Vestibular Care: It's All in Your Ears

Making the world right again: Vestibular therapy eases dizziness from inner ear disorders 
By Jessie DeLuca, PT, and Mary Ann Racette, MPT 

The symptoms seem to come out of the blue. You roll over in bed and suddenly feel like you’re dropping off the face of the earth. The intense spinning sensation may only last a matter of seconds, but the experience is unforgettable. Or, your symptoms might be a lot less dramatic, such as a persistent woozy feeling that doesn’t seem quite right.  

Both situations should prompt a visit to your primary care physician to rule out something serious. But chances are, you just experienced the first episode of vestibular disorder - a condition that affects the inner ear causing a range of symptoms that can jeopardize your balance, function and quality of life. 

The vestibular system is a sensory organ that is housed in both the right and left inner ears. Vestibular disorders can be caused by aging, traumatic head injuries, a virus, other illnesses, and even chemotherapy. The condition unleashes a wide range of symptoms that include extreme spinning, dizziness, unsteadiness and nausea.  Organizations that provide information and support to people with vestibular disorders say that 35% of all adults over the age of 40 have experienced vestibular disorder at some time in their lives. 
 
Left undiagnosed and without vestibular rehabilitation therapy, people who are dizzy or unsteady tend to move around less, leading to an additional range of health problems associated with deconditioning that puts them at a greater risk of falling. Yet, in a majority of cases, vestibular rehabilitation therapy can ease the symptoms, resolve the disorder and restore most, if not all, quality of life. 

Not all rehab facilities provide this specialized care so it’s important to make sure a vestibular therapist is on staff. At BMC’s Center for Rehabilitation, we perform a 90-minute patient evaluation to isolate the specific vestibular disorder and create a customized plan of care.  
 
Vestibular disorders are typically classified as peripheral, which means the disorder is located in the inner ear, or central, which means the disorder originates in the brain. If peripheral, the inner ear is not giving the brain correct information. If central, the inner ear is providing the right info, but the brain is not processing it correctly. The vast majority of vestibular disorders originate in the inner ear, including Benign Paroxysmal Positional Vertigo (BPPV), which is the most common and most treatable vestibular disorder. 

In this case, crystals located in the inner ear break free within vestibular system. When the head is put in certain positions – like when you are rolling over in bed - the free-floating crystals trick the brain into thinking it’s spinning out of control. Therapy involves identifying what ear and which canal is involved and then manipulating the crystals back where they are supposed to be. This condition is 90% treatable, usually in 3 visits or less. 

Another common vestibular disorder that responds very well to therapy is called vestibular hypofunction, which occurs when the vestibular nerve in one ear has somehow been damaged, often by a virus, causing a feeling of imbalance. Specialized therapy encourages the other healthy ear to pick up the slack, restoring your sense of balance. 

Years ago, vestibular disorders were hard to diagnose and people suffered, often with frightening physical symptoms that gradually caused them to be more sedentary, isolated and anxious. Today, physicians are far more likely to refer patients to vestibular rehabilitation for relief. In addition to easing symptoms and restoring a sense of balance and safety, vestibular therapy enables our patients to take back control of their lives. 

Jessie DeLuca, PT, and Mary Ann Racette, MPT, are physical therapist at the Center for Rehabilitation at BMC.