Vestibular Issues: Why You Might Feel Dizzy

Does the world feel like it is spinning, you feel dizzy, or you feel off-balance? If so, it might be all in your head. Literally… your inner ear might be to blame. The vestibular system is located deep inside your ear and helps to control your balance, posture, spatial awarenss, and movements. 

What is the Vestibular System?

The vestibular system is your body’s own spirit level. It is found in your inner ear and helps with balance, detecting head movements, and steadying your eyes. 

It is made up of:

• Bony Labyrinth: the outer shell that is a hard, protective structure.
• Membranous Labyrinth: floats inside the bony labyrinth, filled with a fluid and contains:
• Semicircular canals: 3 in each ear, each are looped tubes that face different directions, and detect rotational movements; nodding, shaking and tilting of the head.
• Otolith organs: 2 in each ear called the utricle and saccule, which detect straight-line movements; walking straight, or standing from a chair. It also detects tilting of the head. These organs have little crystals that move to send signals.

What You Might Be Feeling?

You might feel dizzy which can be described as feeling faint, lightheaded or you could feel yourself spinning or things around you spinning. Associated with this might be issues with your ears such as hearing loss or tinnitus. Or other issues like double or blurred vision, vomiting, nausea and/ or sweating.

BPPV - A Common Vestibular Condition:

Benign Paroxysmal Positional Vertigo, shortened to BPPV, is a condition caused by loose crystals in the semicircular canal. This results in abnormal stimulation of hair cells, sending stronger signals to the brain. The brain gets confused as it’s getting mixed messages about what the head is doing & the person experiences vertigo.

Typical symptoms involve a short period of spinning and is triggered with head position changes. Common triggers include getting in and out of bed, rolling over in bed, looking up, washing hair and suddenly standing. BPPV often comes on randomly, however, it is also associated with head trauma, infections, prolonged bed rest, stress and degeneration of the inner ear. 

BPPV is assessed by your physio through questioning and also with physical testing. They will look at how your eyes move, check your balance and perform special head movement tests. From here, they will use head manouveres to fix it, such as the Epley’s Manouevere. They will provide eye and balance exercises, and give you head movements to do at home too.

BVL: The Other End of Vestibular Conditions

Bilateral Vestibular Loss, shortened to BVL, is another vestibular condition, however this time there’s no dizziness or vertigo experiences. The brain doesn’t receive signals from both ears. With BVL, you might feel unbalanced, have blurry vision with head movements, and have associated general lightheadedness. It can be caused by repeated ear infections, head injuries, meningitis, some genetic conditions or naturally with age. 

Eye movement tests, checking balance and walking, and visual tests may assist your physiotherapist in diagnosing you with BVL. Now, BVL is an issue as your brain uses information from your eyes, ears, and your body’s muscles to create a well rounded understanding to aid in keeping you balanced. Without input from your ears, it must rely on your eyes & muscles for all this information. Made even harder in the dark, when your eyes are taken out of the equation. This increases the risk of falls and hurting yourself.

Unfortunately, there is no cure but through rehabilitation and exercise, the brain can adapt to utilise your eyes and muscles to harness the deficit of not having well functioning ears.

References:

For more in-depth knowledge (mainly for clinicians), see the full masterclass:
Vestibular Dysfunction: From Assessment to Rehabilitation by Tori Cowley
Available on Physio Network: physio-network.com/masterclass/vestibular-dysfunction-from-assessment-to-rehabilitation