Vertigo: Determining the Cause

Vertigo is a common complaint or “diagnosis” given to people who experience dizziness, room spinning, or feelings of imbalance. However, vertigo is not a diagnosis (disease or a condition), it is simply a SYMPTOM. Dizziness, vertigo, and imbalance are often associated with a disturbance of your vestibular system.

What is your Vestibular system?

On a simple level, the vestibular system uses information from your inner ear, eyes, muscles, and joints to communicate with your brain. Input from these sources allows you to feel where your body is in space and helps to maintain your balance. All of these parts need to be communicating well with each other in order for your vestibular system to be functioning at its peak.

Simply labeling yourself as “dizzy” requires further investigation to find the root cause of the dizziness. Dizziness and vertigo are sort of umbrella terms, which have a different meaning for each individual. Some patients will experience rooming spinning, others will describe their vertigo as “just feeling off,” lightheadedness, or a lack of balance. It is estimated that approximately 40% of the population in the United States will experience some form of dizziness or imbalance over the course of a lifetime (National Institute on Deafness and Other Communication Disorders [NIDCD], 2014).

What is the cause of vertigo?

The most common cause of vertigo (accounting for 50 percent of vertigo cases) is benign paroxysmal positional vertigo (BPPV) (1). That’s a mouthful, so let’s break it down.

Benign – non-life threatening
Paroxysmal – brief (less than 60 second) episodes
Positional – the position of your head and neck provoke symptoms
Vertigo – room spinning

BPPV affects people of all ages, but is most common in people over the age of 50. BPPV occurs when calcium carbonate crystals, which are normally implanted in a gel-like substance in the utricle and saccule (organs with in the inner ear), become dislodged. The crystals migrate into one of three fluid-filled semicircular canals of the inner ear. The three semi-circular canals are filled with fluid and tell our brain which direction we move. This is how you can tell you are moving up and down in an elevator or forward while flying on a plane, even though your body is not moving.

When the crystals are displaced in the semi-circular canals, they move the fluid and send a message to the brain that the head is moving when, in fact, it is not (2). This misinformation between your inner ears, eyes, and brain will cause vertigo. Once the crystals settle back down, the spinning stops (typically within one minute). BPPV symptoms will not persist all day, the only arise with changes in the position of your head.

To help determine if you have BPPV, it is important to understand that BPPV is NOT associated with changes in hearing, headaches, blurred vision, fainting, or numbness/tingling in the limbs. Treatment for BPPV is a simple re-positioning maneuver, which is to be performed by a trained professional who will be able to angle your head and neck in a way that moves the crystals back to where they came from. Typically, the re-positioning maneuver is effective within one to two treatments.

Another frequent cause of vertigo is a vestibular dysfunction or hypofunction. This means that your vestibular (inner ear) system is not as “strong” as it should be. Common complaints with vestibular hypo-functioning are difficulty maintaining balance, feeling lightheaded, “off”, or dizzy. These symptoms tend to last most of the day and often worsen with activity. There are many reasons for the vestibular hypofunction. Some causes include autoimmune disorders, vestibular neuritis, infections, injury to the vestibular nerve, and chronic polyneuropathy. However, many vestibular dysfunctions occur without known reason or cause (2).

Treatment includes vestibular rehabilitation exercises, which are designed to challenge your vestibular system and make it stronger. Think of your vestibular system like a muscle, if it is weak, you perform exercises to make it stronger. The key to getting better is having exercises which challenge your system, without overloading it. Exercises will induce symptoms (make you dizzy); however, as you practice, those symptoms will subside. Unfortunately, vestibular retraining is not a quick fix like those suffering from BPPV. It may take up to two to six months of training to return to optimal function.

What can I do if I am dizzy?

It may surprise you that physical therapists are one of the most qualified professionals to determine the cause of vertigo and therefore, determine the best treatment plan. Understanding the reason behind the dizziness, vertigo, and imbalance will lead to the best treatment. These symptoms are incredibly common as we get older, but being dizzy and off balance is not a “normal” part of aging. If you have concerns about your balance and dizziness finding a vestibular therapist may help you get your mobility back with confidence!

If you suffer from dizziness in your daily life, click below to schedule your discovery visit with a physical therapist at Buffalo Rehab Group.

Schedule Your Free Consult Here

References:
1. Centers for Disease Control and Prevention
2. http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
3. http://vestibular.org/BVH

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