Vertigo - A Balanced Guide

According to the Australian Institute of Health and Welfare, at least 32,000 people were diagnosed with feelings or conditions related to vertigo between 2019-2020.[1] This could be an underestimate given that data from non-hospital clinics were not accounted for. In fact, the Australian Society of Otolaryngology Head and Neck Surgery notes that 36% of Australians over the age of 50 have reported that they suffer from dizziness and vertigo.[2]

While vertigo can come and go, some people suffer from chronic vertigo which persists for greater than 3 months. People with this condition can often experience balance issues and even appear intoxicated. Eventually, these symptoms can lead to significant follow-on consequences, including falls, fractures and social anxiety.

Read on to understand what you should know about vertigo; the risk factors, treatment options and expected recovery time.

What is Vertigo?

Vertigo is a type of dizziness that leads to the feeling that you or the world is spinning. It is a symptom rather than a condition. However, there are conditions that lead to vertigo, including Benign Paroxysmal Positional Vertigo and migraines.

What are the symptoms of vertigo?

The most common symptoms of vertigo include; dizziness, feeling like you are moving or spinning, problems focusing the eyes and general balance problems. People may also experience nausea or vomiting, sweating, hearing loss or ringing in the ears.

Common symptoms of vertigo

• Balance problems

• Light-headedness

• A feeling of motion sickness

• Vomiting

• Tinnitus or ringing in the ear

• Nausea

• Headaches

• Nystagmus or uncontrolled movements of the eye from side to side.

What causes vertigo?

Benign paroxysmal positional vertigo is the most common cause of vertigo. Other causes may be an ear infection, severe migraines, and head or neck injuries. On some occasions, certain medications can also cause vertigo.

Common conditions that cause vertigo

• Benign Paroxysmal Positional Vertigo - Dislodging of crystals inside the inner ear structures can stimulate the hair cells of the ear, causing false signals to the brain about head position and movements. This results in vertigo symptoms and nystagmus (uncontrolled movements of the eyes).

• Labyrinthitis - Inflammation of the inner ear labyrinth due to infection that affects the vestibulocochlear nerve, a nerve that sends signals to the brain about your head position and motion. This can be accompanied by hearing loss, headaches and ear pain.

• Cholesteatoma - Non-malignant skin growth behind the eardrum due to repeated infection. This can damage the middle ear resulting in dizziness and hearing loss.

• Meniere’s Disease - Increase in fluid build up in the inner ear, leading to ringing sensation and vertigo symptoms.

Sports that increase the risk of vertigo

High impact and contact sports that result in trauma in the head can damage the vestibular system or the central nervous system leading to vertigo symptoms.

• Football

• MMA

• Boxing

• Wrestling

How is vertigo diagnosed?

Vertigo can be debilitating and affect your daily routine. Disruption of your balance can lead to sudden falls and injury-causing more severe problems.

A comprehensive assessment of your vestibular system and neurologic function is the key to treating vertigo. There are several options available when it comes to diagnosing your vertigo. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are experts in the field of balance and neurologic rehabilitation. They can effectively assess and diagnose conditions and injuries that may cause your vertigo.

The assessment process always begins with a consultation, during which your physiotherapist will ask you a series of questions relating to your dizziness. The more information you provide, the better, as this will assist the physiotherapist in making an accurate diagnosis.

Once the physiotherapist has a better understanding of the background of your vertigo, they will begin with the physical examination process, assessing your neck, head and upper back region. Your physiotherapist may also perform positional manoeuvres to your head to check the areas in your ear that may be affected.

The initial evaluation typically lasts for about 30 to 60 minutes. Your physiotherapist will then create a specific treatment plan based on your assessment to help you recover from injury.

From here, your physiotherapist will give you the details of your treatment program including:

• Advice and recommendations

• List of exercises you need to do at home

• Strategies to manage the pain and to prevent worsening of the condition

• Recovery timeline

• Total number of treatment sessions required.

How is vertigo treated?

Vertigo can be debilitating and comes with a variety of symptoms that can affect your daily activities. Disturbances with your balance can result in accidents and injuries if left untreated.

There are several options when it comes to treating the conditions that cause vertigo. One of the more common and the treatment option referred to by Australian GPs the most is physiotherapy.

Physiotherapists come across vertigo quite regularly and are in the best position to treat it. Once the initial assessment process is complete, they will formulate a treatment plan specific to you and your vertigo.

A combination of treatment protocols such as therapeutic positional exercises, balance retraining and habituation training will be given to you by your physiotherapist.

Your treatment will focus on eliminating your symptoms, restoring your function and allowing you to return to your normal activities without risk of falling or accidents.

Depending on the severity of your vertigo, a physiotherapist may provide you with a combination of the following types of treatments:

• Habituation Techniques - Techniques that use the gradual introduction of head movements as you progress with your rehabilitation.

• Vestibular Rehabilitation Exercises - Involves training the brain to use alternative visual and sensory cues to maintain balance and gait. They are also used to maintain postural control and increase your balance.

• Positional Manoeuvres - Using different positional manoeuvres to your head and body to correct dislodged crystals in your ear labyrinth. It improves symptoms of vertigo and eliminates nystagmus.

• Balance Retraining - Exercise techniques to improve your balance and coordination to reduce the risk of falls and injuries. It allows you to safely return to your daily routine and navigate to stressful or uncontrolled environments.

• Strength and Conditioning - Using conditioning exercises to increase your cardiovascular endurance and help you recover from deconditioning effects due to vertigo.

• Advice and Education - Professional advice to maximise your recovery and prevent worsening of the symptoms.

Physiotherapy treatment can last for about 30 to 60 minutes. Most patients can feel the difference in just a single session.

Next step - Creating a treatment plan made for you

Your physiotherapist will create a detailed treatment plan based on your condition and lifestyle to allow you to return to your normal activities as soon as possible.

Self-care for vertigo

If you think you have vertigo, here are the best things you can do and avoid

Things to do:

• Rest

Lying in a quiet and dark room can decrease sensory stimulation and help you recover when the spinning sensation is severe.

• Use an assistive device.

If you are having episodes of vertigo, it is best to use assistive devices such as canes or walkers to prevent falls or accidents due to balance disturbance.

• Changing sleep position

There are sleeping positions that will help to naturally correct crystal dislodgement in your ear. This position depends on the affected areas of your ear. Your physiotherapist will recommend the best sleeping position for your condition.

• Add safety modifications in your home or workplace.

Add grab bars in high-risk areas of your home, such as the toilet and kitchen. Your safety should be your top priority when you have vertigo.

Things to avoid:

• Avoid bending when picking up things

Squat when you lift or pick up things from the ground.

• Avoid abrupt head movements

Sudden head movements can aggravate symptoms of vertigo.

Do I need a specialist or surgery?

You may need to see a medical doctor depending on the cause of your vertigo.

Infections and abnormal tissue growth in your inner ear require medications and surgery to resolve your symptoms.

Additionally, brain injuries such as stroke and traumatic brain injuries require supportive medications to control symptoms of vertigo.

If you are suffering from vertigo and have not been assessed by a medical professional, it is best to see your GP and get some advice on what the best options are.

What is the recovery time / prognosis for vertigo?

Depending on the condition that causes your vertigo, a typical episode of vertigo may last for a few hours to days. However, complete recovery may take 3 to 6 weeks.

Physiotherapy can accelerate your recovery and help you manage the symptoms. Benign Paroxysmal Positional Vertigo is incredibly responsive to physiotherapy and improves outcomes with a faster recovery.

Most of the time, patients feel immediate improvement after the initial session. However, compliance with your personalised program is the key to maximising your recovery.

Can vertigo be prevented?

It is almost impossible to guarantee the prevention of vertigo, however, there are some simple steps you can take to reduce the likelihood.

• Avoid alcohol – Alcohol can change the fluid composition in your inner ear. Alcohol results in dehydration and balance issues when you are sober.

• Stay hydrated – Sufficient water intake can prevent some conditions that cause vertigo.

• Manage your stress – Episodes of vertigo can be triggered by stress. Allowing yourself to relax and manage your stress can go a long way in treating your vertigo.

• Avoid abrupt movements of the head – Sudden movements of the head such as bending or abrupt looking up can cause episodes of vertigo.

Outlook and the main takeaways

Vertigo can result from a variety of conditions. It can be debilitating and cause balance problems which can lead to serious safety concerns.

Home remedies may work for a while but treating the actual cause of your vertigo immediately is the key to your recovery and long term solution to your problem.

Book a physiotherapy consultation today and start your road to recovery.

Anatomy of the inner ear

Your inner ear is located within the petrous part of the temporal bone. It is in between the middle ear and internal acoustic meatus.

Two-components of the inner ear:

• Bony Labyrinth – consists of a series of bony cavities of Cochlea, vestibule and three semicircular canals.

• Membranous labyrinth – lies within the bony labyrinth. It consists of the utricle, saccule, semicircular ducts and cochlear ducts. These parts of the inner ear are filled with fluid called endolymph.

Your inner ear houses the vestibular sensory cells that send signals to the brain regarding your head position and movements.

Calcium carbonate crystals (otoconia) embedded in the utricle may become dislodged and may end up in semicircular canals. These crystals may stimulate the sensory cells resulting in false signals to the brain and disrupting your sense of balance.

Other conditions that may damage the sensory receptors in the inner ear can also lead to vertigo.