dizziness

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What is it?

Dizziness is defined as a sensation people feel when they lose their orientation in space. They may feel disoriented, experience a sense of movement or may feel off balance.

Vertigo is a form of dizziness which is defined as a hallucination of motion. If the patient feels the environment is in motion, this is known as objective vertigo. If the patient feels he or she is in motion, this is known as subjective vertigo. Frequently the sensation may be of turning or spinning, which is known as rotary vertigo. Vertigo is often linked to problems of the inner ear.

**Balance Retraining**

Other symptoms frequently accompany dizziness or vertigo such as anxiety, lightheadedness, headaches, nausea, unsteadiness or oscillation of the environment. A person’s memory may also be affected as well as their concentration. Hearing may fluctuate or be lost
completely. Distortions such as popping, clicking, ringing or buzzing may occur. Fullness may be felt in the ears and reading or writing may be difficult. Discomfort may be caused by temperature changes, pressure changes or wind currents. You may feel easily fatigued.

Some statistics

• Dizziness is the third most frequent reason people seek medical attention.
• 25% of the population between ages 50 & 65 suffer from dizziness.
• Over 90 million Americans, age 17 or older have experienced an episode of dizziness or balance problems.
• 160,000 new cases of inner ear balance disorders are diagnosed in the USA each year.
• Balance related falls account for more than 50% of accidental deaths in the elderly.

What causes it?

Generally, causes can be broken down as follows: 1/3 medical disease, 1/3 emotional distress/anxiety, and 1/3 trauma.

There are approximately 100 different medical diseases that can cause symptoms of dizziness. Many patients have more than one disease causing their dizziness including ear infections that can lead to vestibular disorders. A type of vertigo called, “benign paroxysmal position vertigo (BPPV)”, occurs when tiny calcium crystals sheer off from membranes and float in the inner-ear fluid. The crystals may be loosened by whiplash, a blow to the head, infection, or in the elderly, deterioration.

How do we treat it?

Before any treatment of dizziness or vertigo can begin, a proper diagnosis must be made by your doctor. After diagnosis, your doctor will refer you to the proper health professional who will assist you with your problem. Health authorities have recognized the successful role being played by Physical Therapists, especially with their conservative treatment of dizziness and inner ear balance disorders.

Treatment of inner ear disorders is known

**Vestibular Habituation Exercises**

as Vestibular Rehabilitation. It consists of an exercise approach which remedies the disequilibrium and dizziness symptoms associated with a peripheral vestibular pathology.

It is designed to:

    1. Decrease dizziness.
    2. Increase balance function.
    3. Increase general activity levels.

Exercises for the above promote the central nervous system (brain and spinal cord) to compensate for inner ear deficits.

What will the physical therapist assess?

     1. The musculoskeletal system.
     2. Balance and gait.
     3. Position Sensitivity.

Types of treatments:

Vestibular habituation exercises: Repeated exposure to specific stimulus causing the vertigo. This causes the brain to habituate or attenuate the vertigo response.

Balance retraining exercises: Designed to improve coordination of muscles responses as well as the organization of sensory information for balance control.

**Canalith Repositioning**

Canalith repositioning (Epley maneuver): Intended to move debris or “ear rocks” out of the sensitive back part of the ear (Semi circular canals) to a less sensitive location. The Epley maneuver has become very popular for treatment of BPPV because it has proven to be: More effective, Better tolerated, Easy to perform and Inexpensive. Dizziness is often eliminated after only one treatment using the Epley maneuver. Approximately 87 percent of BPPV patients remain without symptoms after one treatment.