Vestibular facts

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Dizziness or vertigo affects 20-30% of adults under 65 years of age causing occupational consequences, interference with daily activities and lower quality of life

 

More than 90% of patients with dizziness are treated by their GP without any involvement of a specialist

 

Vestibular rehabilitation and particle repositioning manoeuvres are currently the best treatment options for dizziness and vertigo

 

What is vestibular rehabilitation?

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Vestibular rehabilitation (VR) is an exercise-based treatment approach provided by specialist physiotherapists or other health professionals to improve dizziness, vertigo and unsteadiness caused by vestibular disorders in order to improve function in activities of daily living and quality of life

 

What symptoms we see

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• Dizziness

• Vertigo

• Unsteadiness

 

What conditions we treat

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• Benign paroxysmal positional vertigo (BPPV)

• Vestibular hypofunction

  • Vestibular neuritis

  • Labyrinthitis

  • Acoustic neuroma

  • Ototoxicity

  • Age-related

  • Trauma (see post-concussion syndrome)

• Vestibular migraine

• Meniere's disease

• Post-concussion syndrome

• Motion hypersensitivity

 

Approach to treatment

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A thorough examination will be completed to identify the possible cause/causes of your symptoms from which an individualised treatment plan will be formed and may include advice and education, repositioning manoeuvres and progressive exercises to target gaze stability, balance and strength

 

Expected outcomes

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Response to VR varies depending on the presenting disorder:

• BPPV can be cured in 1-2 sessions with particle repositioning manoeuvres being effective

• Vestibular hypofunction symptoms improve with customised VR

• Unstable and fluctuating disorders such as vestibular migraine and Meniere’s disease do not respond well to VR – however VR can still be useful as education is key for the long-term management of such disorders and treatment of secondary problems may be required

 

Dizziness

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A non-specific description of spatial disorientation, an umbrella term to include sensations such as vertigo, light-headedness, faint feeling, disequilibrium and others

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Vertigo

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An illusion of movement – sensation of you or your surroundings spinning around

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Benign Paroxysmal Positional Vertigo (BPPV)

Positional vertigo occurs with specific head positions such as lying down or sitting up, turning in bed, looking up or bending forward, typically brief attacks lasting less than a minute

 

Vestibular Hypofunction

Dysfunction of the peripheral vestibular system which can occur on one side (unilateral hypofunction) or both sides (bilateral hypofunction) and may be acute or chronic 

 

Vestibular Neuritis

Acute onset of vertigo, nausea, vomiting and unsteadiness caused by inflammation of the vestibular nerve

 

Labyrinthitis

Acute onset of vertigo, nausea, vomiting, unsteadiness and hearing loss caused by inflammation of the labyrinth which affects hearing

 

Acoustic neuroma

Also known as a vestibular schwannoma - a non-cancerous (benign) tumour of the 8th cranial nerve – typically presents with progressive one-sided hearing loss / tinnitus and possible vertigo / dizziness. VR is most beneficial following surgery to aid recovery but may also be helpful when vestibular symptoms are present with small / slow growing tumours that are being monitored

 

Ototoxicity

Quite simply, ear poisoning (oto = ear, toxicity = poisoning), which results from medications causing unsteadiness

 

Vestibular Migraine

Attacks of spontaneous or positional vertigo lasting minutes to days, history of migraine, migraine symptoms during vertigo and migraine-specific triggers of vertigo such as diet, sleep, stress and environmental factors

 

Meniere's disease

Vertigo attacks lasting 20 minutes to several hours with one sided tinnitus, hearing loss and aural fullness. Fluctuating hearing loss with recovery in the early stages and progressive loss over years

 

Post-concussion syndrome

Vestibular complaints are common following head injury or concussion and often settle within a few weeks. However, if dizziness, vertigo or unsteadiness limit function or persist longer than a few weeks it would be beneficial to have a vestibular assessment.

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