Understand Vestibular Disorder

By Margaret Hawkins on 21 January 2016

Experiencing dizziness or vertigo regularly? This could mean that you have a vestibular disorder. Margaret Hawkins talks to Cork-based physiotherapist about such disorders.

Have you had bouts of vertigo in the past but are still experiencing low-grade dizziness since? Are you feeling a bit unsteady or uncertain when using an escalator, for example, or when walking on uneven surfaces or in the dark?

It could be that you have a vestibular system disorder.

The vestibular system includes the part of the inner ear and brain that process sensory information, detecting movement of the head and helping to control balance.

Vestibular disorders can, therefore, affect your balance and lead to disabling symptoms like vertigo (room spinning sensation), dizziness and difficulty concentrating.

Physiotherapists are now coming to the fore in the treatment of such disorders by a type of therapy known as VRT (vestibular rehabilitation therapy).

Chartered physiotherapist Sheila Barrett, based in Midleton, Co Cork, has made VRT her specialty after training in Emory University, Atlanta. Working closely with VEDA, the Vestibular Disorders Association of America, she sees many patients with long histories of vertigo.

“Many people don’t realise that vertigo is a symptom, not a diagnosis,” she says.

“It’s like being told you have back pain but not being told the cause of the pain. That’s why many people with a vestibular disorder can go undiagnosed for many years, incorrectly thinking they have to live with it.”

These life-altering symptoms can deeply inhibit a person’s ability to perform basic day-to-day tasks, she believes.

“They are further compounded by their invisibility to others, making it difficult to understand that a person with a vestibular dysfunction is profoundly struggling to remain orientated and functional.

“They can end up on a downward spiral, trying to remain living independently but losing confidence because they are afraid of falling. Others are unable to work or socialise or function to any degree of normality.”

Because of lack of awareness and lack of management of the disorders, people often, unnecessarily, don’t make a complete recovery, she says.

“They also don’t realise that the less they move about, the worse they get – so, it becomes a vicious cycle that leads to that downward spiral.”

Early treatment for these disorders can mean getting back to a fully active life, she states.

“With proper assessment of their vestibular system to identify the exact source of the problem and specific eye and head movement exercises or manoeuvres done during a treatment session, the problem can be alleviated.

“By intervening, some conditions resolve immediately and others within weeks, allowing patients to get back to a fully active and normal life.”

“It’s not like a person with a back or neck problem who needs repeated physio,” she adds.

“With vestibular disorders, there is very little intervention and the recovery rate is high.”

Treating people effectively for vestibular disorders eases financial pressure on the State also as less people end up taking sick leave, giving up work or being hospitalised because of dizziness, she says.

“In international research, dizziness has been shown to be the number one reason people go to emergency departments. One in three people over the age of 40 and 80% of those over 65 would experience these dizziness symptoms at some point in their lives.

“Vestibular dysfunction also significantly increases the likelihood of falls, which are among the most morbid and costly health conditions affecting the elderly.”

How an assessment is done

Our balance is a complex interaction between three systems – the vestibular system, vision and proprioception (touch sensors in the feet, trunk and spine).

An FVT (functional vestibular testing) system is used to assess the person’s vestibular system and determine their specific problem after a medical history is taken.

Because the vestibular and visual systems are connected, the patient wears infrared goggles linked up to a computer for the period of the assessment.

“A video is taken of the person’s eye movements, which objectively identifies which parts of the vestibular system are functioning normally and which are not.

“If nystagmus (involuntary rapid and repetitive movement of the eyes) is present, its direction allows us to accurately determine the source of the problem.”

Listen to Margaret Hawkins discuss vestibular disorder with features editor Maria Moynihan in our podcast below

Causes of vestibular disorders

But what causes vestibular problems?

“Ear infections, ageing, head trauma (car accident, falls, impact sports, brain injuries), disease, medication – those are the main causes. However, this cause may not always be known at the time.”

The most common vestibular disorder that Sheila treats is BBPV (benign paroxysmal positional vertigo).

“This is a mechanical problem in the ear and occurs when otoconia (tiny crystals of calcium carbonate) that are normally embedded in the gel in the utricle, become dislodged. These then migrate into one or more of the three semi-circular canals in the ear.

“When the head moves, the otoconia shift, sending false signals to the brain, creating a sense of vertigo.”

The vertigo sensation can be triggered by rolling over in bed, getting in and out of bed, bending over or quick head movements, and usually lasts less than a minute.

The sensation can range from being mildly annoying to being a highly debilitating condition that can affect function, safety and fall risk.

“People could be fine all day long but when they bend down they get vertigo. That’s because the little gravelly rocks (otoconia) dislodged in the inner ear are rolling round in the wrong place. By laying the patient down in different positions, while they wear infrared goggles, we can identify which ear and which one of the semi-circular canals in each ear is affected by analysing the nystagmus provoked.”

The manoeuvres to correct this particular disorder take about a minute and a half to do, she says.

“The particles are located and on reassessment 95% of people are cured after one manoeuvre. Patients are also advised about how to minimise reoccurrence.”

Herpes cold virus can cause inner ear problems

Disorders like vestibular neuritis and labyrinthitis can also occur.

These are inner-ear disorders in which a nerve that detects head movement becomes inflamed, usually triggered by a cold or flu. Temporary hearing loss can occur in labyrinthitis.

“Some people find they get these kinds of problems when they have a cold, are overtired or stressed. That’s because they activate the herpes virus which remains dormant along their vestibular nerve.”

Vestibular neuritis is the second most common cause of vertigo and it is a condition that can be 100% improved in younger patients, she states.

“If a patient has persisting dizziness following a vestibular neuritis, they would be guided to do some simple head and eye movements which recalibrate the system.

“They would carry out a progressive home exercise programme (vestibular rehabilitation exercises) for a few weeks and then they’re back to normal.”

Acute vestibular conditions, especially if accompanied by nausea, may need medication for the first few days only, but their use should be limited as they dampen down the vestibular system and so delay recovery.” CL