It has been reported that 42% of the adult population reports episodes of dizziness or vertigo to their physicians. In 85% of patients reporting these symptoms, the cause is vestibular system dysfunction (Vestibular Disorder Association, VEDA). Vestibular dysfunction can be of peripheral origin or central origin. Central vestibular dysfunction includes such conditions as cerebellar disorders and demyelinating diseases that may affect the vestibuar system such as multiple sclerosis. Many people with peripheral vestibular dysfunction undergo spontaneous resolution of their signs and symptoms due to central nervous system compensation. Some patients, however, have persistent problems of dizziness and disequilibrium. Gill-Body reported in an article written in the Physical Therapy journal that for patients with persistent symptoms, it appears that pharmacologic management benefits only a small number and surgical management is appropriate for even fewer cases.

Vestibular physical therapy is an exercise approach that has been developed to help manage persistent functional problems associated with peripheral vestibular dysfunction. About 20% of all dizziness and 50% of dizziness in older people, according to VEDA, is due to Benign Paroxysmal Positional Vertigo (BPPV). BPPV causes vertigo, dizziness, and other symptoms due to debris that has collected in the inner ear. This debris is called otoconia and is made up of small crystals of calcium carbonate that shift with head movement sending false signals to the brain. These particles can be repositioned with repositioning maneuvers that can be very effective. With these positioning maneuvers a remission rate of 70% has been reported in studies after the first positioning maneuver and up to 95% remission of symptoms after 2 weeks. Published retrospective case series reviews and case reports suggest that patients who do not compensate spontaneously within 2 months following the onset of unilateral vestibular dysfunction may respond to rehabilitation. For those that do not have BPPV, habituation exercises, core training, and balance training designed specifically for the patient will help to improve compensation.

Common Signs and Symptoms of vestibular disorders

Vertigo and dizziness:

• A spinning or whirling sensation (as if the room is spinning around you) - vertigo
• Lightheadedness, floating, or rocking sensation – dizziness

Imbalance and spatial orientation:

• Imbalance, stumbling, difficulty walking straight
• Difficulty maintaining an upright posture while walking (looking down at the floor while walking)

Vision:

• Difficulty focusing or tracking objects with eyes; objects or words on a page seem to jump, bounce, float, appeared blurred or seeing double

Hearing:

• Tinnitus (ringing in the ears)
• Hearing loss; distorted or fluctuated hearing
• Sudden loud noises increase symptoms of dizziness or vertigo

Other:

• Nausea or vomiting
• Headaches
• “Hangover” or “sea sick” feeling
• Motion sickness
• Slurred speech

Common vestibular disorders Peripheral Disorders

• Benign Paroxysmal Positional
• Vertigo (BPPV)
• Endolymphatic Hydrops (Meniere’s Disease)
• • Perilymphatic Fistula

Central Disorders:

• Wallenberg (lateral Medullary) syndrome
• Demyelinating Disease
• Other conditions can affect the central vestibular system (i.e. Multiple Sclerosis and brain tumors)