What are vestibular problems?
Vestibular problems are a group of conditions, which can cause symptoms of dizziness or imbalance. Some studies have reported that up to 20% of people over 60 suffer from problems with dizziness that require intervention.
The causes of dizziness are numerous and can be anything from hyperventilation to labyrinthitis as well as more rarely central disorders of the brain such as multiple sclerosis.
The symptoms also vary widely and include:
- Vertigo (sensation of the room spinning)
- Nausea
- Disequilibrium (feeling of unsteadiness)
- Blurring of vision (oscillopsia)
- Fatigue
In many cases, the problems are self limiting and people can recover spontaneously after a few weeks.
However, in a small group of people the body fails to compensate and problems can linger on. For this group of people, this can be very distressing as the symptoms are of an unseen nature and so sufferers can feel anxious about becoming unsteady or embarrassed if they have an attack in a public place. The fatigue from the concentration needed to maintain balance can also have a very negative impact on quality of life.
Assessment of vestibular problems?
Making a diagnosis when the main presenting problem is dizziness can be challenging. Most clinicians can often confirm the diagnosis based on the history and physical examination; using assessment of eye movements and balance tests. However, occasionally, cardiovascular, neurological, and laboratory testing may be needed to confirm the patient’s diagnosis.
A further assessment can be used called the Dix-Hallpike maneouvre, which is a specific test for the diagnosis of Benign Positional Paroxysmal Vertigo (BPPV). BPPV is specific condition where through trauma, virus or sometimes old age, some crystals in the inner ear are dislodged and move around in the semicircular canals. This tends to cause severe vertigo and nausea on head turning which clears in under a minute.
What treatments are there for dizziness?
- Medication; e.g. cinnarizine to reduce symptoms of vertigo and nausea in the short term. Evidence suggests they inhibit recovery in the long term.
- Medical management; treatment of an underlying cause such as treatment of an inflammatory disorder or infective cause.
- Vestibular rehabilitation; the most common treatment for unresolved symptoms of dizziness caused by uncomplicated vestibular damage. In a Cochrane review in 2011 vestibular rehabilitation was shown to significantly improve symptoms of dizziness, visual acuity and quality of gait (walking) when compared to medication or no treatment.
- Surgery; for extreme cases, where all other intervention has failed.
How can we help you?
Vestibular rehabilitation involves assessment of your condition and formulation of an individually tailored exercise programme to retrain your vestibular system to compensate for the area of damage.
A typical exercise regime may include any of the following depending on symptoms and findings on assessment:
- Eye exercises
- Head/neck exercises
- Standing balance exercises
- Gait re-education
- Strengthening exercises
- Fatigue management
- Relaxation exercises
- Conditioning programme
- Epley manouevre; treatment procedure for BPPV, which is 98%effective in curing the condition.
Due to the fluctuating nature of Meniere’s disease, vestibular rehabilitation is of limited value in this condition. However, it may still have a place between attacks to improve general balance and conditioning.
For any further information, please give us a call on 07775 844839 or email and we will be happy to help or answer any questions.
Further information and support can be found at: www.vestibular.org
(Vestibular disorders association)