Dizziness and Vertigo

Written by: Jennifer Buono, PT, DPT

Dizziness is one of the most common symptoms that adults report to their physician. With a wide range of possible causes including, cardiovascular, neurological, metabolic, psychological, pharmacological, as  well as, vestibular disorders, it can be hard for individuals to get a correct diagnosis. Often they will consult with 4 or 5 different physicians before determining the exact cause.

To assist providers in diagnosing the cause it is beneficial for individuals to further define their dizziness symptoms.

According to the Vestibular Disorder Association (VEDA):
● Dizziness: a sensation of lightheadedness, faintness or unsteadiness that does not
contain a rotational component.
● Vertigo: sensation of spinning of either the self or the surrounding environment.
● Disequilibrium: a feeling of being off balance or unsteady and can often be
accompanied by disorientation.
● Spacial disorientation: a sensation of not knowing where one’s body is in space.

More than ⅓ of adults over the age of 40 in the US have experienced some sort of vestibular dysfunction. One disorder in particular called Benign Paroxysmal Positional Vertigo or BPPV is the cause of about 50% of dizziness/vertigo symptoms in older people. BPPV is characterized by frequent episodes of vertigo that typically last less than 60 seconds and are associated with changes in head and body positions. For example, quick head movements can trigger vertigo symptoms, as well as bending forward, looking up toward the ceiling, moving from lying to sitting and rolling to one side in bed.

BPPV occurs when calcium carbonate crystals (otoconia), which are normally in the utricle portion of the inner ear, become dislodged and move into the semicircular canals. This movement interferes with the fluid movement in the canals which sense head motion. The change in fluid movement causes the inner ear to send false signals to the brain and the result is a spinning sensation or vertigo. The cause of
BPPV sometimes is unclear, but it can be due to an infection that affects the inner ear, head injury or it can also be due to degeneration of the hair cells that occurs during the natural aging process.

The good news is that BPPV is not life threatening and is typically easily treated. Physical therapists with specialized training can help treat BPPV with the use of positioning maneuvers, known as canalith repositioning. The most common maneuver is known as the Epley maneuver. The therapist takes the individual through a series of head and body movements to move the crystals out of the semicircular canals.

Studies have shown that in about 90% of cases, resolution of the symptoms can be attained in 1-3 treatments. Sometimes even after the BPPV has been resolved, individuals can also experience a sense of imbalance or disequilibrium for which the physical therapist can provide specific exercises that work to retrain the brain to process the information received by the vestibular system, known as vestibular rehabilitation.

If you are experiencing symptoms of dizziness, vertigo or disequilibrium don’t wait! Come and see one of the physical therapists here at Advanced Physical Therapy and fitness for evaluation and let us help you find the best treatment option, so that you can stop spinning and get back to your normal routine.

Vestibular Disorders Association (VEDA) www.vestibular.org Parnes LS, et al. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ.2003  169(7):681-693.


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