Several factors contribute to a person’s risk for falls. This includes your environment, medications, strength and medical conditions. Yet one cause is often overlooked: the vestibular system.
The vestibular system includes the inner ear and brainstem. This system works with vision and proprioception (your awareness of your body’s position). Together, they are the three main components of the human balance system.
People with vestibular dysfunction usually experience dizziness. Dizziness is a broad term than can include imbalance, gait changes, floating sensations, and true spinning vertigo. Any of these feelings can increase a risk for falls. It can also affect quality of life. Twenty-percent of people have experienced vestibular problems and this rate increases with age.
Your inner ear contains small particles called otoconia — small “ear rocks” or “crystals”. They help your body maintain its balance. Sometimes, otoconia can break off. The pieces float around inside your inner ear canals when you change your head’s position. This can cause a short burst of spinning or tilting vertigo.
This is called benign paroxysmal position vertigo (BPPV). It’s the most common type of positional vertigo, accounting for 40% of vertigo visits in primary care.
Treating BPPV usually requires a series of specific positions that reposition the otoconia. The Epley is the most common repositioning maneuver. It is most often performed by clinicians who have additional training in the vestibular system like physical therapists or ear, nose and throat specialists (ENTs). During the Epley, the clinician will guide you through a specific series of head positions to move the otoconia back to a better location in the inner ear. The success rate of this intervention is 75-90%.
Vestibular hypofunction is another type of vestibular dysfunction. It occurs when the balance system of the inner ear is not working properly. There are many causes of vestibular hypofunction but the most common are vestibular neuronitis or labrinthitis. These are usually caused from a viral or bacterial infection of your inner ear. Symptoms can include dizziness, imbalance, visual changes, mental fatigue, hearing changes and walking difficulties. These problems can come on rapidly or slowly over time depending on the underlying problem.
Treating vestibular hypofunction usually involves medications and vestibular rehabilitation therapy. Therapy focuses on exercises helping the vestibular system compensate to loss in vestibular function, balance, strength, and flexibility. Sometimes, surgery is needed.
Other Causes of Dizziness
Dizziness isn’t always caused from your ears. Stress, dehydration, heart problems and vision issues can contribute. Central nervous system problems, such as stroke or a tumor, can also be a cause.
Talk with your healthcare provider if you have dizziness and concerns about falling. An examination and health history are essential to finding the cause and treatment.
Andy Parsons, DPT, is a board-certified orthopaedic specialist and is also certified in vestibular rehabilitation. He practices at ProMedica Defiance Total Rehab.