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Why am I Dizzy? Is it vertigo?

Written by Libby Bergman PT, DPT, OCS, FAAOMPT

The onset of sudden dizziness can be a distressing, though somewhat common human experience. Whether the room is spinning and you feel sick to your stomach or you experience more of a general sense of lightheadedness or loss of balance, dizziness can often be evaluated and treated by Physical Therapists. Once a more serious medical condition or medication interaction is ruled out, your PT will evaluate your entire vestibular system to find one or more causes of your symptoms.

Dizziness versus vertigo

Dizziness is defined as a more general sense of lightheadedness, faintness or unsteadiness. Vertigo typically involves a feeling of spinning or rotation of yourself or of your environment. It can last for a moment or for days on end and often can be provoked with certain positions or movements of the head. Both dizziness and vertigo can be evaluated by your physical therapist.

What is the vestibular system?

Your vestibular system is a complex, body wide system of joint receptors and nerve endings that, together with your inner ear and eyes, gives feedback to your brain and spinal cord to tell you where you are in space. The main area in our bodies that provides feedback about where we are in space is located deep inside both of our inner ears and is called the labyrinth. This amazing (though tiny!) system is comprised of 3 semicircular fluid-filled canals that rest at about 90-degree angles to each other. As we move our heads in space, the fluid in these canals moves and works together with the opposite side to excite or inhibit nerve endings to our eyes and give information to our brain stem and brain to help us coordinate our movements to our balance.

What Causes Problems in the Vestibular System?

A complete evaluation of vertigo and dizziness will include looking at many systems to determine the influence of each component of your particular case. Many patients have several underlying causes of their symptoms which span multiple systems such as the neck, the cardiovascular system and the inner ear.

Common causes of vestibular dysfunction include:

· Head injury or concussion

· A viral infection which impacts the functioning of the nerve to the inner ear apparatus

· Aging which causes hardening of the canals and changes in the hair cells in the semicircular canals which detect movement of the canal’s fluid

· Whiplash related disorders and motor vehicle accidents from the force of quickly decelerating the head and neck

· Autoimmune diseases such as lupus, rheumatoid arthritis and Sjogren’s syndrome

· Meniere’s disease- a progressive condition which affects the fluid in the inner ear canals

· Benign Paroxysmal Positional Vertigo (BPPV) happens when debris (typically calcium crystals) from the inner ear apparatus end up in the semicircular canals

· Mal de Debarquement- a sensation of rocking that continues after being on a boat for a prolonged period of time

· Migraine associated vertigo which typically includes migraine headache in addition to dizziness, spontaneous vertigo, sensitivity to lights and sounds, imbalance and spatial disorientation

· Medications which damage the inner hair cells or the vestibulocochlear nerve

· Bacterial ear infection

Common causes of dizziness:

· Heart arrythmia

· Atherosclerosis

· Dehydration

· Degenerative arthritis of the neck

· Orthostatic hypotension (low blood pressure upon standing due to underlying circulatory problems)

· Vision problems

· Vasovagal syndrome- a nervous system response that causes loss of muscle tone in blood vessels throughout the body

Your Vestibular Evaluation

Your Physical Therapist will review the history of your symptoms and ask you questions about your medical history to learn more about the functioning of your vestibular, musculoskeletal, neurological and cardiovascular systems. He or she will also perform various tests and measures to see how these systems are interacting together to have a more complete understanding of the source of your symptoms. Part of this examination will involve wearing goggles that feel like wearing a scuba mask and often occlude your vision. This device, called video oculography, helps your PT watch the response of your eye movements to different positions of your semicircular canals (via changing the position of the head). This will help he or she more accurately diagnose the nature of any inner ear canal impairments. Treatment can often proceed directly from these positions and help to clear a canal that does have debris in it such as in BPPV.

Your PT will also give you a home program to help you regain function of your vestibular and balance systems. It is important to know that your balance will not recover on its own after an episode of vestibular system impairment. Just like a weak muscle, it must be strengthened and retrained with regular challenges to improve over time.

The vestibular system is a complex and interesting part of our bodies that can be rehabilitated. If you are experiencing even just occasional dizziness, vertigo or imbalance, call Advanced Rehabilitation Services to have one of our experts evaluate your condition and see how you can live a better, safer and healthier life today!

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