If you have ever felt disoriented or unstable, you are not alone. Dizziness and balance problems account for up to 10 per cent of all physician visits and affect more than 60 per cent of the adult population. In fact, it is one of the top three reasons people over the age of 65 visit their physician.
Those aged over 65 as well as women are most susceptible to dizziness. Other main predictors include cardiovascular disease, osteoporosis, depression, sleep disorders, memory or visual problems, and poor mobility.
Suffering from three or more medical conditions, taking four or more medications, and a history of falls are also strong predictors for susceptibility to feeling dizzy. Dizziness can be linked to many different causes, so it is very important to be assessed by your care provider in order to determine which of the four types your symptoms are associated with:
Vertigo – sense of movement or spinning of the environment. This can also be accompanied by hearing loss, nausea, and vomiting.
Presyncope – feeling like you’re about to faint, often from reduced blood flow.
Disequilibrium – a lack of balance or stability from cerebrovascular, vision, neurological, or musculoskeletal problems and/or medication side-effects.
Lightheadedness – from psychiatric issues such as anxiety/depression, panic disorder, and hyperventilation.
What can cause dizziness and balance disorders?
In about 25 per cent of cases, the causes are unknown. Some possible causes can include: neurological dysfunction (head/brain injuries, concussions, stroke, MS), visual deficits, medications, neck injuries or dysfunction (accidents/whiplash, pathology), psychogenic dizziness (panic disorders) and cardiovascular system problems (hypotension, heart/vascular disease).
For up to half of all cases, a possible culprit could be a vestibular system disorder. The vestibular system is the portion of the inner ear that contributes to our sense of motion and balance.
Vestibular rehabilitation is one area of physiotherapy that specifically treats disorders related to dizziness. Some causes for this specific kind of disorder might include:
- Benign Paroxysmal Positional Vertigo (BPPV) – the most common cause of vertigo
- Vestibular neuritis/labyrinthitis – the second most common cause of vertigo
- Meniere’s Disease
- Vestibular System Degeneration (over 65 and decreases by 35 per cent by age 75)
- Repeated ear infections or ear and drum injuries
- Damage from high dosage/long term use of certain antibiotics
- Benign tumors
- Head trauma/whiplash (common in people under age 50)
If you think you might have a vestibular system disorder, your physiotherapist will begin by taking your health history, including when your symptoms began, possible triggers and any related vision or hearing changes.
They will then test your inner ear (for BPPV), balance, motion sensitivity, eye movements (oculomotor testing) and perform a gait assessment.
If you have been diagnosed with this disorder, you may experience one of the following forms of treatment, depending on your specific condition:
1. Benign paroxysmal positional vertigo
In this most common type of vestibular disorder, inner ear calcium “crystals” (otoconia) become displaced, altering the flow of fluid within the inner ear, causing vertigo, nausea and balance problems. Treatment involves repositioning the crystals in the inner ear. This is usually very effective with a 90 per cent cure rate after the first visit and a 98 per cent cure rate after two to three visits.
2. Vestibular lesions/damage
This case is treated with head, eye and body movement exercises to habituate and restore balance.
3. Balance/gait problems
Treatment includes balance and gait retraining exercises.
4. Vestibular-visual mismatch
This is caused by a mismatch of information to the brain from the eye and the inner ear. Treatment includes adaptation exercises to retrain the brain.
5. Motion sensitivity (also known as car or sea sickness)
Treatment for motion sensitivity includes habituation exercises to desensitize the brain to a specific motion, such as repeated head-turning.
6. Cervicogenic dizziness
In this case, treatment for neck disorder or injury would be applied.
If you suffer from any form of dizziness or vertigo, please visit your physician for an assessment. Where appropriate, you will be referred to a physiotherapist for further treatment.