Causes of Vestibular Disorder

The vestibular system includes the peripheral vestibular apparatus located in the inner ear, connecting nerves and areas of the brain that process this information. The vestibular system is crucial for maintaining balance and for stability of your gaze/vision. 

Vestibular disorders arise when a condition or injury affects any part of this system and can cause symptoms of vertigo, dizziness, visual disturbance and/or imbalance.  Causes of vestibular disorder are grouped into peripheral (meaning the inner ear) or central (meaning the brain), and people can have both types of condition. Problems can also occur due to ageing, medications, and autoimmune conditions.

The most common causes of vestibular disorder are:

1.     Benign paroxysmal positional vertigo (BPPV)

2.     Migraine

3.     Vestibular neuritis

1. Benign paroxysmal positional vertigo (BPPV)

This is the most common cause of vertigo. It is a condition where patients typically experience vertigo or spinning only when completing specific position changes. These include getting in and out of bed, rolling over in bed, bending down or looking up. Turning their head left and right while sitting up will not cause dizziness as a result of this condition. Patients will experience brief symptoms, usually less than 30 seconds, although they may feel out of sorts for longer. Their balance can also be affected, and they may fall. 

It is caused by debris (otoliths/calcium carbonate crystals) becoming dislodged from the central area of the vestibular apparatus and moving into the canals.  Here the debris typically moves like a ball bearing in the canal whenever the person moves in the ways listed above.  It is more common in females and as we age. 

 

Common causes of BPPV include after:

  • Head injury

  • Whiplash

  • Vestibular neuritis

  • Migraine

It can also occur without any other vestibular cause or health condition. 

 

To confirm this condition, a clinician will complete specific tests (Dix-Hallpike and Roll tests) that may trigger your symptoms.  Treatment will then involve completing certain movements to move the debris back out of the canal.  Occasionally, these movement need to be repeated but typically one treatment will resolve this condition.

2. Vestibular migraine

This is another episodic cause of dizziness and is a complex condition with a wide range of presentations. Patients may classically experience a visual aura, typically a shimmering edge, growing black dots or zigzag lines, with accompanying light or sound sensitivity and nausea, before developing a headache. The headache may be located at the front or back of their head, manifest as tenderness in the neck and back of the head, or not be present at all.  They usually want to lie down and sleep until it passes. When patients experience any range of dizziness, vertigo or imbalance symptoms, then it is termed vestibular migraine. 

3. Vestibular neuritis

Patients will experience an acute onset of vertigo, nausea and imbalance that lasts for days. They may be prescribed anti-sickness tablets by their GP, but these should only be taken for a week.  Over several weeks they will usually make a full recovery, without any intervention, however, a proportion will continue to experience symptoms and need customised rehabilitation. Hearing changes can occur if the whole inner ear apparatus is affected and, in these instances, it will be termed labyrinthitis.

VESTIBULAR REHAB PHYSIO

London

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