What Is a Vestibular Dysfunction?

Benign Paroxysmal Positional Vertigo (BPPV)

A person may complain of brief episodes or sudden onset of vertigo, precipitated by a rapid change of head position. Vertigo is the illusion of either rotational or translational motion of either self or environment. Symptoms may include dizziness, unsteadiness, nausea, fatigue or tiredness, blurred vision, headaches, and occasionally ringing in the ears. These vertigo symptoms may be provoked by looking up overhead, quick movements, stooping over, and rolling to one side in bed. BPPV is the most common cause of vertigo and may be brought on by the natural aging process, trauma (motor vehicle accident-whiplash or fall), disembarking a ship/boat (i.e. cruise), or a viral and/or bacterial infection in the inner ear. An infection can cause a neuronitis or labyrinthitis and should be consulted by your primary or ENT physician.

Our Sensation of Balance is made up of three separate systems: Vision, Proprioception, and Vestibular. Our eyes translate light to the brain to imprint an image on our brain to tell us our position (vertical, horizontal, etc.). Our feet and joints are surrounded by small receptors (proprioreceptors), which translate a signal to the brain to tell use our position in space and give us a perception of balance. Our Vestibular System, located in our inner ear, consists of a network of tubes (semicircular canals) and sacs (the vestibule) filled with a thick fluid (endolymph) which gives us an unconscious sense of motion of the head to keep our balance or equilibrium. As the position of our head or body changes, the thick fluid or endolymph moves within the inner ear and bends sensory hairs in the canals and initiates a nerve impulse from the vestibular nerve. This stimulates the brain and then returns commands to move the eyes and muscles of the body to allow us to maintain our balance.

Suspected cause of these vertigo symptoms appears to be debris (calcium carbonate crystals in the utricle and saccule) which is collected within the inner ear. The debris is believed to be free-floating in the inner ear canal, thus amplifying the speed of the fluid movement. This type of BPPV is called canalithiasis. It is also thought that this debris may attach or adhered to the cupula at the base of the canal, thereby making the cupula sensitive to changes in position in relation to gravity. This type of BPPV is called cupulolithiasis.

PROCare Physical Therapy of Milwaukee can treat BPPV by using repositioning and habituation exercises. The repositioning exercises clear out the debris in the canals and reposition the crystals in the inner ear, while the habituation exercises gradually condition the balance system to tolerate head and/or body movements. Gait training, balance and head-eye coordination exercises are also used to normalize the balance system and to return you to normal activities of daily living and work safely.

* Most insurance companies cover the cost of Vestibular Rehabilitation.