Common Patient Complaints

Patients often have a difficult time describing the symptoms they are experiencing. A crucial part of the evaluation process by the Physical Therapists is to interview the patient to determine what symptoms they are experiencing, which will then guide the clinician towards diagnosis, and initiating targeted treatment to achieve improvement and returning individuals to living their best life.

If the vestibular system is damaged by disease, aging, or injury, a vestibular disorder can cause one or more of these symptoms, among others.

Dizziness

This is a sensation of lightheadedness, faintness or unsteadiness.

Vertigo

Vertigo is the sensation of spinning. Even when being still, you may feel like you are moving or that the room is moving around you. You may also experience nausea, vomiting, sweating, and abnormal eye movements.

Imbalance

Feeling a sense of unsteadiness and loss of equilibrium and difficulty maintaining balance, known as disequilibrium.

Vision changes

There is a link between the vestibular system and the visual system, known as the vestibulo-ocular reflex (VOR) This can cause a problem with a person’s ability to stabilize their gaze/vision on objects when you are moving and turning your head, or walking in a very busy environment without moving the head. Patients often describe this as “their eyes having to catch up to their head” when they turn their head.

Conditions of the Vestibular System that can cause Vertigo, Dizziness and Imbalance

  • Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is the most common type of vestibular disorder and the most commonly occurring in individuals age 65 years old and older. BPPV is a vestibular condition that causes episodes of vertigo (the sensation that the room/environment is moving around you), lasting 5-15 secs. The positions that will trigger the vertigo will be lying down, getting out of bed, rolling in bed, or looking up and down. It can also cause nausea, vomiting and imbalance. BPPV occurs when pieces of calcium carbonate crystals (Otoconia) break off from a part of the inner ear where they are supposed to be and end up in the semicircular canals which detects where are body is in space.  When you move your head or body in the positions mentioned above, the crystals move in the fluid of the canal and will cause the abnormal sensation of vertigo. This condition is treated with the Canalith Repositioning Maneuver and resolves typically in 1-3 sessions.

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  • Vestibular Neuronitis / Labyrinthitis / diminished / loss of hearing

Vestibular Neuronitis and Vestibular Labyrinthitis are inner ear disorders that occur due to a viral infection, causing damage to the vestibular and hearing nerve connecting the inner ear to the balance centers of the brain. Symptoms that result will be a sudden onset of intense vertigo (usually lasting hours), with associated nausea, vomiting, imbalance and problems with vision. While Neuronitis affects only the inner ear balance apparatus and does not affect the hearing; however, a Labyrinthitis will have similar symptoms as a Neuronitis, but also

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  • Meniere's disease

Menieres Disease is a vestibular disorder that is a result of an abnormal increase in the amount or pressure of the endolymphatic fluid that is within the inner ear. It is characterized by episodes of vertigo (spinning) usually lasting hours, and is often accompanied by hearing loss, tinnitus (ringing/whooshing sounds), ear fullness, nausea/vomiting and imbalance. Episodes and symptoms can be successfully managed through diet, lifestyle modifications, and, if needed, medication.

 

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  • CONCUSSION / TRAUMATIC BRAIN INJURY
  • Vestibular Migraines
  • Persistent Postural-Perceptual Dizziness

Dizziness, vertigo and imbalance can result from trauma to the brain. Benign Paroxysmal Positional Vertigo is a common condition following head trauma. Other symptoms which may occur are vision issues, memory and sleep changes, and headaches.

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Migraine is the second most disabling chronic disorder in the world. Approximately 55% of migraine patients experience vestibular symptoms at one time or another. A large portion of people with vestibular migraine often have no accompanying headache, their predominant symptom instead being vertigo or dizziness.

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Persistent Postural-Perceptual Dizziness …Persistent Postural-Perceptual Dizziness (PPPD) causes dizziness without vertigo and fluctuating unsteadiness provoked by environmental or social stimuli (e.g. crowds), which could not be explained by some other neuro-otologic disorder. PPPD typically starts shortly after an event that causes acute vertigo, unsteadiness, dizziness, or disruption of balance, but may occur for unknown reasons.

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  • Cervicogenic Dizziness

This is a clinical syndrome of disequilibrium and disorientation/dizziness in patients with neck problems that include cervical trauma (whiplash), arthritis and muscle spasms.

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  • Mal de debarquement

This is a sensation of rocking or movement that persists after a cruise or air travel. Individuals will feel like they are still on the "boat" when on stable ground.

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  • Acoustic Neuroma

Acoustic neuroma (also called a vestibular schwannoma) is a serious but nonmalignant tumor that develops on the sheath of inner ear's vestibulo-cochlear nerve, which transmits both balance and sound information to brain. (This nerve is also referred to as the acoustic nerve, hence the name.) As an acoustic neuroma grows, it compresses the vestibulo-cochlear nerve, usually causing hearing loss, tinnitus, and dizziness or loss of balance.

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  • Ototoxicity

This vestibular condition is caused by exposure to certain drugs or chemicals (ie, intravenous amino glycoside antibiotics) that damage the inner ear. This can result in dizziness, imbalance and occasionally a sensation that the environment "bounces" (oscillopsia) when moving or walking.

Learn More
  • Neurological conditions

Individuals with Parkinson's disease, Multiple Sclerosis and Stroke can experience dizziness/vertigo, imbalance and gait abnormalities, as well as a risk for falls.

 

Learn More

Conditions of the Vestibular System that can cause Vertigo, Dizziness and Imbalance

  • Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is the most common type of vestibular disorder and the most commonly occurring in individuals age 65 years old and older. BPPV is a vestibular condition that causes episodes of vertigo (the sensation that the room/environment is moving around you), lasting 5-15 secs. The positions that will trigger the vertigo will be lying down, getting out of bed, rolling in bed, or looking up and down. It can also cause nausea, vomiting and imbalance. BPPV occurs when pieces of calcium carbonate crystals (Otoconia) break off from a part of the inner ear where they are supposed to be and end up in the semicircular canals which detects where are body is in space.  When you move your head or body in the positions mentioned above, the crystals move in the fluid of the canal and will cause the abnormal sensation of vertigo. This condition is treated with the Canalith Repositioning Maneuver and resolves typically in 1-3 sessions.

Learn More
  • Vestibular Neuronitis / Labyrinthitis / diminished / loss of hearing

Vestibular Neuronitis and Vestibular Labyrinthitis are inner ear disorders that occur due to a viral infection, causing damage to the vestibular and hearing nerve connecting the inner ear to the balance centers of the brain. Symptoms that result will be a sudden onset of intense vertigo (usually lasting hours), with associated nausea, vomiting, imbalance and problems with vision. While Neuronitis affects only the inner ear balance apparatus and does not affect the hearing; however, a Labyrinthitis will have similar symptoms as a Neuronitis, but also

Learn More
  • Meniere's disease

Menieres Disease is a vestibular disorder that is a result of an abnormal increase in the amount or pressure of the endolymphatic fluid that is within the inner ear. It is characterized by episodes of vertigo (spinning) usually lasting hours, and is often accompanied by hearing loss, tinnitus (ringing/whooshing sounds), ear fullness, nausea/vomiting and imbalance. Episodes and symptoms can be successfully managed through diet, lifestyle modifications, and, if needed, medication.

Learn More
  • CONCUSSION/TRAUMATIC BRAIN INJURY

Dizziness, vertigo and imbalance can result from trauma to the brain. Benign Paroxysmal Positional Vertigo is a common condition following head trauma. Other symptoms which may occur are vision issues, memory and sleep changes, and headaches.

Learn More
  • VESTIBULAR MIGRAINES

This is typically characterized by head pain with symptoms associated with vestibular impairment such as motion, light and sound sensitivity, nausea, dizziness and imbalance and if needed, managed medically with medication (a Diuretic).

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  • Cervicogenic Dizziness

This is a clinical syndrome of disequilibrium and disorientation/dizziness in patients with neck problems that include cervical trauma (whiplash), arthritis and muscle spasms.

Learn More
  • Mal de debarquement

This is a sensation of rocking or movement that persists after a cruise or air travel. Individuals will feel like they are still on the "boat" when on stable ground.

Learn More
  • Acoustic Neuroma

Acoustic Neuroma is a very slow growing benign tumor which over time can eventually compromise and press on the vestibular and/or cochlear (hearing) nerve. This result in a hearing loss, tinnitus, dizziness and balance issues.

Learn More
  • Ototoxicity

This vestibular condition is caused by exposure to certain drugs or chemicals (ie, intravenous amino glycoside antibiotics) that damage the inner ear nerve hair cells or the vestibule-cochlear nerve. This can result in dizziness, imbalance and occasionally a sensation that the environment "bounces" (oscillopsia) when moving or walking.

Learn More
  • Neurological conditions

Individuals with Parkinson's disease, Multiple Sclerosis and Stroke can result in dizziness/vertigo, imbalance and gait abnormalities, as well as a risk for falls.

Learn More