The Vestibular System

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The vestibular system sits within the inner ear; is responsible for keeping your eyes (gaze) steady during head movement and is vital for balance function. The vestibular system is made from the peripheral portion (inner ear) and brain centres responsible for vestibular function (central component).

Symptoms of a vestibular disorders may include:
* dizziness
* imbalance
* headaches/migraines
* neck complaints
* motion sickness
* hearing loss
* tinnitus
* ear pressure

VertiGO Physio and Rehab Physiotherapists are trained in the assessment and treatment of all vestibular conditions, peripheral (e.g. BPPV) and central (e.g. stroke).

Common Vestibular Conditions
The below is a brief summary of some common conditions VertiGO Physio and Rehab can assist you with. More information relating to your presentation will be provided to you by your treating clinician.

VertiGO Physio and Rehab clinicians are advanced trained and treat all vestibular conditions. Please see the below link to a trusted vestibular organisation for more details of such presentations.

BPPV
'AKA Particles in the inner ear in the wrong place!

 

What is BPPV?

Benign= not harmful 

Paroxysmal= sudden onset 

Positional= positionally triggered 

Vertigo= sense of self or the world moving.

What Causes BPPV

There are 5 separate components of the inner ear. The centre 2 compartments house Otoliths - 'inner ear crystals/particles'. There are 3 semi-circular canals responsible for sensing head rotation. If the Otoconia dislodge and enter the semi-circular canals- false information about head movement is sent to the brain.

How is BPPV assessed?

The inner ear and eyes have a strong working relationship. The inner ear is responsible for keeping your eyes steady during head movement. Nystagmus is an involuntary repetitive eye movement that can be driven by the inner ear or the brain. Nystagmus can present with different behaviours and directions in different clinical tests. Your vestibular physiotherapist has advanced training in reading such nystagmus, in an array of clinical tests. This leads to the diagnosis and correct identification of the canal affected in BPPV.

Management of BPPV

Advanced vestibular physiotherapists are trained in using multiple techniques to treat BPPV. The Epley is the most common technique to treat the most commonly affected canal- The Posterior Canal. There are 3 separate canals in each inner ear, each separate canal requires a different technique to treat successfully.

Unilateral or Bilateral  Vestibular Hypofunction

What is it?

Unilateral Vestibular Hypofunction (UVH) is a term used to describe when one side of your vestibular system is not working well. 

Your inner ear systems work as a pair to optimise balance and gaze stability. When one side (or both) of the vestibular system is affected- symptoms of imbalance, dizziness and nausea can be experienced.

Causes

Some known causes: viral/bacterial infection, toxicity, auto-immune disorder, tumours, trauma, inner ear pathology (E.G Meniere's Disease).

Treatment

Vestibular rehabilitation programs are exercises designed by your vestibular physiotherapist that promote ‘compensation’ of your vestibular system. The process may involve adaptation of your inner-ear eye reflex (gaze stability exercises) , substitution of alternative strategies of inner ear/eye and balance systems, habituation of symptoms, and regaining overall functional balance. Programs are individualised to each case. Vestibular rehabilitation is strongly supported in literature and is proven to be effective in reducing symptoms and improving function.

Meniere's Disease

What is it?

Ménière’s disease, a form of endolymphatic hydrops, produces a recurring set of symptoms because of abnormally large amounts of a fluid called endolymph collecting in the inner ear. 

Common Symptoms

Meniere's Disease can present with an array of symptoms which can include: episodes of dizziness with ear related symptoms (hearing loss, tinnitus, fullness). Ear symptoms are often unilateral.

Treatment

Treatment of Meniere's Disease is strongly medically based. Vestibular Physiotherapy will not cure the disease itself, however is an important component of maintaining a functional lifestyle and adequate balance.

Vestibular Migraine

What is it?

Vestibular migraine is a subcategory of migraine where vestibular symptoms can be experienced. Migraine itself is a complex neurological presentation. Vestibular Migraineurs can experience headaches without dizziness and vice versa. Migraine is the second most common cause of episodic dizziness.

Treatment

Migraine management is multi-factorial and may include: lifestyle changes, trigger management, medications, dietary changes, general exercise and physiotherapy. Medical management is a key component. Vestibular physiotherapy and cervical (neck) physiotherapy are 2 treatments which may assist in reducing potential triggers to your migraine. A thorough assessment is required to determine your potential triggers, in order to formulate an individualised physiotherapy treatment plan specific to you.