What is Vertigo?
Understanding Vertigo:
It’s crucial to understand that vertigo is a symptom, not a diagnosis. Vertigo often indicates either a peripheral or central disorder.
A central disorder suggests a problem in the brain, whereas a peripheral disorder implies a vestibular (inner ear) dysfunction. It’s also important to distinguish between vertigo and lightheadedness. Lightheadedness, often associated with presyncope and fainting, may suggest low blood pressure as the underlying cause.
In this blog article, we will focus on vertigo as a symptom of vestibular dysfunction.
Help! I’m dizzy! Everything is moving!
The Most Common Cause for Vertigo: BPPV
The most prevalent cause of vertigo is Benign Paroxysmal Positional Vertigo (BPPV), which typically affects the right side.
BPPV can result from mild head trauma but often has no identifiable cause and becomes more common in adults over 65 years old. The name BPPV explains the condition well:
- Benign: Not life-threatening
- Paroxysmal: Sudden, short spells
- Positional: Symptoms triggered by specific head movements or positions
- Vertigo: Spinning sensation
Anatomy and Mechanism:
Inside our ears, we have three semicircular canals responsible for detecting rotational movement.
These canals signal our brain about our head’s direction. The canals include the Anterior, Horizontal, and Posterior canals. In the utricle, an organ that detects linear acceleration, there are tiny calcium crystals called otoconia. Sometimes, otoconia can dislodge and move into one of the canals. When these crystals accumulate inside the canals, they alter the canals’ response to gravity.
This false information causes our brain to perceive vertigo. The posterior canal is most commonly affected due to its anatomical position, as shown in the diagram below.
Symptoms and Diagnosis:
Symptoms of BPPV are often triggered by specific head movements and changes in position, such as turning in bed, looking up or down, or moving your head quickly.
Fortunately, there is a simple test to confirm BPPV and treatment maneuvers to reposition the otoconia back to the utricle. Although an MRI cannot detect the location of the otoconia, an experienced healthcare practitioner can diagnose BPPV with simple head position tests. The most common test is the Dix-Hallpike maneuver, specific to the posterior canal.
A positive test shows nystagmus, repetitive uncontrolled eye movements. Upon a positive Dix-Hallpike test, the healthcare provider will perform the Canalith Repositioning Procedure. This treatment usually needs to be done only once on the treatment day, though it might take a few days to feel better. Re-evaluation in a week is recommended, as over-treating can cause the otoconia to move into another canal.
Avoid sleeping flat on your back or on the affected side the same day as the treatment.
Post-Treatment and Recurrence:
After resolving BPPV, it’s normal to experience mild lingering sensitivity to motion and unsteadiness, which typically resolves as your brain re-processes information normally.
If symptoms persist, additional rehabilitation strategies can help. BPPV can reoccur, but it usually reoccurs in the same canal, making management straightforward.
For More Help:
For more information and help, please contact Hesti Steyn at the Paarl Branch.
Hesti
Physiotherapist & Practice Owner
References:
Picture: https://www.nasafordoctors.co.za/articles.php?cid=9&id=39&aid=260
4th South African Vestibular Assessment & Rehabilitation Therapy (VART) Course
Healing Vertigo – Virtual Vestibular Physiotherapy = https://www.healingvertigo.ca/
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