• Feeling Dizzy?


    When we get a patient who complains of being dizzy we ask several follow-up questions but the most important is what does dizziness mean to you. It can range from all sorts of symptoms such as:  lightheadedness, fogginess, spinning, unsteadiness and disorientation. The medical term for dizziness is vertigo. Vertigo is further defined as the sensation of spinning oriented to environment or person.  

    Vestibular dysfunction can originate from many causes and manifest in different symptoms.  According to VEDA , “ People with measured vestibular dysfunction who are also symptomatic have a 12-fold increase in the odds of falling…”   .  Falling can have extremely devastating consequences such as fractures, resulting in significant surgeries and may mean rehabilitation in a facility outside of the home.

    The most common causes of vertigo are Benign Paroxysmal Positional Vertigo (BPPV) and Meniere’s Disease, both of which can be treated successfully in physical therapy with distinctive strategies associated with the etiology of the symptoms.  

    BPPV is the most common cause of vertigo accounting for approximately 50% dizziness symptoms in the elderly.   It is caused by the otoconia (crystals) being displaced in the semi-circular canals within our inner ear’s vestibular organ.  This gives misinformation to  the brain about the position of our head.   The most effective treatment for BPPV is the Canalith Repositioning Maneuver (also called Epley’s maneuver) as performed by a skilled practitioner on a patient.  This is done by  purposeful positioning of the patient in a specific order and held in that position by the PT for a timeframe after symptoms have dissipated.  Additionally, balance and vestibular rehabilitation exercises are instructed to increase safety in community ambulation.  

    In contrast, Meniere’s Disease is a chronic progressive condition that results in episodic vertigo lasting 1-24 hours, initially infrequent.  It is caused by loss of viscosity of inner ear fluids, decreased production or altered flow of these fluids which change the  vestibular organ’s communication with the brain.  Other symptoms include intermittent tinnitus, hearing loss or fullness in the ear.   This needs treatment that allows the patient to learn strategies in dealing with episodes as well as training the brain to habituate to erroneous data coming from the inner ear.  Additionally, balance exercises will help prevent falls.  

    In conclusion, dizziness is a symptom that needs to have more immediate attention and not ignored, even if it goes away.  There are other more severe causes that would need to be ruled out by a trained practitioner, and treatment can relieve that uncomfortable feeling.   If you are experiencing symptoms, please reach out to our clinic and ask about treatment.


    Vestibular Rehab and Balance Training Manual ,  Karen Hogan-Curran, PT, DPT

    Vestibular Rehabilitation Therapy: Reivew of Indications, Mechanisms, and Key exercises,  Byung In Han, MD, Hyun Seok Song and Ji Soo Kim;   J Clin Neurol 2011, Dec 7;  184-196