Living with a vestibular disorder can be life-altering and extremely challenging. There are so many steps that you can take to get better, but it can be overwhelming where to start. A good place to begin is by incorporating small, yet impactful lifestyle changes that can make a great difference in your symptoms. It is the foundation on which all health is built on, whether people are looking to lose weight, have more energy, or get stronger. Those changes revolve around diet and lifestyle adjustments.
Diet
The goal of healthy eating is to fuel our bodies to function at an optimal level. Certain foods can support strong nerve cells, manage blood sugar levels, and help fight against inflammation. All of these things can impact dizziness and vestibular function. When cells and nerves are not functioning properly, it can exacerbate symptoms.
While the health world has many ideas of how people should be eating, it can be extremely confusing. There are hundreds of different diets, and none of them are a one size fits all situation. To begin on your journey of eating healthy, keep it simple. Eat whole foods. This means avoiding processed foods. When grocery shopping, the majority of your food should come from the outside sections of the store, and avoiding the middle sections. Eating high quality protein, vegetables, fruits, dairy, and whole grains can make a huge impact on your health.
The general rule of thumb is to eat protein, fiber, and fat with every meal. This helps regulate blood sugar and transform food into nutrients that the body needs to function. Eating this way helps balance hormones, build muscle, and boost energy. When we fuel ourselves properly, the body and brain can function optimally, reducing dizziness and making us overall healthier.
If you’re interested or feel like you need extra help, you can look into an Anti-inflammatory Diet, and Low Histamine Diet, the Mediterranean diet, and other. The most important part is that you keep your blood guar balanced and eat enough protein & fiber! You may also want to work with a registered dietitian to help you optimize your gut health!
Lifestyle Changes
Supplements:
Eating healthy is a great start, but the body and brain need extra support. Our food does not contain the nutrients we need. Many people find that they have low levels of certain vitamins and minerals that can affect their dizziness. That’s where supplements come in. Taking certain supplements to give you that extra boost you need can make a huge difference. Getting levels tested and talking to your doctor is the best way to determine what you need and should take. You can work with a functional medicine doctor to get an in-depth approach to all the micronutrients you might lack.
Movement:
Moving with dizziness can be hard, but it is essential to getting better. Getting in some sort of movement everyday is key to not only feeling better but also building trust in your body. Even without a vestibular disorder, exercise is an important part to becoming healthier. You can get in a walk, pilates, yoga, dance, or anything else that gets your body moving.
Strength training is a great place to start. By lifting weights, you improve your balance, muscle strength, bone density, and cognitive function. It also improves your mood, helps with sleep, and strengthens your vestibular system. Check out the workouts in VGF, designed to help you get movement in safely!
Sleep Hygiene:
Getting enough sleep is essential to reduce dizziness and getting healthier. We need sleep! During sleep is the time the brain repairs itself, clears out toxins, and build the immune system. It not only impacts your physical health, but mental health as well. You should establish a sleep schedule, going to sleep and waking up at the same time everyday. Aim for 7-8 hours of sleep a night. Some people need more!
Nervous System Regulation:
Dizziness can be very scary and when symptoms occur, it often sends our bodies into flight or fight mode. Living in survival mode for too long can cause serious health issues, and lower quality of life. We need to regulate our nervous systems to move out of this mode to manage physical symptoms and live a full life. By regulating our NS, we improve cognitive function, digestion, lower blood pressure, and stress less. This can be done through deep breathing, grounding, meditation, spending time outside, and mindfulness. Start with a breathing schedule, set a timer for every hour to deep breathe and notice yourself feeling calmer throughout the day!
It may seem like a lot, but focus on the basics- diet, supplements, movement, sleep, and nervous system regulation. By implementing these small changes into your daily routine, you can make a huge impact on your help and dizziness! Yes, implementing diet and lifestyle changes can help with your dizziness! To learn more and get support, click here!
Can an ear infection make me dizzy? What is a vestibular neuritis and labyrinthitis? How are they different? In this article, we’ll delve into these conditions, explore whether an ear infection can cause them, and discuss potential treatments to help you find relief.
Both of these conditions can result in a unilateral vestibular hypofunction. Other conditions can also result in a unilateral vestibular hypofunction. This is why vestibular rehabilitation could look similar but the cause of the hypofunction may sound different between people.
The Vestibular System: Your Body’s Balance Center
Before we dive into labyrinthitis and neuritis, let’s first understand the vestibular system. This intricate network of structures within the inner ear is responsible for maintaining balance, spatial orientation, and coordinating eye movements. It consists of the semicircular canals, the utricle, and the saccule, all which have their own special role in signaling and detecting motion and gravity. Check out this blog post for further detail on vestibular anatomy in writing, or this youtube video for audio/visual presentation of vestibular anatomy.
Labyrinthitis: A Disorienting Disturbance
Labyrinthitis occurs when the labyrinth becomes inflamed. This inflammation disrupts the transmission of sensory information from the inner ear to the brain, leading to symptoms such as vertigo, nausea, vomiting, and difficulty focusing. This type of inflammation can result in hearing loss.
Vestibular Neuritis: A Nerve-Wracking Experience
Vestibular neuritis specifically refers to inflammation or infection of the vestibular nerve, often resulting from a viral infection. It typically presents with sudden, severe vertigo that can last for days to weeks, accompanied by nausea and imbalance. While the exact cause of vestibular neuritis is not always clear, it’s often associated with viral infections such as the herpes simplex virus or the varicella-zoster virus. This type of inflammation or infection does not typically result in hearing loss.
Can an Ear Infection Cause Vestibular Disorders?
Yes, an ear infection could be a preceding event to a labyrinthitis or neuritis. The inflammation or infection itself could impact the nerve (as in the case of vestibular neuritis) or the labyrinth (in case of labyrinthitis), disrupting their normal function and causing symptoms of vertigo and imbalance. The image below outlines what structures are impacted in both labyrinthitis and neuritis to further understand the differences of these conditions.
Below is a written out comparison of the similarities and differences of vestibular neuritis and labyrinthitis.
Treatments for Vestibular Disorders
If you’re experiencing symptoms of labyrinthitis or neuritis, it’s essential to seek medical attention for an accurate diagnosis and appropriate treatment. The sooner proper treatment are implemented the better. While these conditions can be distressing, there are several strategies to manage symptoms and promote recovery:
- Vestibular Rehabilitation: This specialized form of physical therapy focuses on exercises and maneuvers to improve balance, reduce dizziness, and enhance your ability to compensate for vestibular dysfunction.
- Pacing, Rest and Hydration: Adequate rest and hydration are crucial for supporting your body’s healing process and managing symptoms.
- Medications: Your doctor may prescribe medications such as vestibular suppressants or anti-nausea drugs to alleviate vertigo and nausea. This can be helpful for short term relief. While this is a tool that is encouraged to help manage symptoms, working towards adaptation and habituation through VRT is recommended for long term improvement. While medications are helpful, they can slow the adaptation and habituation process.
- Modify Challenging Activities or Environments: Minimize exposure to triggers that exacerbate your symptoms, or modify to dampen their impact. This is helpful in the present moment as a short term solution while working towards overall long term progress to these challenges.
- Address Underlying Conditions: If an underlying infection is causing your vestibular disorder, your doctor may prescribe steroids, antibiotics or antiviral medications
CNavigating Towards Relief
Living with labyrinthitis or neuritis can feel like navigating through a dizzying maze, but with the right guidance and treatment, relief is within reach. By understanding the vestibular system, recognizing the symptoms of these disorders, and seeking appropriate medical care, you can take steps towards regaining your balance and reclaiming your life. Remember, you’re not alone on this journey, and there are resources and support available to help you every step of the way.
Want to learn more about dizziness and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life? Find out more at this link here.
Disclaimer:
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
Vestibular disorders can be frustrating and complex, but they are all actually incredibly different. There are a few key factors that differentiate each from one another very distinctly. Two very distinct, but often confused, diagnoses are BPPV and Meniere’s Disease. Remember, BPPV stands for Benign Paroxysmal Positional Vertigo. The differences lie in the diagnostic criteria, as well as the clinical presentations. Both do come with room-spinning vertigo, but they will feel very very different.
Diagnostic Criteria
These two diagnoses are very different. BPPV will cause short and spontaneous episodes of vertigo, while Meniere’s Disease triggers long and difficult to tolerate episodes of vertigo.
Meniere’s Disease (MD) Diagnostic Criteria:
- Two or more spontaneous episodes of vertigo each lasting 20 minutes to 12 hours
- Audiometrically documented low- to medium frequency sensorineural hearing loss in one ear, defining the affected ear on at least one occasion before, during or after one of the episodes of vertigo
- Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
- Not better accounted for by another vestibular diagnosis (1)
This is important to understand because many people (and providers) diagnose Meniere’s Disease despite people not actually meeting these criteria. This is especially try of my patients who tell me they have MD but have never experienced room spinning vertigo, or they experience quick spins, rather than long duration spinning, but still have an MD diagnosis. Those things do not qualify you for an MD diagnosis. So, when you may be thinking you may have this diagnosis, know that is both rare and requires a LOT of room spinning vertigo.
Speaking of being rare, yes, Meniere’s Disease is really rare. According to the American Hearing Research Foundation, only about .2% of the US population has Meniere’s Disease, where as BPPV is much more common (2). BPPV has a lifetime prevalence of 2.4%, meaning it will happen in about 2.4 % of the population at some point in their in their lifetime. That is WAY more than Meniere’s Disease (3)!
Benign Paroxysmal Positional Vertigo Diagnostic Criteria
A. Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or
turning over in the supine position.
B. Duration of attacks < 1 min.
C. Positional nystagmus elicited after a latency of one or few seconds by the Dix-Hallpike maneuver or side-lying maneuver (Semont diagnostic maneuver). The nystagmus is a combination of torsional nystagmus with the upper pole of the eyes beating toward the lower ear combined with vertical nystagmus beating upward (toward the forehead) typically lasting < 1 minute.
D. Not attributable to another disorder.
Okay let’s break these down, because they’re a bit more confusing than the Meniere’s Disease diagnostic criteria.
What the BPPV criteria are saying is that when you lie down and sit up, you will have spontaneous room-spinning vertigo for less than 1 minute, which also has a delay (typically 5-10s) because it sets. AND it needs to be non-attributable to another disorder. This is where things get sticky, because vestibular migraine can actually act JUST like BPPV. I see people almost weekly in my clinic that say ‘I have been doing BPPV maneuvers for weeks, and NOTHING is happening,’ and it’s almost always actually vestibular migraine. To learn about the differences between vestibular migraine and BPPV, please click here.
So, how do I know the difference Between Meniere’s Disease and BPPV?
The best, and easiest, way to know the difference is based upon the length of your room spinning vertigo. If your vertigo is quick, and ends in less than a minute, it’s more likely to be BPPV (unless, of course, it’s VM, please read here). If the vertigo is more arduous, tiring, lasting longer than 20 minutes, but also causing hearing loss and tinnitus, it’s more likely to be Meniere’s disease.
What do I do if I have BPPV or Meniere’s Disease?
If you have BPPV, the best plan of care is to call your local physical therapist (hopefully a vestibular therapist!) and get in for a canalith repositioning maneuver to move the crystals back to where they belong! Out of your semicircular canals, and into the otolith organs.
If you have Meniere’s Disease, be sure to call your local vestibular ENT to talk about your treatment options and look further into why your body may have triggered this. There are definitely treatment options for you!
No matter what, there are treatment options for BPPV, MD, and VM. We have treatment options in Vestibular Group Fit, or you can find them at your local doctor. Be sure to address: the actual disorder, inflammation, lifestyle, blood work, and more! If you have questions about what these things should be, please reach out and join us here!
Sources:
(1) American Academy of Audiology. (2022, January 14). Classifications of meniere’s disease. https://www.audiology.org/classifications-of-menieres-disease/
(2) Meniere’s disease. American Hearing Research Foundation. (2022, August 24). https://www.american-hearing.org/disease/menieres-disease/
(3) von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):710-5. doi: 10.1136/jnnp.2006.100420. Epub 2006 Nov 29. PMID: 17135456; PMCID: PMC2117684.
Diagnostic testing for vestibular disorders-explained
Entering the realm of diagnostic testing for vestibular disorders can be overwhelming, to say the least. But fear not; this guide aims to shed some light on the process, helping you navigate through the labyrinth of medical terminology and procedures.
When first going to a doctor for dizziness, it’s normal for tests to be ordered to gather more information as to what might be going on. Below are common diagnostic testing for vestibular disorders to assist providers in gathering more information on the function of each vestibular organ. These are commonly performed by an audiologist. Other tests performed by a physical therapist are in detail here.
Taking into account each individuals story is so important. Your provider will listen to your experience, consider other medical history factors to assist in further referrals. Typically an MRI or CT scan will be ordered to rule out other causes. In most cases, this type of imaging will come out normal in those with vestibular conditions. MRI and CT scans are not great at finding vestibular related conditions. MRI and CT are good at ruling out other causes (stroke, tumor, MS etc).
CT scan is useful with identifying Superior canal dehiscence or thinning of the temporal bone. Symptoms such as “hearing your eyeballs move” or dizziness with sneezing or coughing are common symptoms that prompt this type of imaging. In most other cases however, MRI and CT scan are just the beginning of tests. Below includes testing to determine the status and function of the vestibular system.
Quick vestibular system background
Let’s quick talk about what it is that we’re testing–the vestibular system. The vestibular system, nestled within the inner ear, plays a pivotal role in maintaining balance and spatial orientation. When this delicate system becomes disrupted, whether due to injury, infection, or other underlying conditions, it can wreak havoc on your equilibrium, leading to a myriad of symptoms such as dizziness, vertigo, nausea, difficulty concentrating, unsteadiness, neck pain and more. Diagnostic testing for vestibular disorders looks at directly testing the nerve the shares information between the vestibular system and brain to determine possible diagnoses.
Diagnostic testing for vestibular disorders
Listed below are common tests used to gather more information. This information can assist with other physical assessments and personal report to help with diagnosis and moving forward with a treatment plan.
- Electronystagmography (ENG): This test tracks your eye movements in response to various stimuli, helping to identify abnormalities in the vestibular system.
- Videonystagmography (VNG): Similar to ENG but utilizing infrared video technology for more precise measurements of eye movements. This includes tracking objects, looking between targets and other eye movements. Positional testing to assess any dizziness when in different head and body positions are performed with eye movement recorded and measured. This can help identifying any signs that don’t indicate a vestibular/peripheral cause, and other conditions such as BPPV.
- Caloric Testing: By stimulating each ear with warm and cool air or water, this test assesses the superior branch of the vestibular nerve. Movement sensations are a very normal sensation to have here. It is not an attack. The temperature differences is stimulating only one side of the vestibular system on purpose. This produces involuntary eye movements (nystagmus). By comparing one side to the other. This test looks for symmetry of each vestibular signal and can help identify asymmetries.
- Rotary Chair Testing: You’ll be comfortably seated in a rotating chair while your eye movements are monitored, providing valuable information about your vestibular function.
- Vestibular Evoked Myogenic Potentials (VEMP): This test evaluates the inferior branch of the vestibular nerve which helps with the otolith and saccule function. This involves electrodes on the head/neck with some head movements and sounds. This can help in diagnosing: vestibular neuritis, Meniere’s disease, superior semicircular canal dehiscence.
- ECOG (electrocochleography Exam): This looks for increased fluid pressure in the inner ear. This can be indicative of Meniere’s disease. This test is not used in isolation to diagnose Meniere’s disease as this test isn’t as accurate if being done in between attacks. This involves some electrodes and a few sounds played. A relatively quick and easy test!
- Audiogram: A basic hearing test can help determine any hearing loss and what type. Meniere’s disease can cause low frequency hearing loss on the affected side. Labyrinthitis will also cause hearing loss.
- Auditory Brainstem Response (ABR): Similar set up to an ECOG this test helps measure for any hearing loss. Typically this is done in those that are unable to perform an audiogram.
Other considerations
Other considerations include vision exams to determine a need for vision therapy, or blood work to determine thyroid function, any deficiencies, or inflammatory markers in bloodwork that may be contributing to symptoms. These areas might not be explored initially, but are good to keep in mind as more information is gathered.
There are also additional tests that can help indicate vestibular involvement performed by a physical therapist. More on that in the blog post here. For more info on what to expect during testing, check out this post here
To learn more
Want to learn more about testing, diagnoses, and listen to an interview with a vestibular audiologist? Learn about other vestibular tools from the experts and be a part of a supportive community to get back to your daily life? Find out more at this link: https://tvd.flywheelstaging.com/about-group/
Disclaimer:
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
Tests for a vestibular diagnosis
Imagine seeking answers for persistent dizziness, only to find yourself shuttled between neurologists for MRI or CT scans, ENT specialists for auditory and balance testing, and even cardiology to rule out heart-related issues—all to no avail. You’re left bewildered, feeling anything but normal, despite test results consistently coming back within normal ranges. This frustrating journey is all too familiar for many individuals grappling with vestibular disorders. However, the key lies not in the conventional diagnostic avenues, but rather in understanding the intricacies of vestibular diagnosis.
Vestibular system background
The vestibular system, alongside proprioception and vision, plays a crucial role in maintaining balance and spatial orientation. Situated within the inner ear, the vestibular apparatus comprises semicircular canals and otolith organs, which detect rotational and linear movements, respectively. When this system malfunctions, individuals often experience a myriad of symptoms, including vertigo, dizziness, imbalance, nausea, and visual disturbances. These symptoms can significantly impair daily life, affecting mobility, productivity, and overall well-being.
Vestibular information is used in two ways. One is for balance, and the other is to keep our eyes focused and steady on a target, even while moving. For this to happen, information needs to be sent from the vestibular system to the brain. Certain systems and reflexes are designed to take this information and perform the necessary movements of the head, neck, trunk and eyes to do this seamlessly.
There is also an additional pathway that connects the vestibular system to the autonomic nervous system called the vestibulo-auntomic pathway. Knowing the different pathways the vestibular system is used in can help explain a lot about symptoms. Unsteadiness, bouncing vision, anxiousness etc. This also helps explain tests performed to help determine a vestibular diagnosis.
Testing to determine vestibular involvement
To unravel the mysteries of vestibular disorders, a range of specialized tests and examinations are utilized. The tests below are something that can be expected during a clinical examination at a physiotherapist or physical therapists office. If interested in learning more about specific diagnoses, check out the list of more detailed posts here.
Nystagmus, characterized by involuntary eye movements, can provide valuable insights into vestibular function. The vestibular system helps in keeping vision stable, so involuntary eyes movements that act a certain way can give insight into what signals are being sent by the vestibular system and vestibular nerves.
Positional testing, particularly for benign paroxysmal positional vertigo (BPPV), involves maneuvering the head to provoke characteristic symptoms and identify the affected canal. Involuntary eye movement (nystagmus) is helpful in combination with positional testing to determine the involved side (left or right) and canal to perform the proper corrective maneuvers.
Dynamic Visual Acuity (DVA) testing assesses the ability to maintain clear vision during head movements, offering further clues to vestibular dysfunction. If there is inaccurate signaling or information, this test will yield abnormal results. Retesting can help determine progress being made.
Standing balance assessments, such as Computerized Dynamic Posturography (CDP) or modified Clinical Test of Sensory Integration of Balance (mCSTIB), evaluate postural stability under various conditions while manipulating the different sensory inputs used for balance. This gives insight into what conditions are challenging, and what sensory systems are involved.
Functional balance assessments like the Functional Gait Assessment (FGA) gauge the individual’s ability to perform everyday tasks requiring dynamic balance control. This ties the functional movement aspect that is so impactful with vestibular conditions. To include movements such as turns, stepping over objects, narrow walking, walking eyes closed, or walking with head turns helps determine troublesome movements for each individual. These types of test can also help build a rehab program and act as a retest to track progress.
Testing from other providers
Videonystagmography (VNG) and Vestibular Evoked Myogenic Potentials (VEMP), we delve deep into the function of the vestibular nerve branches, shedding light on the superior and inferior pathways. By assessing the integrity of these neural pathways, we gain invaluable insights into vestibular function. However, it’s essential to acknowledge the limitations—while VNG and VEMP offer vital information, they can’t capture every nuance of vestibular nerve activity. Consequently, normal test results don’t always rule out vestibular involvement, especially in conditions like vestibular migraine. This type of testing does include a hearing test, which can help determine conditions such as Meniere’s Disease. More on this type of testing here and here.
MRI: this can rule out central causes of dizziness such as MS, stroke, Parkinsons, cerebellar disorders, acoustic neuroma. This cannot diagnose a concussion or vestibular migraine, which can be a vestibular condition resulting in dizziness, but a normal test result. This type of test is important to rule out other possible causes, but can feel discouraging as a normal test result when you’re not feeling normal.
Cardiology workup, tilt table testing. This is an area that can result in dizziness with conditions such as atrial fibrillation. Screening for other areas such as orthostatic hypotension, or Postural Orthostatic Tachycardia Syndrome (POTS) should be considered with a cardiologist (sometimes this is neurology as well) to diagnose and assist with management.
In conclusion
Navigating the labyrinth of vestibular diagnosis demands a holistic approach, recognizing the unique challenges posed by vestibular disorders. While conventional testing may yield normal results, it is imperative to delve deeper into the vestibular system to uncover underlying dysfunction. By harnessing specialized tests and examinations tailored to assess vestibular function, individuals can finally find clarity amidst the dizzying array of symptoms. So, if you find yourself trapped in the cycle of unexplained dizziness, remember—it’s not just about normal test results; it’s about deciphering the vestibular puzzle to reclaim your equilibrium and quality of life.
Want to learn more about testing, diagnoses, and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life? Find out more at this link: https://tvd.flywheelstaging.com/about-group/
Disclaimer:
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
Renga V. Clinical Evaluation of Patients with Vestibular Dysfunction. Neurol Res Int. 2019 Feb 3;2019:3931548. doi: 10.1155/2019/3931548. PMID: 30863640; PMCID: PMC6377969.
What causes vertigo?
The Causes of vertigo are vast, but we first need to remember that Vertigo is a symptom, and never ever ever a diagnosis. Vertigo is like saying ‘it hurts’. What hurts? What does it feel like? Where is the pain? Is it sharp or dull? Is it acute or chronic? What is the cause of the pain, just like we would ask ‘what is the cause of the vertigo?’
Knowing the pain is like knowing your vertigo. It’s only a symptom, and it is never a diagnosis. We need to determine the cause of the vertigo in order to accurately help you understand your body better and manage life with a vestibular disorder!
What causes a vestibular disorder?
A vestibular disorder is an inner ear disorder that can cause many symptoms, including but not limited to, dizziness, vertigo, nausea, vomiting, lightheadedness, and more. Vestibular Disorders are largely split into central and peripheral vestibular disorders. A central disorder happens in your brain; like vestibular migraine, concussion, persistent postural perceptual dizziness, or a stroke. A peripheral vestibular disorder happens in the vestibular system itself, like vestibular neuritis, BPPV, or Meniere’s Disease.
In order to understand a vestibular disorder, we also need to understand the vestibular system itself.
What causes vertigo? Many things, but typically vestibular disorders are what causes vertigo.
What is the vestibular system?
Your vestibular system lives in your skull, deep in your inner ear. It is attached to your hearing organ, AKA your cochlea, and the vestibular system itself. It’s made up of bone, cartilage, and two types of fluid. If you want to learn more about the vestibular system and it’s inner workings, read more here.
5 causes of vestibular dysfunction
What causes vertigo? Vestibular disorders are very common causes of vertigo!
- Illness
- Injury
- Medication ototoxicity
- Mechanical issues and calcium debris
- Migraine disorders
Illnesses and infections of vestibular disorders
There are many illnesses that are associated with vestibular disorders, which cause vertigo symptoms.
Inner ear infections, like a vestibular neuritis, will leave you with a vestibular hypofunction, which is a peripheral vestibular disorder. IF you want to learn more about peripheral disorders, listen to this free podcast episode. This kind of inner ear infection can also cause labyrinthitis, which is the same as neuritis but includes hearing loss.
Long COVID is another infection that can cause dizziness. COVID infections can infect the vestibular system, also leaving you with a hypofunction, or can cut off the blood circulation to the inner ear, causing damage to the vestibular system itself. This can cause chronic or acute dizziness, both of which are treated in Vestibular Group Fit! You can read more about Long-COVID and dizziness in this article here.
Injuries and vestibular disorders
Your vestibular system can be injured, specifically with head and neck trauma, in a Traumatic Brain Injury. TBI, mTBI, or concussion can cause a vestibular hypofunction. In some cases, if the person is impacted in the side of their head it can cause a hypofunction in the vestibular system itself. These disorders, just like all disorders, are manageable and rewiring your brain with vestibular rehab is possible to do to get back to a place where dizziness is not 24/7.
Medication ototoxicity
Ototoxic medications are some NSAIDs, Chemotherapy drugs, Gentimicin, antimalarials, loop diuretics, and salicylates (1). Sometimes, these medications are absolutely necessary, especially chemotherapy medications. Because these medications can cause injury to the vestibular system(s), they can be what causes vertigo.
However, when they’re taken they can be toxic to your inner ear and cause a decrease in function, hypofunction, in one or both ears. This can cause intermittent or permanent symptoms in one or both ears. For example, after chemotherapy treatment, bilateral vestibular hypofunction can be common, as well as
Sometimes, there are intentional ototoxic doses of Gentamicin, like for the treatment of Meniere’s Disease.
Mechanical disorders and debris
Benign Paroxysmal Positional Vertigo, Superior Canal Dehiscence Syndrome, and Perilymph Fistula are all mechanical disorders.
BPPV is a mechanical disorder because calcium carbonate crystals are misplaces from the otolith organs into the semicircular canals, causing episodic vertigo. If you want to learn more about BPPV, click here.
Superior canal dehiscence and perilymph fistula are both mechanical disorders as they are physical holes in your inner ear causing specific symptoms. A surgical or other medical intervention is usually recommended.
Migraine disorders (Vestibular Migriane)
Migraine is more than just a headache. Migraine is a full body neurological disorder that occurs in your brain 24/7 but presents itself in attacks. Vestibular migraine is the most common cause of neurological dizziness and vertigo! Vestibular Migraine is so treatable, but can feel so difficult to get there. We will help you with this, as you need a comprehensive treatment program with a comprehensive outlook, from everything from medical treatment to lifestyle adjustments and being educated about your disorder.
Dizziness gets better, you just need the right tools!
The right tools exist and they’re all in 1 place in Vestibular Group Fit! You can learn more about Group, and why we use this method here.
Sources:
(1) Joo Y, Cruickshanks KJ, Klein BEK, Klein R, Hong O, Wallhagen M. Prevalence of ototoxic medication use among older adults in Beaver Dam, Wisconsin. J Am Assoc Nurse Pract. 2018 Jan;30(1):27-34. doi: 10.1097/JXX.0000000000000011. PMID: 29757919; PMCID: PMC6044447.
Bilateral vestibular dysfunction
Learn about what bilateral vestibular dysfunction is and what treatment options are available. This vestibular condition requires a different approach due to the nature of the condition. Learn more about this lesser known vestibular condition below.
What is bilateral vestibular dysfunction
Bilateral vestibular dysfunction (BVD) is also known and bilateral vestibular loss (BVL) or bilateral vestibular hypofunction (BVH). This is when both our left and right vestibular systems are affected by an event that results in reduced function. This impacts about 4% of individuals that have a vestibular disorder.
Bilateral vestibular dysfunction can be a result of:
- genetics/congenital inheritance
- bilateral neuritis (super rare but technically could happen)
- bilateral Meniere’s disease
- surgical
- ototoxicity
- undetermined reason (50% of the time we just don’t know why) [1]
Typically with bilateral vestibular loss, dizziness is not a main symptom. Balance tends to be the main concern that brings someone to the doctor. Those with bilateral vestibular loss tend to experience:
- imbalance and unsteadiness. Especially in darkness
- trouble with balance and walking on uneven surfaces. Darkness makes this even more challenging
- oscillopsia or “bouncing vision”
- little to no dizziness
- Challenging to perform daily tasks and activities.
I have bilateral vestibular dysfunction, what type of progress can I expect?
The difference in bilateral vestibular loss is that both vestibular systems are impacted. This makes progress variable. With both systems impacted, it’s difficult to get the benefits of adaptation and habituation that is utilized in vestibular rehabilitation therapy (VRT) when only 1 vestibular system is involved.
VRT can still be beneficial. The goal is to promote the maximum amount of habituation and adaptation as possible while also working on ways to compensate for BVL. This helps many return to functional daily activities, but it most likely doesn’t look exactly how someone performed the activity prior to BVL. [2]
Bilateral vestibular dysfunction treatment options
As mentioned above, treatment will look different for those with BVL. Vestibular therapy will trial various VRT exercises to promote as much adaptation as possible. Finding ways to substitute and compensate movements will be a major focus of treatment. The goal of these compenstations is to get people back to their daily routines and activities, just in a slightly different way.
This might include using motion sensor night lights in the home to promote safe walking at night, or use of a hiking pole for safe walking on uneven surfaces. A popular hiking pole brand that physical therapists have recommended to me are linked here.
Part of treatment will be finding exercises to promote overall health and activity. Exercising and movement has many benefits to our overall health and well being. An animal study looking animals with BVL showed that animals who exercised on a regular basis were able to return to normal movement and ability. This might not happen exactly in the same way in humans, but movement is important! [3]
Another area of treatment undergoing development is surgical implants. These surgical implants act as vestibular prosthesis. There’s been great results and improvement in mobility, reduced falls, and overall quality of life at 6 months and 1 year out from surgery. There are a few clinical trials going on with the goal of making this an available treatment option for the public.
Disclaimer
Want to learn more about bilateral vestibular dysfunction and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life? Find out more at this link: https://tvd.flywheelstaging.com/about-group/
Disclaimer:
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
Sources:
(1) Lee SU, Kim HJ, Kim JS. Bilateral Vestibular Dysfunction. Semin Neurol. 2020 Feb;40(1):40-48. doi: 10.1055/s0039-3402066. Epub 2020 Jan 14. PMID: 31935769.
(2) McCall AA, Yates BJ. Compensation following bilateral vestibular damage. Front Neurol. 2011 Dec 27;2:88. doi: 10.3389/fneur.2011.00088. PMID: 22207864; PMCID: PMC3246292.
(3) Igarashi M, Ishikawa K, Ishii M, Yamane H. Physical exercise and balance compensation after total ablation of vestibular organs. Prog Brain Res. 1988;76:395-401. doi: 10.1016/s0079-6123(08)64526-4. PMID: 3217529.
(4) Chow MR, Ayiotis AI, Schoo DP, Gimmon Y, Lane KE, Morris BJ, Rahman MA, Valentin NS, Boutros PJ, Bowditch SP, Ward BK, Sun DQ, Treviño Guajardo C, Schubert MC, Carey JP, Della Santina CC. Posture, Gait, Quality of Life, and Hearing with a Vestibular Implant. N Engl J Med. 2021 Feb 11;384(6):521-532. doi: 10.1056/NEJMoa2020457. PMID: 33567192; PMCID: PMC8477665
Concussion treatment in 5 buckets
Learn about what concussion is, common symptoms, recovery timeline and the 5 main areas of concussion treatment. Dr. Madison talks with concussion expert Dr. Heisig in Vestibular Group Fit to go over the different areas of concussion and important treatment areas to consider. check out some of the great information below!
What is a concussion
A concussion is classified as a mild traumatic brain injury. Traumatic brain injuries are classified on a spectrum from mild to severe, we are only looking at concussion in this post.
A concussion occurs from hitting your head, or a sudden speed change that impacts the brain. You don’t have to hit your head for this rapid speed change, but is a common way concussions occur.
Imaging will not show a concussion. imaging can show blood clots, bleeding, or broken bones and other structures, but it cannot show a doctor that there is a concussion. This is determine by the method of injury and reported symptoms.
Concussion metabolic cascade
What happens to our body during an acute concussive event happens at the cellular level. The sudden change in speed creates stretching and shearing of the brain cells and neurons.
Sudden stretching and shearing of our neurons changes the balance of our electrolytes. These electrolytes are important for brain function and how our neurons fire. This sudden change in electrolyte balance results in random neuron firing and neural toxicity.
Getting our brain’s electrolytes back in proper balance takes a lot of energy and time. Typically around 3-4 weeks. During this time our brain is functioning in a metabolic energy deficit. Our brain has difficulty carrying out typical functions due to the metabolic energy deficit. This energy deficit leads to many symptoms people experience such a disorientation, fatigue, brain fog, headaches etc.
One way to think of this is with a circle or pie analogy. A full circle is the total amount of energy we have to perform daily functions. The electrolyte rebalancing is taking up a large part of this energy pie. This leaves a smaller amount of energy pie to do the typical activities our brain does. This leaves to picking and choosing certain activities, or having to take additional time between tasks to restore energy.
Rest or not rest? What research says about best concussion treatment
New guidelines in concussion have changed the way concussion treatment is performed. Typically in concussion treatment, someone might be told to rest for weeks, this should no longer be the case. Research shows that resting after a concussion for 24-48 hours and then gradually getting back into typical activities yields the best results.
Rest doesn’t mean sleeping all day. It means taking things a little slower than you normally would. This might look like a short walk instead of a high intensity workout, or limiting screen time with more breaks in between screen use. This can vary by the person depending on their concussion treatment buckets we’ll talk about next.
The goal with concussion is to gradually increase the intensity of activity to get back to your baseline. Again this can take up to 3-4 weeks. Listen to your body as guidance, new or worsening symptoms is your body saying that you’re taking on more than your body can tolerate. Take a note from your body to rest and recover and adjust the activity.
What are the 5 main buckets of concussion treatment
Recent concussion treatment and management has taken on a new way to help classify concussion to better include the many different presentations and symptoms someone with a concussion can have. A questionnaire tool called the CP Screen gives a series of questions that help determine the main categories of symptoms someone is experiencing. This screen has 5 main subtypes and 2 modifiers to help capture the main symptom areas to address on a person to person basis.
The five concussion treatment buckets are:
- Autonomic and Exercise Intolerance
- Visual Vestibular
- Neck and Cervical
- Hormonal and Metabolic
- Psychological (Mental and Emotional)
In the next section, we’ll go into more detail on each of these 5 areas of concussion treatment. More than one can apply to someone with a concussion but breaking down into these categories can help determine how to prioritize treatment to address the major concerns being experienced.
5 buckets of concussion treatment cont.
1.Autonomic and Exercise Intolerance
Concussion can impact blood flow. This can lead to autonomic dysfunction such as lightheadedness, dizziness, tunnel vision or elevated heart rate when standing up. In other cases, symptoms might be gone at rest, and reappear during exercise or increased exertion. Graded movement, and testing such as the Nasa lean test or buffalo concussion testing performed by a medical provider can assist in working with you in exercise progression and treatment.
2. Visual Vestibular
A concussion can impact our visual and vestibular system making us feel dizzy, off balance, or even difficulty with reading, screens or eye strain. BPPV prevalence increases after concussion and should be screened as part of a comprehensive concussion assessment. VRT or vision therapy can further determine areas to work on to address these symptoms.
3. Neck and Cervical
Neck pain, stiffness, limited range of motion are common after a concussion. This again can vary based on the mechanism of injury and individual presentation. Focused treatment on the neck can assist with headaches, muscle pain, reduced range of motion and more.
4. Hormonal and Metabolic
Keeping the full picture in mind includes looking at lifestyle and other medical conditions someone has. Nutrition and hydration is key for overall health and recovery. Avoiding any allergies or food sensitivities is important to reduce stress and inflammation while healing from a concussion. Pre existing metabolic conditions such as a thyroid condition can also contribute to concussion symptoms and should be evaluated and ensure it is being properly managed.
5. Psychological (Mental and Emotional)
A concussion can create a major shift in how you’re feeling, your usual routine, or maybe even result in trauma from the event that the concussion came from. Those with a concussion will report feeling more irritable, anxious, depressed, or just not like their typical self. for concussion treatment, having a skilled professional to assist with mental health can be extremely helpful as part of concussion treatment. There are ways to see someone over telehealth or over the phone to make this essential healthcare more accessible and provide the privacy some may want. Check out some options here or here or here, yup that important!
Learn more with Vestibular Group Fit
Want to learn more about concussion and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life? Find out more at this link: https://tvd.flywheelstaging.com/about-group/
Disclaimer:
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
Best steps to Treat MDDS (Mal de Debarquement Syndrome)
Learn about what MDDS is, how it can be treated, and other resources to learn more about MDDS management.
Diagnosis criteria for Mal de Debarquement Syndrome
Criteria for the diagnosis of Mal de Débarquement syndrome
- Non-spinning vertigo characterized by an oscillatory perception (rocking, bobbing, or
swaying) present continuously or for most of the day. - Onset occurs within 48 hours after the end of exposure to passive motion.
- Symptoms temporarily reduce with exposure to passive motion.
- Symptoms continue for >48 hours. (More on this in the next section)
- Symptoms not better accounted for by another disease or disorder.
MDDS diagnostic criteria has changed slightly to include a spectrum of time someone has been experiencing symptoms. This has been designed to help those get a diagnosis and begin treatment sooner which is a great addition. Here they are:
- MdDS in evolution: symptoms are ongoing but the observation period has been less
than 1 month - Transient MdDS: symptoms resolve at or before 1 month and the observation period
extends at least to the resolution point - Persistent MdDS: symptoms last for more than 1 month
3PD vs MDDS: what are the differences?
When searching for answers and finding a diagnosis, it can be tough to know which description fits best. You can also have more than one vestibular condition to make diagnosis more challenging. Dr. Madison talks with Vestibular Group fit Members the differences between Vestibular Migraine, PPPD, and MDDS as well as treatment considerations if you have a combination of diagnoses.
In this blog we’ll briefly talk about some differences between 3PD (persistent postural perceptual disorder) and MDDS
3PD
- People typically feel worse in car
- Will typically feel worse with walking/movement
- additional 3PD criteria can be found in this blog post here.
MDDS
- People usually feel better in car
- Will tend to feel worse with walking
Non-motion triggered Mal de Debarquement Syndrome
If you’re searching for answers, you might come across non-motion triggered MDDS. This area of vestibular research and classification is still up for debate. Some think this is a different form of chronic dizziness, or vestibular migraine, or something else. Time will tell where this ends up!
MDDS treatment: Dai protocol
A very popular protocol for MDDS treatment is the Dai protocol. A 2018 research study by Dai et al show that 75% of those undergoing treatment had significant improvement when followed for 1 year. This protocol involves a few important tests and equipment to follow and is best to be done with a provider knowledgeable in this protocol. If you’re in a place where a provider isn’t familiar, they can read research and implement the protocol with you.
More information on the Dai protocol can be found here.
A great treatment tool for MDDS or other visual vertigo can be found here through 360 Neuro Health. Talk to your provider before using to find the best dosage and progressions.
Mal de Debarquement Syndrome treatment continued
There are more treatment considerations than the Dai protocol. Medications such as SNRIs/SSRIs and benzodiazepines have been shown to be a beneficial part of treatment for some.
Other factors to consider as part of treatment include:
- sleep
- diet
- exercise
- stress management
- vestibular exercises/VRT
- mindset
- neuromodulation
Dr. Shin Beh goes into detail on MDDS and treatment in his book Disembark, check it out here as well as other great books Dr. Beh has written.
Disclaimer
Interested in learning more? Check out this other blog post on Mal de Debarquement Syndrome
here.
Want to learn more about MDDS, and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life? Find out more at this link: https://tvd.flywheelstaging.com/about-group/
Disclaimer:
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
In Vestibular Group Fit, Dr Madison Oak and Vestibular PT Cheryl Wylie, MPT talk all things BPPV and vestibular migraine. They discuss what BPPV is, what assessment and treatment look like, and Cheryl’s amazing app Healing Vertigo (check it out here). There’s great conversation too revolving around a very common yet difficult task, am I dizzy with a vestibular migraine flare, or BPPV? Read on for some background, or jump to the differences between BPPV and VM at the of this post.
Cheryl Wylie has been working in vestibular rehabilation for 13 years. Throughout her time traveling, she realized how common BPPV is, yet how difficult it can be to get it treated for those outside of big cities and specialized therapists. The app Cheryl created, Healing Vertigo, is designed for patients to learn how to address BPPV themselves.
What is BPPV?
BPPV stands for “Benign Paroxysmal Positional Vertigo”. This is a common vestibular condition, and gets its name from its own characteristics.
Benign: Not harmful (Don’t worry, we know firsthand how disruptive, scary and down right uncomfortable BPPV is…we have had it! They used the term benign in naming BPPV due to the fact it is not considered life threatening.)
Paroxysmal: sudden onset
Positional: certain head/body positions bring on symptoms
Vertigo: sensation of motion or spinning
BPPV and the Vestibular System
We’ll keep this review brief, but feel free to check out this previous post that dives deep into all things BPPV here.
Our vestibular system has 3 semicircular canals. These canals are filled with fluid and sit at different angles. Their job is to detect angular motion (are we moving sideways, up, down diagonal).
In the otolith of the inner ear, tiny (but heavy for their size) crystals that help detect gravity and motion.
If a crystal breaks away from the otolith and finds it’s way into a semicircular canal, this is the start of BPPV. When this crystal moves through the semicircular canal, the crystal pushes the fluid of the canal at a different rate. Our inner ear is now sending two very different signals of movement to our brain to try and understand. This results in a specific eye movement called a nystagmus (more on this here). This is why testing involves certain head positions, and looking at your eyes to assess any nystagmus present. Nystagmus is important information in addition to head position to know the next course of action, treatment! Here’s a chart of the different nystagmus here.
NOT EVERYONE GETS DIZZY WITH BPPV. Some may not feel dizzy with BPPV, but off balance. This is why it’s important to screen for BPPV in those that are dizzy and those with balance concerns to rule out BPPV.
Vestibular Migraine
Vestibular migraine is a neurological condition that can result in a variety of unpleasant symptoms. Common symptoms of vestibular migraine include: brain fog, light/sound sensitivity, neck pain, tingling, vision changes, and dizziness and/or vertigo. For more background check out our beginners guide to vestibular migraine.
Those with vestibular migraine have most likely been treated for BPPV. The kicker here though, is not all had BPPV. Unfortunately, this results in people getting treated for BPPV over and over, with no change in symptoms or feeling worse than before. This is because vestibular migraine can result in positional dizziness, but is not due to BPPV. This is why it’s important to understand the mechanism and nystagmus of BPPV to determine if treatment is warranted, or if it is due to a vestibular migraine attack.
BPPV and Vestibular Migraine, which is it?
BPPV charactersistics:
- lasts 10-30 seconds typically (but can last longer if you have cupulolithiasis-read on here)
- nystagmus that matches a semicircular canal (chart here)
- Tends to have a slight symptom delay (a few seconds)
- will continue to happen until treated (spontaneous resolution can occur, but can take weeks and isn’t guaranteed)
Vestibular migraine characteristics:
- quick spins while sitting up or sensation of dropping
- nystagmus isn’t consistent. or doesn’t match that of BPPV
- comes with a migraine attack (light/sound/smell sensitivity etc).
- You feel like you keep doing the Epley and it doesn’t work
- You get episodes of spinning or dizziness in certain positions but will go away in a day or two without you doing any treatment and just “wait it out”.
It’s hard to know the difference between BPPV and vestibluar migraine. Hopefully this list helps point you in the right direction. BPPV needs to be treated with a repositioning maneuver to improve. A vestibular migraine needs to be treated during a flare, and then work on managing symptoms and increasing your migraine threshold. If you’re unsure, schedule with your vestibular PT for an assessment for BPPV or check out Cheryl’s Healing Vertigo App (website here, video presentation here)
Disclaimer
Want to learn more about what to expect with BPPV assessment and treatment, debu7nking BPPV myths, reducing BPPV risk and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life? Find out more at this link: https://tvd.flywheelstaging.com/about-group/
Disclaimer:
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
