Have you ever rolled over in bed or woken up from bed and become dizzy upon sitting up? Have you looked down to pick something up and all of a sudden the room begins to spin? Or maybe you have turned your head quickly and you feel dizzy or off balance? These can all be signs of a vestibular dysfunction which induces vertigo.
Vestibular dysfunctions are a disturbance of the body's balance system. Our peripheral vestibular system consists of the utricle, 3 semicircular canals on each side, and a saccule. The utricle contains otoconia which are calcium carbonate crystals that are held together with filaments. Viruses, trauma to the head, or just aging causes the linking filaments of the otoconia to weaken and become thin. The crystals can develop fissures, become pitted, or begin to fragment. As this occurs, fragments can become loose and can enter the semicircular canals.
The semicircular canals contain endolymph (fluid) and end with structures called the ampulla and cupula which contain hair cells that move when your head changes positions. Our bodies sense a change in angular acceleration through movement of the fluid and displacement of the hair cells located within the cupula. Typically when your head stops moving the fluid does as well. When crystals have become dislodged and enter the canals they continue to move for a few seconds after motion of your head has stopped. This stimulates the Vestibular nerve, causes mixed signals to the brain, and leads to vertigo and altered balance. Vertigo symptoms include dizziness, imbalance, a sensation of spinning, and sometimes nausea. These symptoms can last for a few seconds or up to many months. Vertigo may vary in duration, frequency, and intensity.
Vestibular dysfunctions can be peripheral or central so it is important to be properly evaluated for vertigo symptoms. The most common peripheral dysfunction is Benign Paroxysmal Positional Vertigo (BPPV) and can be effectively treated with Physical Therapy, typically in just a few visits. Treatment consists of canalith repositioning techniques such as the Epley’s maneuver. Other sources of vertigo may be from neuronitis, labyrinthitis, Meniere’s Disease, acoustic neuroma, vestibular migraine, post concussion syndrome, orthostatic hypotension, cervicogenic dizziness, and Persistent Postural Perceptual Dizziness (3PD). Physical Therapy can also be beneficial for these conditions when there are joint mobility concerns, balance issues, and safety with gait is impaired.
Fun Fact: In normal situations, the specific gravity of the cupula is equal to the endolymph. However, when we have had one too many drinks the cupula becomes lighter than the endolymph which is what causes the room to spin when we become inebriated.
~Amy McFadden, Physical Therapist
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