What is Vertigo?
Vertigo is a type of dizziness that is often described as feeling that you are spinning or that the world is spinning around you, particularly if you change position.
What causes Vertigo?
Vertigo is the result of an inner ear problem.
Can be caused by
· Head Injuries
· Stroke
· Circulation problems
· Infection
· Inner ear disorders
· Degeneration of inner ear structures
Inner ear conditions
· Meniere’s disease – build up of fluid in the inner ear
· Vestibular neuritis – swelling/infection of vestibulocochlear nerve
· Labyrinthitis – inflammation of the labyrinth
What does the inner ear do?
The inner ear contains a series of canals filled with fluid. These canals are at different angles. When your head is moved, the rolling of the fluid inside these canals tells your brain exactly how far, how fast and in what direction your head is moving. Information from these canals is passed along to the brain via the vestibular (balance) nerve. If your brain knows the position of the head, it can work out the position of the rest of your body.
What is BPPV?
BPPV is a mechanical problem in the inner ear. It occurs when some of the calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the 3 fluid-filled semicircular canals, where they are not supposed to be. When enough of these particles accumulate in one of the canals they interfere with the normal fluid movement that these canals use to sense head motion, causing the inner ear to send false signals to the brain.
· Benign – it is not life-threatening
· Paroxysmal – it comes in sudden, brief spells
· Positional – it gets triggered by certain head positions or movements
· Vertigo – a false sense of rotational movement
Fluid in the semi-circular canals does not normally react to gravity. However, the crystals do move with gravity, thereby moving the fluid when it normally would be still. When the fluid moves, nerve endings in the canal are excited and send a message to the brain that the head is moving, even though it isn’t. This false information does not match with what the other ear is sensing, with what the eyes are seeing, or with what the muscles and joints are doing, and this mismatched information is perceived by the brain as a spinning sensation, or vertigo, which normally lasts less than one minute. Between vertigo spells some people feel symptom-free, while others feel a mild sense of imbalance or disequilibrium.
BPPV is commonly reported when lying down in bed, rolling in bed and change of head position whilst doing normal every day activities.
How do you diagnose BPPV?
When someone with BPPV has their head moved into a position that makes the dislodged crystals move within a canal, the error signals cause the eyes to move in a very specific pattern, called “nystagmus”.
There are two types of BPPV: one where the loose crystals can move freely in the fluid of the canal (canalithiasis), and, more rarely, one where the crystals are thought to be ‘hung up’ on the bundle of nerves that sense the fluid movement (cupulolithiasis). With canalithiasis, it takes less than a minute for the crystals to stop moving after a particular change in head position has triggered a spin. Once the crystals stop moving, the fluid movement settles and the nystagmus and vertigo stop. With cupulolithiasis, the crystals stuck on the bundle of sensory nerves will make the nystagmus and vertigo last longer, until the head is moved out of the offending position. It is important to make this distinction, as the treatment is different for each variant.
Physio is often one of the final stages of working out what is causing your vertigo. Your GP will have most likely sent you to have scans or see a specialist to ensure that your vertigo is not being caused by something serious. Often its several months before BPPV is thought about as a diagnosis.
Our physios will perform specific tests to determine which type of BPPV you have. Treatment is then specific to the type of BPPV diagnosed.
Treatment
Medication – not effective
Surgery – in severe cases that do not respond
Mechanical treatment – most effective, 90% in 3-4 treatments
Epley Maneuver
For treatment of the most common type of BPPV (crystals in posterior semicircular canal).
Each treatment usually takes about 10 minutes plus time to ensure you are ok to get up and move again. You will feel the symptoms of your BPPV during treatment.
Other Causes of Vertigo
Meniere’s
Meniere's disease is a disorder of the inner ear that causes hearing and balance problems. There is no cure, but the symptoms can be managed.
People with Meniere’s disease experience attacks vertigo that usually lasts between 2 and 4 hours. Some people have several attacks of Meniere’s disease in a short period of time, while other people only have it every few months or years. In between attacks, most people usually have mild or no symptoms.
Most people with Meniere’s disease have it in just one ear. It often leads to worsening hearing loss in that ear.
There is no cure for Meniere’s disease. Treatments aim to control the symptoms.
During an attack, you can use medicine that reduces vomiting, nausea, vertigo and anxiety.
Vestibular Neuritis and Labrynthitis
Vestibular neuritis (or vestibular neuronitis) and labyrinthitis are disorders that result in inflammation of the inner ear and/or the nerve connecting the inner ear to the brain. Generally caused by a viral infection, these conditions cause vertigo (usually experienced as a spinning sensation), dizziness, imbalance, unsteadiness and sometimes problems with vision or hearing.In a healthy balance system, the brain combines messages sent by the balance control systems in both ears, but if one side is affected, the messages from that side are distorted, causing symptoms of dizziness and vertigo.
Symptoms of vestibular neuritis include a sudden onset of a constant, intense spinning sensation that is usually disabling and requires bed rest. It is often also linked with nausea, vomiting, unsteadiness, imbalance, difficulty with vision and the inability to concentrate.
While neuritis affects only the inner ear balance apparatus, labyrinthitis also affects the inner ear hearing apparatus and/or the cochlear nerve, which transmits hearing information. This means that labyrinthitis may cause hearing loss and/or ringing in the ears (tinnitus).
Our physios are experienced at diagnosing and treating BPPV. If you are experiencing vertigo give us a call on 9838 8449 or book online at www.winstonhillsphysio.com.au/online-booking and we can help you get back to the activities you love.
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