Treating Vestibular Conditions

Spring is here and like many of you, I am excited about getting back into some warmer
weather activities! For some people though, dizziness is a deterrent for them in enjoying their
favourite hobbies.

According to Bernard Tonks vestibular lecturer/physiotherapist, 80% of people over 65 have
experienced dizziness and with an aging population, dizziness will become a larger issue
globally. Dizziness is also a problem as it increases the risk of a person falling and it has been
reported to effect a person in their regular activities of daily living. Dizziness can be caused by
a number of different reasons such as the cardiovascular system, neurological or vision
dysfunctions, cervicogenic (neck related) or psychogenic (due to psychological factors)
dizziness or it can be produced by vestibular system disorders. Vestibular disorders effect
older people much more often than those who are younger; however, children with a vestibular
impairment can also have compromised gaze stability that can lead to problems with reading.

So what is the vestibular system? It is the sensory system that is responsible for providing our
brain with information about head position relative to gravity and head movements – both linear
and rotational. It consists of 5 organs – 3 semicircular canals and 2 otoliths – the saccule and
the utricle. This system is protected by fluid within a bony labyrinth in the temporal bone of our
skull and it is connected to the cochlea, part of our hearing system, thus, it is part of our inner
ear. We have one on each side of our head.

Vestibular system disorders can be caused by a variety of issues: head trauma such as a
whiplash or concussion, vestibular system degeneration as people age, inflammation of the
vestibular nerve or labyrinth, hydrops (fluid build up in the inner ear) such as Meniere’s disease
and most commonly, Benign Paroxysmal Positional Vertigo (BPPV). BPPV is the cause of
nearly 50% of peripheral vestibular system disorders.

So what is BPPV? In the otoliths, there are tiny calcium carbonate crystals called otoconia.
They are supposed to stay here in the otoliths but if they get dislodged they can migrate into the semicircular canals where they do not belong. The movement of the crystals in a
semicircular canal triggers the nerve to send off improper information to the brain which
creates the sensation of vertigo, causes abnormal involuntary eye movements (nystagmus) and
may lead to nausea as well. The crystals do not cause a problem in the semicircular canal until
the person changes position of their head which is typical when looking up or down, laying
down flat quickly, bending forward or rolling over in bed. The vertigo created typically only
happens for a short time (< 60sec) while the crystals are moving.

Fortunately, treatment can be quite straight forward for a BPPV client. The assessment starts
with 1-2 tests called the Dix Hallpike test and the roll test. These are done to determine which
of the three semicircular canals – anterior, posterior or horizontal is involved and on what side
of the head the affected canal is on. This is done by watching for the direction of the
nystagmus in the clients eyes while completing the tests. After determining which canal is
involved then a particle repositioning technique for that specific canal can be used to move the
crystals back to their correct position in the utricle where they belong which quickly alleviates
the vertigo.

So if dizziness is effecting your daily life or keeping you from thoroughly enjoying your spring
activities, do not hesitate to reach out to us to ask questions and to book an assessment/
treatment so we can help you alleviate your symptoms and get you back to living your full life!

Sarah Fedun