Inner Ear - Vestibular Disorder Treatment
Tallahassee Memorial Rehabilitation Center has expertise in and provides unparalleled care for patients with vestibular and balance disorders. Vestibular disorders are caused by problems in the inner ear. Vestibular rehabilitation is a specialized, exercise-based form of physical therapy aimed at easing the problems caused by inner ear disorders.
At the Tallahassee Memorial Outpatient Neurological Rehabilitation Clinic, our team of physical therapists have more than 130 years of combined treatment experience and advanced certifications in the field of vestibular disorders. This includes advanced and comprehensive training for the evaluation and management of vestibular disorders. We also specialize in the treatment of people who have fallen or who are at risk of falling. Patients will receive individualized treatment programs and exceptional care which may include use of the Neurocom Balance Master or Frenzel goggles.
Common symptoms that can be helped with vestibular rehabilitation include:
- Dizziness
- Blurred vision with head movements
- Feeling off balance or unstable when standing or walking
- Falls
- Generalized dizziness or "foggy head" sensation
- Vertigo or a sense of spinning
- Motion sickness
- Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is one of the most common types of vertigo. The exact cause is unknown but it does become more common as we age. In this condition, certain head positions or movements cause a sense of spinning. These movements may include getting in and out of bed, bending over or looking up. The symptoms are due to the presence of microscopic crystals of calcium carbonate moving through an inner ear canal as your head moves.
Vestibular Neuronitis & Labrynthitis
Vestibular Neuritis and Labrynthitis are caused by an irritation of the nerve to the inner ear (vestibular nerve) due to infection. This type if infection is usually viral and may result in sudden vertigo, nausea and balance problems. These symptoms are usually severe and can last a few days with gradual improvement over several weeks. In some people, activities like driving, walking in stores or crowded malls can continue to cause dizziness and balance problems. Some people also complain of difficulty concentrating and blurred vision.
Meniere's Disease
Meniere's disease is a syndrome in which you experience unpredictable episodes of vertigo, hearing loss and tinnitus (ringing of the ear). It may ultimately result in permanent hearing loss in the ear. Some patients also complain of a sense of fullness or pressure in the ear associated with the episodes of vertigo. Meniere's disease usually affects only one ear. Between the episodes, there are usually no symptoms. The cause of Meniere's disease is currently not known.
Migraine-related Dizziness
Migraines are believed to be due to changes in blood flow to the brain which then change the activity of the nerves in that area of the brain. Migraines can occur in the part of the brain that controls the vestibular system. This can cause dizziness, motion sickness and unsteadiness. This can occur before, after or WITHOUT a headache. Symptoms may last hours to days.
Cervicogenic Dizziness (neck-related dizziness)
Neck pain is a common complaint in people with dizziness. The neck pain can be due to the way you are limiting your head movements because of your dizziness; however, sometimes the neck pain is the cause of the dizziness. The symptoms of this kind of dizziness are similar to other causes of dizziness. The dizziness can be felt as a sense of being off balance when moving your head. The dizziness may also be worse when the head is held in one position for a long time. There are no specific tests for this type of dizziness. The majority of patients will improve as their neck is being treated, however, some patients will also need vestibular rehabilitation.
Concussion
Trauma to the brain during the concussion can cause vestibular problems. The inner ear can also be damaged directly by the force of the injury. This may even result in BPPV. When the vestibular system is not working well the brain relies on information from your vision. This can result in eye strain, fatigue and headaches in addition to the dizziness from the trauma.
Space and Motion Sensitivity
Some vestibular problems may result in a sense of being dizzy or nauseous (like feeling motion sick). Everyday activities like walking in the grocery store, scrolling on a computer or driving down a road with a lot of trees may cause nausea, dizziness and anxiety. It is believed that this may be related to an over-reliance on your vision for your balance. Vestibular therapy can help to reduce the symptoms by re-training the brain to use sensory information more effectively.
Mal de Débarquement Syndrome
Mal de Débarquement Syndrome can occur after prolonged travel such as a cruise, long air flight or a long car ride. After the travel has finished, you may feel a persistent sense of motion as if you are rocking, swaying or bobbing. This sensation of having to "get your sea legs back" is very common. However, for most people the symptoms of away within 24 hours. For those with Mal de Debarquement Syndrome, the symptoms persist for a longer period. The symptoms may feel less intense when you are riding in a car. It is believed that the exposure to a new environment (the travel) causes your brain to adapt to the new situation. When you return to your normal environment, your brain does not return to its normal situation. It is unclear why this occurs. There is no specific test for Mal de Debarquement Syndrome. Vestibular rehabilitation may be beneficial.
Ototoxicity
Ototoxicity is damage to the inner ear, or the nerve to the inner ear, caused by drugs or chemicals. The extent of the damage varies. It can also affect one or both ears. Ototoxicity can also cause hearing loss and tinnitus. If both ears are damaged, your balance may be severely affected. Vestibular rehabilitation is helpful in reducing dizziness and helping to restore balance.
Vestibular Rehabilitation Therapy (VRT)
When the vestibular system has been damaged or affected by a condition, the brain learns that it cannot rely on the information from the vestibular system and it begins to rely more on your vision and on the messages from your joints and muscles. This can cause changes in head movements and positions. It changes the way that you are able to balance as well as the your ability to recover when you lose your balance. You may develop headaches, neck stiffness, fatigue or anxiety. You may feel unstable and afraid of falling. You may begin to avoid the situations that cause symptoms. This avoidance can actually make things worse.
VRT will help you to reduce the symptoms, retraining your brain to work with your inner ear effectively and improve your balance.
At your first appointment, your physical therapist will evaluate your symptoms and identify problems with your balance, walking, visual stability, strength, joint motion, as well as other problem areas. Based on the findings, an individualized plan of care is developed to improve the identified deficits and improve your ability to function, reduce your risk of falling and improve your quality of life.
Some examples of exercises that you may learn include: gaze stabilization exercises, postures exercises, stretching and strengthening exercises, balance exercise and head and eye movement exercises. If you are found to have BPPV, canal repositioning maneuvers will be performed.
Some patients may only need 2 to 3 sessions; however, other patients may need treatment for a few months. The physical therapist makes individualized recommendations based on the needs of the patients, the severity of the symptoms and the response to treatment. The sooner you start the therapy, the better. The brain recovers best in the first few months after the vestibular deficit occurs.
