The inner ear contains the cochlea and vestibular system. These are closely associated organs that contribute to hearing and overall balance, respectively. The vestibular system is a dime-sized, fluid-filled organ that detects head movements and changes in position. It is composed of a sac that houses crystals resembling grains of sand and three canals that function to detect various head movements. The vestibular system communicates changes in head position to the brain via the vestibular nerve.
Despite being small in size, the vestibular system can cause big problems when not functioning properly. Under normal circumstances, the crystals in the inner ear are adhered to a sticky membrane within the vestibular system. These crystals convey information about head position to the brain by moving across the membrane due to gravity.
For unknown reasons, these small crystals in the inner ear can break loose from the sticky membrane and fall into one of the canals attached to the sac housing the crystals. When this happens, the unwelcome crystal moves within the fluid-filled canal every time the head is moved. This results in dizziness known as “vertigo.” Visually, the individual’s surroundings appear to move until the crystal settles within the canal. This dizziness only lasts for seconds and subsides once the head stops moving. It very commonly occurs when laying down to go to bed, rolling over in bed, or looking up/down into cupboards as these activities require large head movements that cause the loose crystal to move within the canal.
The practitioners at FYZICAL Therapy & Balance Centers are specially trained to diagnose and treat conditions affecting the vestibular system. Dizziness resulting from crystals loose within one of the three canals is known as benign paroxysmal positional vertigo. This condition is diagnosed with special testing that causes the loose crystal to move within the canal and recreate the dizziness that has been afflicting the patient. When a crystal is loose in one of the canals, it causes the eyes to move rapidly in a characteristic pattern. Based the patient’s symptoms and eye movement, the physical therapist identifies which canal contains the loose crystal.
BPPV is very common and the treatment method is simple and non-invasive. The head is maneuvered in a specific sequence to facilitate movement of the crystal from the canal back into the sac portion of the vestibular system. The treatment itself typically takes less than five minutes. Following treatment, it is important to follow specific post-treatment instructions provided by the physical therapist until the crystal is reabsorbed by the body. BPPV typically requires 1-2 treatments to fully resolve.
Following successful treatment, the physical therapist will perform a balance assessment and screen of symptoms to ensure the vestibular system is functioning properly. While many patients feel complete resolution of symptoms after 1-2 treatments, other patients report a lingering “off” feeling. In this case, the vestibular nerve on the affected side is not functioning as well as the nerve on the unaffected side. The weakened vestibular nerve can be treated with vestibular rehabilitation. The physical therapist provides specific exercises that stimulate the weak vestibular nerve and improve its ability to transmit signals to the brain. This lingering “off” feeling takes longer to treat, but most patients report relief within the first 6 weeks of treatment.
Summary
The vestibular system is small but mighty. When crystals break loose and end up in one of the canals in the vestibular system, they cause a condition known as benign paroxysmal positional vertigo (BPPV). The practitioners at FYZICAL Therapy & Balance Centers are specially trained to diagnose and treat BPPV and other conditions that affect the vestibular system.
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