Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a common cause of dizziness causing short epsiodes of vertigo (room spinning), imbalance, nausea and disorientation. Symptoms are usually precipitated by a change in head position, with common aggravating activities being rolling over in bed and shopping (looking at shelves, bending forwards). Episodes last less than a minute, though it may take a little longer for the head to clear completely. The exact cause of BPPV is often unknown, though a can sometimes be attributed. It is more common in women than men, and with advancing age.

It is thought that the sensations of vertigo and imbalance are caused by a disruption in the normal functioning of the balance mechanisms in the inner ear. Small rocks that are part of the mechanism which detects acceleration (the 'utricle') are thought to migrate into the semi-circular canals which detect rotation. These canals detect rotation direction and speed by sensing the speed at which fluid moves through them. Since one of the canals is disrupted, the canals on the right and left give the brain a different report on the movement occuring and this produces the sensation of vertigo, dizziness and disorientation. 

Diagnosis of BPPV is made through positional testing and observing eye movements, which provide an indication of the functioning of the inner ear. Treatment is often a combination of canal repositioning move the rocks out of the semicircular canal and home exercises to improve balance and orientation. Medication may assist with the symptoms of nausea but does not correct the underlying mechanical problem.

Unilateral Vestibular Hypofunction

Unilateral vestibular hypofunction (or loss) describes a weakness of the inner organs on one side which causes constant symptoms of dizziness, imbalance and posible blurred vision. Imbalance is often worse in environements that challenge the vestibular system such as walking on uneven ground or in the dark. The cause of vestibular hypofunction is often a viral or inner ear infection, though it can also be caused by trauma, fracture or the use of antibiotics such as gentamiacin.

Diagnosis is made through observing eye movements, testing balance and testing strength. Treatment is tailored to the individual and usually consists of exercises designed to encourage the brain to adapt to the altered functioning of the inner ear. A good analogy is the adaptation to sea sickness which occurs after a few days on a boat. This process requires a fairly intensive period of exercising which lightly provokes the symptoms through exercises involving eye and head movements. 

Bilateral Vestibular Hypofunction

Bilateral Vestibilar hypofunction is a less common cause of dizziness, resulting from damage to both inner ear organs (right and left). Causes are similar to unilateral hypofunction, with antibiotic medication a common factor. Imbalance and visual disturbance are most often reported, with vertigo a less common complaint.

Treatment focusses on removing the cause where possible and completing home exercises assidiously. The rehabiliation process is usually much longer than for unilateral hypofunction and some symptoms may persist for a number of years, or permanently in some cases.

Mal De Debarquement

This is a more unusual condition causing persistent sensations of dizziness, rocking, imbalance, visual disturbance and fatigue. Mal De Debarquement usually occurs following a cruise or flight but is more prolonged than the common sensation of motion sensitivity lasting hours or a few days after travelling. A tailored home exercise programme is usually provided to assist the brain to adapt and to improve balance.

The content provided above is for information only and is not intended to assist with self-diagnosis. If you suffer from any of the symptoms described please contact James Creak on 07786 390 318 to discuss your problem or to arrange an appointment.