Dizziness and balance problems account for 5 to 10 percent of all physician visits and affect approximately 50 percent of all adults at some time. One in 10 working-age adults report some degree of disability due to dizziness and 2% experience chronic, frequent & substantially debilitating episodes. Dizziness is the number one reason for physician visits by people over the age of 65. Greater than 1 in 5 persons older than 60 years of age have current dizziness that has led to significant disability, medical consultation or the use of medication. In the elderly population, dizziness is also associated with falls, fear of falling and loss of independence.
Vestibular disorders can be caused by:
1. Head Trauma (whiplash, sports injuries, workplace injuries) is a frequent cause of vestibular disorders in people under age 50.
2. Vestibular system degeneration - primarily in an elderly population
3. Ear infections such as otitis media; inner ear infection such as labyrinthitis or
4. Ototoxicity – high dosage or long term use of certain antibiotics
5. Acoustic neuroma
7. Vascular insufficiency
8. Benign Paroxymal Postional Vertigo (BPPV)
Presently in Canada, physiotherapy assessment and treatment of vestibular dysfunction is a rapidly growing and well-developed component of the overall management of dizzy patients.
Benign Paroxysmal Positional Vertigo or BPPV is the most common cause of vertigo dueto a peripheral vestibular disorder. It accounts for 20 to 30% of all patients seen for vertigo. It occurs in adults of all ages, although it is more common among older individuals. The lifetime prevalence of BPPV has been estimated at 2.4% and it is more common in women than men in all age groups.
Patients with BPPV complain of vertigo and possibly nausea when bending forward, looking up, rolling over in bed, and lying down flat. Other complaints associated with BPPV include balance problems that may last for hours or days after the episodic vertigo has stopped.
BPPV is a biomechanical problem in which one or more of the semicircular canals
(anterior, posterior, or horizontal) is inappropriately excited. BPPV occurs
spontaneously in most patients (approximately 35% to 70%), but it may also
follow head trauma (approximately 7-17%), inner ear infections (approximately 15%) such as labyrinthitis and neuritis, or endolymphatic hydrops (eg Meniere’s disease).
WHAT IS VESTIBULAR REHABILITATION?
Vestibular Rehabilitation is a form of therapy that primarily uses exercises to help treat problems associated with vestibular, or inner ear, disorders. Problems with these structures can lead to symptoms such as dizziness, nausea, tinnitus (ringing in the ears), light-headedness, and double-vision. Since each person’s conditions is slightly different, your Physiotherapist will create a specific exercise program that will help best treat your condition. While it might seem odd that exercises are used to treat problems associated with the inner area, these exercises are aimed at retraining balance and proprioception, which should help prevent falls.
VESTIBULAR REHABILITATION INVOLVES:
A detailed assessment of the Oculomotor System, Vestibulo-ocular System, Motion Sensitivity Testing, and a BPPV (Benign Paroxysmal Positional Vertigo) assessment
Your Vestibular Physiotherapist will then determine:
-The cause of your symptoms
-Appropriate treatment including in-clinic physiotherapy and home exercise program as indicated
-Whether referral to another health professional is indicated