A few of the more typical diagnoses and their treatments are listed below:
BPPV (Benign Paroxysmal Positional Vertigo): BPPV is the most common cause of vertigo. In BPPV, small crystals that have a job to do in one part of the inner ear (called the otolith) make their way into the wrong part of the ear (called the semicircular canals, there are three in each ear). We don’t know why it happens but it is more likely to happen after a bump to the head and it is more likely to happen as we get older. This causes very intense vertigo lasting from a few seconds to a couple of minutes, most commonly when you look up or down or when you get in and out of bed. It is sometimes accompanied by a constant feeling of less intense dizziness or light-headedness. Treatment consists of helping you take your head and body through a specific set of movements that remove the crystals from where they don’t belong. The good news is that this is the easiest type of vertigo to treat with 80% of people getting better after one treatment and over 90% getting better with two treatments.
Vestibular Hypofunction: Vestibular hypofunction is what happens when one or both of your inner ears become damaged. Several of the conditions described below can result in vestibular hypofunction. Normally, even when you remain perfectly still, the vestibular portion of your inner ears is sending signals to your brain. Your brain is used to “listening” to two ears that are equally strong. When the signal from one side is weaker than the other, your brain does not know how to interpret this information and the result can be the sensation of vertigo or dizziness.
Labyrinthitis/ Vestibular Neuronitis: Labyrinthitis and Vestibular Neuronitis are two different kinds of infection of the inner ear. In severe cases, symptoms may begin with constant intense vertigo lasting for more than a day. It is not uncommon for people in this circumstance to be sent to the hospital by their doctor to make sure that the vertigo is not being caused by something more serious like a stroke. The infection can cause damage resulting in a vestibular hypofunction that may be temporary or permanent. Afterwards you can have lasting dizziness or short bursts of vertigo when you move your head. Vestibular rehabilitation cannot fight the infection or repair the damage, but the resulting vestibular hypofunction can be treated.
Acoustic Neuroma: An acoustic neuroma is a benign (non-cancerous) tumor on the nerve that goes from the ear to the brain. This condition must be monitored by a doctor who will determine if and when it requires surgery. The tumor itself and the side effects of surgery both can impair the ability of the inner ear signals to get to the brain, resulting in dizziness from a vestibular hypofunction. Vestibular rehabilitation will not help treat the tumor itself nor can it repair the damage to the nerve, but the resulting vestibular hypofunction can be treated.
Meniere's Disease: Meniere's Disease causes attacks of constant intense vertigo lasting for hours and hours. Vestibular rehabilitation cannot do anything to stop these attacks. Sometimes after an attack you can have lasting dizziness or short bursts of vertigo when you move your head. This might be due to the disease damaging your vestibular system on one side and causing a vestibular hypofunction or due to your brain becoming hypersensitive to vestibular stimulation, both of which can benefit from vestibular rehabilitation.
Central Vestibular Dysfunction: This refers to damage to the brain, such as from a stroke or a disease like multiple sclerosis, that causes dizziness or vertigo. Similar to the case of vestibular hypofunction, your therapist will identify appropriate exercises to stimulate the brain to learn to adjust to “the new normal” of its damaged state and learn to ignore the signals that it is currently interpreting as dizziness.
Post Concussion Syndrome: Concussion, also called a mild traumatic brain injury, often results in a few weeks of unpleasant sensations such as dizziness, nausea, visual problems, and problems with concentration. Unfortunately, the only way to deal with this is to follow your doctor’s orders and rest. However, if these symptoms continue beyond several weeks, vestibular rehabilitation can be used to desensitize the brain to symptom-provoking stimulation.
Chronic Subjective Dizziness: This is a catch-all term meaning “we don’t know why you feel dizzy all the time”. Some people appear normal on every test modern medicine has to offer and yet they still feel dizzy. One theory is that the vestibular part of the brain might have become “reset” by a mild case of BPPV or Labyrinthitis in the past, so that as the ear returned to normal the brain began to perceive it as abnormal. Another theory is that some people for some reason become “hypersensitive” to stimulation to their vestibular system. When dizziness has been interfering with someone’s life for a long time sometimes anxiety and worrying about the dizziness can contribute to the problem, sometimes not. Whatever the reason, vestibular rehabilitation can often help even in these cases where we don’t know what the cause of the problem is.
Cervicogenic (Neck-muscle-related) Dizziness: Rarely, problems in the neck muscles can be the cause of dizziness. If your therapist suspects that this is the case, you will be given orthopedic treatment in addition to vestibular exercises.
Migrainous Vertigo: There is a relationship between migraine headaches and vertigo that is not fully understood. Some attacks of vertigo, even without a headache, can be caused by migraines. Vestibular rehabilitation may or may not help relieve some of these symptoms. More importantly, if your therapist is able to identify signs of this problem you can speak to your doctor about managing your migraines.
Motion Sickness: People who become nauseous because they are carsick, airsick, or seasick, but have no problems with dizziness have not been found to benefit from vestibular rehabilitation.
Low Blood Pressure/ Low Blood Sugar: People who become dizzy due to low blood pressure or low blood sugar will not benefit from vestibular rehabilitation and should discuss their dizziness with their doctor.
Hearing Loss or Tinnitus (Ringing in the Ears): Vestibular rehabilitation has no effect on hearing.