Most cases of dizziness are benign and can be managed with conservative care. In some limited cases urgent medical care maybe required. Cases needing urgent medical care would include dizziness associated with:
- Severe ‘worst ever’ headache – especially in a person who does not normally experience headaches
- Tight, crushing chest and/or shoulder pain
- Slurring speech
- Loss of muscle strength on one or both sides of the body
- Hallucinations or psychotic events
Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo that can gives individuals an intense spinning sensation.
As the name suggests BPPV is not caused by a serious disease (benign), comes on intermittently (paroxysmal) and is often bought on by turning movements such as rotating the head or rolling over in bed (positional).
Typically there is a delay of 1-2 seconds between the movement and the onset on vertigo. Although benign, the vertigo can be intense and debilitating. Episodes may last 10-30 seconds or many minutes and longer.
The cause of BPPV comes from the labyrinth system, which is located in the inner ear and responsible for maintaining balance. The labyrinth is made up of cavities called otoliths (made up of the utricle and saccule) and three semi-circular canals on both the left and right side.
The cavities are fluid filled and lined internally with hairs connected to nerve endings. As we move about the fluid moves in the labyrinth cavities, stimulating the hairs and firing nerve massages to brain. The brain registers this information as body movement.
Small crystals called cupuloliths line the walls of the utricle and saccule. In the case BPPV these crystals fall away and end up in an area where they irritate the nerve endings causing episodes of vertigo. The posterior semi-circular canal is the most common site where cupuloliths become lodged.
Most people have experienced vertigo as children from spinning around fast then suddenly stopping. The fluid in the semi-circular canals continues to move after you stop giving the sensation of vertigo. This is sometimes also associated with nausea and vomiting.
The accepted treatment for BPPV is Epley’s Maneuver. This is a series of head movements that shift the crystal out of the semi-circular canal into an area where they no longer irritate the nerve endings.
This requires special skills to firstly diagnose BPPV and secondly to determine which of the three semi-circular canals has the crystal.
To see the Epley’s being performed please click to watch this video.
With post-graduate qualifications in Chiropractic Neurological Rehabilitation we have chiropractors qualified to diagnose BPPV and perform the Epley’s Maneuver.
Meniere’s Disease is a disorder characterized by the symptoms of:
- Vertigo (spinning sensation)
- Nausea and occasional vomiting
- Tinnitus (ringing or buzzing in the ear)
- Intermittent hearing loss
- Sense of ‘fullness’ in the ear
The condition is named after the French physician Prosper Menire who first made the connection between vertigo and the inner ear.
The inner ear is made up of two parts:
- Cochlea – sense hearing
- Semi-circular canals and otolith organs – control balance
Both of these contain cavities filled with two types of fluid called Perilymph (outer fluid) and Endolymph (inner fluid).
In the case of Meniere’s, there is excess endolymph (known as Endolymphatic Hydrops) causing pressure to build up in the inner ear.
The symptoms tend to come in bouts that last anywhere from 10min to a few hours. Mild deafness may follow after the bout, but then return back to normal. Some unsteadiness and tinnitus may remain constant and over time measureable hearing loss may occur.
The exact cause of Meniere’s is unknown. About 1 in 600 Australians are affected and onset tends to be in middle age. Diagnosis is based on history and physical examination. A CT scan or MRI of the brain to rule out other causes, such as an Acoustic Neuroma (tumour of the 8th cranial nerve) is recommended. Other tests to determine the level of hearing and balance loss are also important.
A consultation with a neurologist is important in confirming diagnosis.
While there is no absolute cure for Meniere’s disease, proper management is important and would include the following:
- Diet low in salt (found in most processed foods) – salt increases fluid retention
- Limit caffeine (tea, coffee and cola drinks)
- Limit alcohol
- Vestibular Rehabilitation Therapy
With post-graduate qualifications in Chiropractic Functional Neurology we have chiropractors qualified to provide Vestibular Rehabilitation Therapy.
For more information look at the Meniere’s Australia website on http://www.menieres.org.au/
Labyrinthitis is the inflammation and irritation of the inner ear (labyrinth). The most common cause of labyrinthitis is a viral infection. Other causes include bacterial, head injury, extreme stress and allergy. Medication such as aspirin can cause labyrinthitis in some individuals.
As with BPPV, the key symptom of labyrinthitis is vertigo. Other associated symptoms may include unsteadiness, nausea, vomiting and anxiety.
While movement may aggravate labyrinthitis, it does not fit the pattern of BPPV. Unlike BPPV, labyrinthitis symptoms typically last longer, may be ongoing and remain present while at rest. An individual with acute labyrinthitis may be bed-ridden in the early stages.
Viral labyrinthitis typically lasts 4-6 weeks, gradually improving over this time. In some cases residual dis-equilibrium and mild dizziness may continue for months or even years.
Once the initial symptoms settle, the inner ear is likely to remain injured. The brain needs to compensate and re-calibrate for the mis-matched signal from the inner ear. If this is done effectively the individual will recover well.
MANAGEMENT DURING THE ACUTE (IMMEDIATE) PHASE
- This stage lasts from 2-14 days
- Rest and avoiding rapid movements
- Relaxation techniques
- Medication if required
MANAGEMENT DURING THE CHRONIC (LONG TERM) PHASE
Once the acute phase of labyrinthitis has settled (usually within one week or earlier), movement is important for the brain to compensate and re-calibrate.
- Increase physical activity
- Avoid medication such as Stemitil and muscle relaxants as this slows the brains responsiveness and reduces brain compensation
- Chiropractic care to improve spinal function and muse tone (at this stage high quality research in this area is lacking)
- Vestibular Rehabilitation Therapy