Deep inside the inner ear lie what are called the vestibular organs. These organs are part of the vestibular system that gathers sensory information about the position and movement of the head and plays an important role in balance and gaze stability. Inside each inner ear lie 5 small organs–3 semicircular canals that provide information about angular acceleration (head rotation) and 2 otolith organs that are sensitive to linear (straight line) acceleration.

When the head and body move, these organs send information via the vestibular nerve into the brain to update the nervous system about how the body is moving so it can fire the proper muscles to keep you balanced and stable. Typically, the signals in each ear balance one another. Certain medical conditions can cause a sudden imbalance in vestibular input between the ears or a reduction in function in both ears. When this system is not functioning optimally symptoms like vertigo, dizziness, and unsteadiness result.

Some common vestibular disorders encountered by vestibular physical therapists are as follows:

• Benign Paroxysmal Positional Vertigo (BPPV)
• Meniere’s Disease
• Vestibular Neuritis
• Vestibular hypofunction
• Concussion
• Labyrinthitis
• Cervicogenic Dizziness
• Persistent Postural Perceptual Dizziness

COMMON SYMPTOMS OF A VESTIBULAR DISORDER

There are a number of conditions that can affect the inner ear and vestibular system. Each condition comes with its own set of symptoms though many of them overlap. If you are experiencing any of the following symptoms, you may benefit from working with a vestibular therapist:

There are a number of conditions that can affect the inner ear and vestibular system. Each condition comes with its own set of symptoms though many of them overlap. If you are experiencing any of the following symptoms, you may benefit from working with a vestibular therapist:

• Feeling off balance or unsteady when you turn your head, change position, walk or are in a space with a lot of visual stimuli like a grocery store or busy airport
• Feeling like the environment around you or words you are trying to read are bouncing up and down or oscillating back and forth
• Room-spinning vertigo that occurs in response to a position change such as rolling over in bed or bending down to clean out the dishwasher
• Feeling of unsteadiness in low light conditions or on uneven terrain
• Dizziness when turning your head or changing position
• Dizziness or vertigo when bearing down
• Nystagmus

Additional symptoms that may be associated with conditions that affect the vestibular system include:

• Neck pain or stiffness in the muscles around the neck
• Loss of hearing or changes in hearing in one or both ears
• Tinnitus
• Hearing your own heartbeat or footsteps more loudly than usual
• Nausea or vomiting associated with dizziness
• Recent upper respiratory, gastrointestinal or other viral infection
• Concussion or brain injury

In rare cases, symptoms of a vestibular disorder such as dizziness, vertigo, and losses of balance can be symptoms of a more serious condition such as a stroke. If you are experiencing any of the following symptoms it is important to seek immediate medical attention:

• Weakness, especially on one side of the body or face
• Loss of coordination
• Changes in vision
• Severe headache
• Changes in sensation
• Abnormal eye movements
• Confusion
• Changes in speech
• Vomiting
• Chest pain or pressure
• Unrelenting vertigo or dizziness

If you decide to work with a physical therapist to help correct your vestibular issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized vestibular physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY TECHNIQUES USED TO ADDRESS VESTIBULAR SYMPTOMS

While the specific physical therapy techniques used to treat you will depend on the specific condition you have, here is a list of common physical therapy techniques used to address symptoms of a vestibular disorder:

Vestibular adaptation and compensation exercises: this category of exercises uses a combination of head and eye movements to either strengthen components of the vestibular system or help your body compensate for weakness in those components.

Cervical proprioception and manual therapy techniques: if the neck itself is contributing to your symptoms then training to improve the sensory systems in the neck and manual therapy to address limited mobility, neck pain and stiffness may be prescribed.

Motion habituation and desensitization: repeatedly performing symptom-provoking movements can help habituate the vestibular system to these movements so over time they become more comfortable and provoke fewer symptoms.

Balance exercises: vestibular conditions often affect balance. Working on balance under different conditions to strengthen the body’s utilization of vestibular information or compensate for its loss while improving confidence and safety with standing and moving is an important goal in vestibular physical therapy.

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