate.

Mike Policella, DPT, certified vestibular rehab.

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