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Vertigo and ear infections


What Are The Signs and Symptoms of an Inner Ear Infection?

By The Harley Stre... Inner Ear, Ear, Ear Infection, Article 0 Comments

Ear infections can happen anywhere in your outer, middle or inner ear. The symptoms can be very different depending on where the problem is located. If the infection is in your inner ear then it can have a particularly dramatic effect on your senses of balance and hearing. Read on to learn more about inner ear infections and how they can affect you.

The Inner Ear

Your ear is made up of three sections that are known as the outer, middle and inner ear. All three parts of the ear work together to enable us to hear, but the inner ear also plays a vital role in our sense of balance.

  • The outer ear includes the part that you can see along with the ear canal. These channel soundwaves into the ear so that you will be able to hear them.
  • The middle ear is made up of the ear drum and the space behind it, which contains the tiny bones that transmit vibrations from the ear drum to the inner ear.
  • The inner ear contains the cochlea, which receives the signals and transforms them into a message your brain can “hear”. The inner ear also contains the semicircular ducts, which send signals to the brain to tell us how our head and body are positioned. We use these signals to stay balanced. The cochlea and vestibular system (balance organs) are sometimes known together as the labyrinth.

What Causes Inner Ear Infections?

Infections can happen in any part of the ear, including the inner section. When the inner ear is infected, the problem is sometimes known as labyrinthitis.

The infection can be caused by a virus or bacteria, which usually reach the inner ear after affecting another part of your body.

  • Viral Infections: Lots of different viruses can affect the inner ear, including the common cold and flu. The infection usually spread to the inner ear from other parts of the body (such as the throat or airways), so you may start to develop symptoms related to your inner ear after noticing cold-like symptoms. Antibiotics can’t help with this type of infection.
  • Bacterial Infections: Bacterial infections are less common, especially in adults, but they can happen. Bacteria are more likely to get into the inner ear if the membranes separating it from the inner ear are broken, which might happen if you have a middle ear infection. If the infection is caused by bacteria then taking antibiotics might help.

In some cases, the problem that we call an inner ear infection isn’t actually an infection at all. Labyrinthitis can happen when the inner ear becomes inflamed for other reasons, for example if you have an autoimmune condition that causes your immune system to mistakenly attack the tissue. You might need to get treatment for this underlying condition in order to prevent the inner ear problems from returning.

Symptoms of Inner Ear Infection

Since the inner ear plays key roles in both hearing and balance, any issues with these senses could be linked to an infection in this area. Infections in other parts of the ear are less likely to affect your hearing or balance, but the other symptoms can be similar.

Possible signs of an inner ear infection or inflammation include:

  • Vertigo, a sensation that you or your surroundings are spinning or moving around even when everything is still
  • Having trouble balancing or walking normally
  • Dizziness
  • Nausea or vomiting
  • Problems with your hearing
  • Feeling like the ear is full or blocked
  • Tinnitus or ringing in your ears
  • Earache
  • Headaches
  • Fluid or pus coming from your ear

Inner ear infections can also be linked to other symptoms, depending on the source of the infection. For example, if the infection spread to the inner ear from your airways, you might also have a runny nose. In some cases, these other symptoms might be fading when the problems in your inner ear begin, because the original infection might have been eliminated. You could also have more generalised symptoms of infection, such as a fever.

Longer Term Effects of Inner Ear Infections

Generally, the symptoms will clear up as soon as the infection is gone. However, the effects can sometimes last longer.

You might still feel dizzy and off-balance even when the other symptoms caused by the infection have gone. This can be a sign that the balance organs were damaged. Your brain can usually learn to work with these changes, so your sense of balance should usually come back by itself. However, if you’re struggling to cope or the problem persists, you should see an ENT specialist. The doctor can check for any underlying causes and may refer you for vestibular rehabilitation therapy to help you to recover your balance.

Inner ear infections can also have a longer term effect on your hearing. This is more likely if you had bacterial infection, so your doctor might recommend a hearing test to check on your ears after the infection.

What to Do?

Inner ear infections will usually clear up by themselves within a few weeks, although some can last for six weeks or more. If the symptoms are severe or they don’t start to improve within a few days, then you should see a doctor. The doctor might prescribe antibiotics if the infection appears to be caused by bacteria. You will also be able to get help with any long term effects on your hearing or balance.

However, in most cases you will be able to manage the symptoms of an inner ear infection at home. Taking an over the counter painkiller like ibuprofen should help relieve any pain and may help with the other symptoms by reducing the inflammation. Holding a warm compress against your ear can also be soothing. It’s also a good idea to stay upright as much as possible and to prop your head up while sleeping, as this can encourage any fluid in the ear to drain away.

Do you have any other tips for coping with an inner ear infection?

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Labyrinthitis and vestibular neuritis - NHS

Labyrinthitis and vestibular neuritis are types of inner ear infection that affect your balance. They usually get better on their own within a few weeks.

Check if you have labyrinthitis

The most common symptoms of labyrinthitis are:

  • dizziness or feeling that everything around you is spinning (vertigo)
  • feeling unsteady and off balance – you might find it difficult to stay upright or walk in a straight line
  • feeling or being sick
  • hearing loss
  • ringing in your ears (tinnitus)

The symptoms of vestibular neuritis are very similar, but it does not cause hearing loss or tinnitus.

Symptoms can start suddenly. They may be there when you wake up and get worse as the day goes on.

The symptoms often ease after a few days.

You'll usually get your balance back over 2 to 6 weeks, although it can take longer.

Things you can do to help

Labyrinthitis usually gets better on its own. But there are things you can do to ease the symptoms:

Do

  • lie still in a dark room if you feel very dizzy

  • drink plenty of water if you're being sick – it's best to drink little and often

  • try to avoid noise and bright lights

  • get enough sleep – tiredness can make symptoms worse

  • start to go for walks outside as soon as possible – it may help to have someone with you to steady you until you become confident

  • when you're out and about, keep your eyes focused on a fixed object, rather than looking around all the time

Non-urgent advice: See a GP if you have:

  • symptoms of labyrinthitis or vestibular neuritis that do not get better after a few days
  • symptoms of labyrinthitis or vestibular neuritis that are getting worse
  • been diagnosed with labyrinthitis or vestibular neuritis and your symptoms have not improved after another week

The GP may refer you to a hospital specialist.

Urgent advice: Ask for an urgent GP appointment or call 111:

  • if you have sudden hearing loss in 1 ear

You may need to be referred to a specialist for tests, and possibly treatment.

Information:

Labyrinthitis and vestibular neuritis – what's the difference?

Labyrinthitis and vestibular neuritis are problems with different parts of the inner ear, which are needed for balance:

  • Labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear
  • Vestibular neuritis is inflammation of the vestibular nerve – the nerve in the inner ear that sends messages to the brain

The symptoms of vestibular neuritis and labyrinthitis are very similar.

However, if your hearing is affected, then labyrinthitis is the cause. This is because inflammation of the labyrinth affects hearing, while inflammation of the vestibular nerve does not

Treatment from a GP for labyrinthitis

If you have labyrinthitis, a GP may prescribe antihistamines or motion-sickness tablets for up to 3 days. Do not take them for any longer, as they can slow down your recovery.

Labyrinthitis is usually caused by a viral infection, such as a cold or flu, so antibiotics will not help. But a GP may prescribe antibiotics if they think your infection is bacterial.

Exercises for long-term balance problems

Sometimes, balance problems can last for much longer – for many months or even years.

Vestibular rehabilitation is a series of exercises that can help restore balance. You should only do the exercises under the supervision of a physiotherapist.

You can ask a GP to refer you to a physiotherapist, or it may be possible to refer yourself directly.

Waiting lists for NHS physiotherapy can be long and you may prefer to pay for private treatment. Most private physiotherapists accept direct self-referrals.

Read more about accessing physiotherapy.

Information:

The Brain & Spine Foundation has a factsheet about vestibular rehabilitation exercises

Video: labyrinthitis and vertigo (BPPV) - Hazel's story

In this video, Hazel talks about how labyrinthitis affected her balance and perception and how she found help.

Media last reviewed: 1 July 2020
Media review due: 1 July 2023

Page last reviewed: 11 February 2020
Next review due: 11 February 2023

Causes and treatment of dizziness | Dikul Center

Trunk balance provides body balance. The body does a lot of work to maintain balance. The brain uses many sources of information to determine where the body is located in relation to the outside world and allow the body to function. Sensory information from the eyes, ears, proprioceptors in the trunk help the trunk to stay upright and perform coordinated movements.

Information from the vestibular apparatus in the inner ear and visual information from the eyes, information about the position of the body from proprioceptors from the trunk through the spinal cord enters the cerebellar lobes located at the base of the brain. The cerebellum uses this information to maintain posture, coordinate body movements such as walking, and fine motor coordination such as using a pen to write.

Vertigo, a feeling of rotation of the body, sometimes accompanied by nausea, occurs when there is a failure in the balance system. However, people prefer not to use this word to describe symptoms either, more often using terms such as dizziness and lightheadedness. It is up to the physician to determine how to label the patient's symptoms.

Dizziness is a symptom that is difficult to describe and can be roughly divided into lightheadedness and vertigo proper. And therefore, the doctor needs to determine whether the feeling of lightheadedness is a sign of cerebral hypoxia, which may occur due to cardiovascular diseases (rhythm disturbances), dehydration or circulatory disorders of the brain. Dizziness also gives prerequisites for the search for neurological problems or problems in the middle ear.

The most important point in helping a patient with vertigo is to differentiate his sensations.
Dizziness is a pathological sensation that is described by a person as a feeling that he himself is spinning or that things around him are spinning around him. Most often this is due to problems in the inner ear.

The inner ear has two parts, the semicircular canals and the vestibule, which help the body understand where it is in relation to gravity. There are three semicircular canals that are at right angles to each other and are actually a gyroscope for the body. The channels are filled with fluid and lined with a membrane that is encrusted with nerve receptors that transmit information to the cerebellum (the part of the brain responsible for balance and coordination). The cerebellum adds to the information received from these receptors information from the proprioreceptors from the muscles of the body and this summarized information helps the brain to understand how the body is located in relation to gravity and the world around it.

Normally, when the head moves, the fluid in the semicircular canals also moves and this information is transmitted to the brain. When the head stops moving, fluid movement also stops. Sometimes there are prerequisites for a delay in the synchronous cessation of fluid movement, which causes dizziness (for example, when rotating on carousels or during children's games) When a person rotates on a carousel, the fluid in the internal channels gains a certain inertia and continues to move, even when the head has stopped rotating. This causes dizziness and can cause the person to fall, stumble, or stagger. It may also be accompanied by vomiting.

Patients may experience dizziness when the fluid becomes inflamed or crystals irritate the nerve membrane that lines the walls of the semicircular canals, and this can cause a sensation of rotation without movement of the head. . Often, one canal is involved and the person will not have symptoms as long as they are not moving.

Causes

While there are many causes of vertigo, the main difference is between central and peripheral causes of vertigo. Central causes occur due to disturbances in the work of the cerebellum.

Separation of central and peripheral causes is important for assessing neurological problems. The brain and spinal cord make up the central nervous system, while the peripheral nervous system includes nerves outside the central nervous system. Sometimes it's easy to tell the difference, other times it's hard to tell which part of the nervous system is involved. For example, if a person injures their elbow and suffers from pain and numbness in the arm, it is mainly due to a direct injury to the ulnar nerve. This is a peripheral nerve problem and most people do not seek medical attention. If, for example, the leg becomes weak and numb, then the cause can be either central (brain stroke) or peripheral (nerve compression).

Our orientation in the surrounding space and, accordingly, balance and balance is determined by three sensory systems:

  1. Eye (visual) system
  2. Balance (vestibular) system of the inner ear
  3. General sensory system including movement, pressure sensation, and proprioception in joints, muscles, and skin.

These three systems continuously feed the brain stem and brain about our position in the environment and gravity. The brain stem connects the brain to the spinal cord. The brain, in turn, processes this data and uses the information to make changes in the position of the head, body, joints, and eyes. When all three sensory systems and the brain are functioning properly, the final result of this activity is the normal balance of the body.

Visual information shows the brain where the body is located in the surrounding space where it is directed in what direction it moves, turns or where it stopped. Simple tasks like walking and picking up things are much easier if we can see the environment. Seasickness is associated with a violation of the relationship between visual information and vestibular information from the middle ear. When rolling on the water, the vestibular system tells a person that there is movement, while the eyes can only see part of the cabin. Similar things happen in diseases of the eyes (such as glaucoma or cataracts) - and this also leads to an imbalance in the body.

Vestibular system.

The inner ear, or labyrinth, is located deep in the ear in the middle ear, and is enclosed within the petrous part of the temporal bone of the skull. The middle ear includes the eardrum and three tiny hearing bones. The bones are called the malleus, anvil, and stirrup, and these names reflect their shape. The middle ear is connected to the back of the throat by the auditory tube (Eustachian tube). The inner ear (labyrinth) contains the semicircular canals and the vestibule, which perform the function of balance, and the cochlea necessary for hearing.
Vestibular structures of the inner ear - the vestibule, which consists of the uterus and sac, and three semicircular canals. These structures perform a job similar to that of a carpenter leveling the surface of levels both vertical and horizontal, that is, the function of a gyroscope. They send information via the vestibulocochlear nerve to the cerebellum, the part of the brain that processes information about body balance and position in space. The rest of the inner ear, the cochlea, is responsible for hearing.

The vestibular system measures linear and rotational movement. Many conditions can lead to disruption of this system or transmit incorrect information to the brain. These conditions (diseases) include Meniere's syndrome, labyrinthitis, benign paroxysmal positional vertigo, ear infections, tumors, or trauma.
Peripheral Sensory System
The sensory system consists of motion, position, and pressure receptors in the skin, muscles, and joints. These receptors provide important information about touch and position and help maintain balance. For example, if someone pushes you from behind, there is a slight increase in receptor activity at the base of your feet. As these receptors register increased pressure, the brain is informed (experientially) that the body is moving. The brain then uses this information to tell the body to shift a small amount of weight back to prevent the body from falling forward.

Brain

The brain processes information from three sensory systems. Any problem that alters the normal functioning of the central nervous system can lead to an imbalance in the body. Unlike the problems associated with the three sensory input systems discussed above, with problems in the central nervous system itself, dizziness is not the only symptom. Thus, the most common cause of vertigo is a peripheral problem related to the inner ear or labyrinth.

The most common causes of vertigo are:

  • Benign paroxysmal positional vertigo (BPPV) can be caused when crystals in the inner ear become dislodged and irritate the semicircular canals. The reason for this is not precisely defined, but it is associated with an incorrect position or movement of the head. This type of vertigo is most common in people over 60 years of age.
  • Labyrinthitis can occur after a viral infection that causes inflammation of the middle ear.
  • Meniere's disease is a symptom complex consisting of dizziness, hearing loss, noise or ringing in the ears.
  • Acoustic neuroma is a benign ear tumor that can cause dizziness.
  • Trauma to the inner ear may have different developmental mechanisms. With a fracture of the base of the skull, there may be direct damage to the labyrinth or due to contusion upon impact, which in a vector way causes displacement of the otoliths and this can lead to dizziness.
  • The inner ear can also be damaged by barotrauma - that is, the injury occurs due to a sudden pressure drop - and this can cause dizziness. This type of injury occurs when diving into water, when the air remaining in the external passage is compressed sharply and damages the eardrum. Barotrauma can also occur as a consequence of scuba diving, where an increase in air pressure within the middle and inner ear can damage both the membrane and the structures of the inner ear. This can cause hearing loss if the eardrum has ruptured, or it can cause dizziness if the round and oval windows in the inner ear are damaged.
  • Central causes of vertigo that originate in the brain are much less common. Strokes, tumors, seizures, and multiple sclerosis can cause dizziness.
  • Vestibular migraines are migraine headaches associated with vertigo and are often the cause of imbalance. Migraine is a vascular disease characterized by recurrent, usually unilateral, headaches. These headaches are often preceded by neurological symptoms for a period of time called an aura. Vertigo may occur in migraine patients as part of the migraine aura or alone. In younger patients, dizziness may precede the onset of headaches. Migraines often have a genetic basis and the presence of a family history may be a clue that an imbalance may be related to the migraine.

Symptoms

While some people use the term vertigo when feeling dizzy, true vertigo is the feeling of rotation of surrounding objects or the body itself. Very characteristically, this feeling is noted when a person leaves the carousel. In this case, dizziness and loss of balance can be so pronounced that the person may fall. A similar gait occurs in a person who has taken a good dose of alcohol. Dizziness itself is a symptom or indicator of vestibular dysfunction involving the labyrinth or cerebellum. If other ear structures are involved, there may be hearing loss and tinnitus along with dizziness.

If there is a problem with the cerebellum, the person may also complain of difficulty coordinating movements.

Nausea and vomiting are symptoms that often accompany dizziness. The more intense the dizziness, the more pronounced the nausea and vomiting. These symptoms can be so severe that the person may become dehydrated.

Diagnosis

Diagnosis of vertigo is based on history and physical examination. First of all, it is necessary to identify the symptom before starting to look for the cause. The key is a thorough analysis of the patient's complaints. It is necessary to find out what makes dizziness worse and less, whether there are other associated symptoms, such as hearing loss, tinnitus, nausea, vomiting. Medical history and treatments used may suggest the cause of dizziness.

Physical examination detects nystagmus, an abnormal eye movement that the body uses to compensate for disturbed information from the vestibular apparatus that enters the brain. A complete neurological examination is needed to determine if the cause of vertigo is a peripheral problem and is related to problems in the inner ear rather than problems in the brain. Conducting tests for coordination and balance help determine the function of the cerebellum.

A hearing test can be helpful to make sure that the middle ear, cochlea, and auditory nerve are functioning properly and only the labyrinth is causing vertigo.
The Dix-Hallpike test can be performed by a physician and can assist in the diagnosis. By moving the head in different directions, eye movements can be assessed and see if they correlate with vertigo symptoms.

MRI or CT may be used if central problems are suspected. Screening of blood tests may also be ordered.

In order to rule out an ENT disease, it may be necessary to consult an ENT doctor (this can help with both diagnosis and treatment).

Treatment

Some dizziness can be cured on its own or with medication, in other cases, for example, with BPPV or labyrinthitis, certain exercises give a good effect. There is a so-called Epley manipulation, in which the head is turned in different directions in order to restore the position of the crystals in the semicircular canals and reduce the inflammation that caused crystal dystopia. This procedure gives effect after several sessions. Currently, there are many drugs for the treatment of dizziness and accompanying nausea and vomiting. These drugs are a combination of drugs that affect the metabolism of acetylcholine, dopamine and antihistamines. GABA (gamma-aminobutyric acid) is an inhibitor of neurotransmitters in the vestibular system and benzodiazepines (diazepam) cause an increase in GABA activity, which leads to a decrease in dizziness and nausea. Medications are most effective for the treatment of acute onset dizziness, lasting from several hours to several days.

In internal diseases of the ear, it is necessary to reduce the inflammatory process and it is possible to use both corticosteroids and drugs that reduce nausea, dizziness, such as antivert and diazepam or Dramamine.
Diuretics and a low-salt diet may be used in Meniere's disease.

In the presence of acoustic neuroma or other morphological changes in the ear, surgical treatment may be required.

If there are signs of viral labyrinthitis or viral neuritis, it is advisable to use antiviral drugs (Zovirax or Valtrex)

A neck collar may be used to reduce the range of motion in the head until symptoms of vertigo subside.

In case of dizziness associated with disorders in the central nervous system (for example, with a stroke), measures are needed to improve the blood supply to the brain and taking drugs to reduce dizziness, nausea and vomiting should be short, as the brain needs to adapt to work. In general, dizziness of central origin requires a thorough examination and treatment of the main causes of the disease, where dizziness is secondary and the regression of this symptom depends on the treatment of the underlying disease. With psychogenic dizziness, which occurs in neurotic conditions, it is possible to use psychotherapy and antidepressants.

Prevention

Body imbalances are often unpredictable. Depending on the cause, symptoms may appear at any time, even after a long period without any symptoms. Therefore, care must be taken to avoid accidents that may be caused by an imbalance in the body.

For people with symptoms of dizziness or with a tendency to develop dizziness, symptoms can be reduced or avoided by adhering to the following rules:

  • Change body position slowly, especially when standing up. When you need to get out of bed, it is advisable to sit on the edge of the bed for a few seconds to get a normal orientation in space and give the vascular system time to adapt to the change in body position.
  • When walking, you need to focus on distant objects. Do not look at your feet. It is advisable to avoid walking in the dark or on uneven surfaces. When walking around the house, falls are possible when moving from one coating to another (for example, from linoleum to carpet)
  • When traveling in a car, try to sit in the front seat. Look out the window at a fixed point. Avoid following the road with your eyes on a winding road, look into the distance at some object.
  • Wear glasses if you have vision problems and hearing aids if you have hearing problems.
  • Use a cane to support your body so you can get more sensory information.
  • Avoid activities that require repeated up and down movements of the head.
  • Prolonged tilting of the head back should be avoided as much as possible, for example when painting walls above head level.
  • Great care is needed when taking drugs where dizziness is a side effect.

If a person has had an episode of dizziness, then driving a car can only be resumed after a doctor's permission. In addition, it is necessary to avoid climbing stairs or other situations with a sudden change in body position. This will minimize the danger to both the person himself and those who are nearby.

Dizziness: cause, diagnosis, treatment

Vestibular rehabilitation therapy

Fortunately, most of us go about our daily lives without paying attention to the complexity of our body systems that keep us upright and balanced. But this only happens until, for some reason, our coordination and balance are disturbed, reminding us how vital simple daily tasks are.

Vestibular Rehabilitation Therapy (VRT) consists of a set of exercises that encourage the brain and spinal cord to restore imbalances arising from diseases or abnormalities of the vestibular apparatus or lesions of the central nervous system.

This guide will help you understand:

  • anatomy of the vestibular system
  • why ART is needed
  • what disorders ART usually treats

Anatomy

The anatomy and physiology underlying the sense of balance in the human body is complex. Many systems are involved, including the brain, spinal cord, eyes, ears, and receptors in the skin, joints, and muscles. Disturbance in any of these areas due to injury or illness can negatively affect the sense of balance.

The inner ear, also called the labyrinth, is made up of the semicircular canals along with the sac and uterine. Collectively, this system of the inner ear is called the vestibular system or the vestibular apparatus.

The inner ear also contains the cochlea, which is the main structure involved in the perception of hearing.

The three semicircular canals respond to rotational movements of the head. The channels are at 90 degrees to each other and are filled with a fluid called endolymph. Hair cells are located at the base of each semicircular canal and protrude into the endolymph. The movement of the head causes the movement of the endolymph in the channels, which in turn causes the hair follicles to move accordingly and emit balance impulses that enter the brain. Hair cells in the sac and womb respond to linear acceleration of the head, such as when riding an elevator or moving forward.

Sensory information from the inner ear is transmitted to the brain via the vestibular portion of the eighth cranial nerve, also called the vestibulo-cochlear nerve. The cochlear part of the nerve transmits information about hearing. Certain areas of the brain, such as the cerebellum and brainstem, as well as parts of the cerebral cortex, process sensory information from the inner ear. When both the right and left inner ears send the same information to the brain, the body is balanced. When the body or head moves, the sensory information from the ears is not identical, so the brain perceives the movement and the body adjusts accordingly.

The ears work closely with the eyes to maintain balance. This is based on

vestibulo-ocular reflex (VOR). It is an automatic function of the eyes that stabilizes images on the retina in response to head movements. This reflex causes the eyes to move in the opposite direction to the movement of the head, so that the eyes remain fixed on the observed target. Thus, accurate information from the vestibular apparatus affects the sense of balance.

If one inner ear is affected by disease or injury, then the sensory information sent to the brain will falsely indicate movement from that vestibular system. In this case, the eyes will adjust accordingly and move in the opposite direction of the perceived movement, despite the fact that the head is actually stationary. As a result, involuntary movements of the eyes back and forth occur. This eye movement is called nystagmus and, if present, makes any healthcare professional suspect a vestibular problem.

There are two other reflexes, vestibulo-cervical reflex and vestibulo-spinal, which also help the body maintain a sense of balance.

The vestibulo-cervical reflex works in conjunction with incoming vestibular information and neck muscles to stabilize the head. And the job of the vestibulo-spinal reflex is to create compensatory body movements in response to vestibular input in order to maintain balance and avoid falling.

Disturbance along any part of the anatomical pathway described above can affect the perception of balance or balance. A problem with part of the inner ear or sensory information being transmitted to the brain via the vestibulo-chochlear nerve is called peripheral vestibular disorder.

If the problem affecting balance is due to damage to a structure within the brain itself, which then affects the reception and integration of balance information, it is called central vestibular disorder.

General disorders treated with ART

The most common peripheral vestibular disorders treated with ART are benign paroxysmal positional vertigo (BPPV) and any injury or disease that results in decreased function of the inner ear. This reduced function may be associated with disorders such as Meniere's disease, vestibular neuritis or labyrinthitis, or acoustic neuroma. The term unilateral or bilateral vestibular hypofunction may be used to describe decreased function of the vestibular system in one (unilateral) or both (bilateral) ears due to disease or injury.

Clinically, any peripheral dysfunction in the vestibular system that affects balance can potentially be treated with ART, however, the effectiveness of treatment will depend on the exact cause of the vestibular problems.

Central vestibular disorders such as multiple sclerosis or stroke may also respond to ART, although generally peripheral vestibular disorders tend to respond better.

Benign paroxysmal positional vertigo (BPPV)

BPPV is a common clinical balance disorder characterized by recurrent bouts of vertigo that are brief in nature (usually 10-60 seconds) and are most often triggered by certain head positions. Benign, medically speaking, means it is not life threatening. Paroxysmal means that it occurs with a rapid and sudden onset or increase in symptoms.

BPPV is the most common cause of recurrent vertigo. BPPV is thought to be caused by calcium carbonate crystals (called otoconia, otoliths, or "ear calculi") in the semicircular canals of the inner ear. Under normal circumstances, these crystals are located within the ear pouch, but in BPPV, these crystals are thought to be dislodged and migrate into the semicircular canals of the ear. This misalignment is thought to be due to a number of possible causes, such as trauma to the ear or head, ear infection or surgery, or natural degeneration of the structures of the inner ear. Often, however, the direct cause cannot be identified.

Otoconia settle in one place of the canal when the head is motionless. The most common lesion is the posterior semicircular canal. A sudden change in head position, often caused by activities such as rolling over in bed, getting out of bed, tilting the head, or looking up, causes the crystals to move. This shift, in turn, sends false signals about balance to the brain and causes dizziness.

Dizziness due to BPPV can be severe and accompanied by nausea. Attacks can occur for seemingly no reason and then disappear for weeks or months before returning again. Usually, BPPV affects only one ear, and although it can occur at any age, it often occurs in patients over 60 years of age and is more common in women. Nystagmus is usually present.

Meniere's disease

Ménière's disease is a chronic, incurable vestibular disorder characterized by symptoms of episodic severe dizziness, fluctuating hearing loss, "bursting" in the ear and/or ringing in the ear (tinnitus), and nystagmus.

The disease got its name from the French physician Prosper aMenière, who in the late 1800s theorized the cause of these symptoms, which he noted in many of his patients.

The exact cause of Ménière's disease has not yet been determined, but it is thought to be due to an abnormal amount of endolymphatic fluid accumulating in the inner ear and/or an abnormal accumulation of potassium in the inner ear.

The early stages of acute attacks of Ménière's disease range in length from 20 minutes to 24 hours. Attacks may occur regularly for a week or may occur after weeks or months. Other symptoms may coincide with an attack, such as restlessness, diarrhea, tremors, blurred vision, nausea and vomiting, cold sweats, and an increased pulse or palpitations. After attacks, patients often experience extreme fatigue, which requires many hours of rest to recover. For some patients, the time between attacks may be symptom-free, but other patients report persistent associated symptoms even between attacks.

Vestibular neuronitis

Vestibular neuronitis is inflammation of the inner ear or associated nerve (the vestibular part of the vestibulo-cochlear nerve) that causes dizziness. Hearing may also be affected if the inflammation also affects the cochlear portion of the nerve.

Vertigo due to vestibular neuronitis has an abrupt onset and may be mild or extremely severe. Nausea, vomiting, unsteadiness, decreased concentration, nystagmus, and blurred vision may also occur. Most often, infections that cause inflammation of the inner ear or vestibulo-cochlear nerve are viral in nature, not bacterial. Proper diagnosis as to whether it is viral or bacterial is important to ensure the most effective and adequate treatment.

Acoustic Neuroma

Acoustic neuroma is a benign tumor on the vestibulo-cochlear nerve. Early symptoms are associated with hearing loss in the affected ear, ringing in the ear (tinnitus), dizziness, and a feeling of fullness in the ear. The tumor grows slowly, so symptoms appear gradually and can be easily missed in the early stages. As the tumor grows, it may press on other nerves in the area, and symptoms such as headache or facial pain and numbness may appear. Dizziness or other balance problems may occur as the tumor grows.

Vestibular symptoms

Peripheral or central vestibular disorders can lead to a number of different symptoms. VRT has the potential to alleviate or resolve any symptoms associated with a vestibular disorder.

Common symptoms include:

  • dizziness
  • blurred vision
  • fatigue
  • anxiety
  • headaches
  • nausea and/or vomiting
  • cold sweat
  • tinnitus
  • hearing loss
  • eye twitching
  • ear pressure
  • panic attacks
  • declination to the side
  • fear of falling
  • increased risk of falls
  • disturbed balance
  • wobbly walking
  • anxiety
  • depression

Diagnosis of the cause of dizziness

A detailed history of your illness is the most important information a doctor needs to diagnose the cause of your vestibular disorder and then proceed with appropriate ART.

The doctor will ask you to describe your vestibular symptoms in detail. Any of the symptoms listed above that you are experiencing, or others, should be mentioned. Your doctor will want to know when your first episode of symptoms occurred, how long they lasted, and whether they were related to any other events, such as a car accident, head injury, illness, or infection.

He will also want to know how often the symptoms have recurred since the first episode and a general picture of the frequency of symptoms. It clarifies what specifically causes your symptoms, such as moving your head in a certain direction or getting out of bed. Regarding dizziness, your doctor will ask about the nature of what you are feeling and whether you experience episodes of true dizziness where you have a sensation of spinning.

The doctor will also want to know if there is anything that reduces or worsens your symptoms and if you are taking any medications, or if you have a family history of any inner ear or central nervous system disorders.

He may ask you to rate the intensity of some of your symptoms on an objective scale. Finally, they will ask about all the daily activities that are related to your vestibular problem, such as walking, driving, working, and even household chores such as dressing, bathing, showering, and housework.

He will also want to know if you are having falls.

The doctor examines your eye movement by asking you to follow certain objects with your eyes or by asking you to move your head while keeping your attention on a specific target.

An examination of the joints, neck muscles is also carried out to determine the cervicogenic nature of dizziness.

Finally, your doctor may ask you to fill out a questionnaire, which he will use to clarify the severity of your vestibular symptoms.

Depending on what the doctor finds during the initial examination, they may send you for a series of other tests to further determine the cause of your vestibular symptoms.

Vestibular rehabilitation

As stated above, various disorders that cause dizziness or imbalance can be treated with ART. Virtually any disorder that is due to vestibular dysfunction and is not adequately compensated can be treated with ART. The effectiveness of ART depends on the correct diagnosis of the cause of the imbalance, the skill/training of the therapist in designing and administering the treatment, and adherence to the prescribed exercise program.

As explained earlier, the goal of ART exercises is to encourage the brain and spinal cord to compensate for any balance deficits that result from diseases or abnormalities of the inner ear or central nervous system. In other words, patients train their vestibular system to do one of several things; adapt to the presented stimuli, replace other sensory pathways, or get used to changing the vestibular signals sent to their brain so that they can manage their vestibular disorder and maintain normal functioning despite possible ongoing symptoms.

In some cases, ART can eliminate vestibular symptoms. Unfortunately, however, this is not always the case, so minimizing symptoms or symptom recurrence is considered a successful outcome of ART.

ART research shows that, in general, ART exercises are effective in relieving many of the symptoms of vestibular disorder, and that these improvements can often be maintained for several months after therapy. However, the effectiveness of therapy is often highly dependent on what exactly is causing the vestibular symptoms in the first place and on the use of individual exercises rather than a standard exercise protocol.

ART, however, is not always effective for all vestibular problems. There are even some vestibular problems where exercise is not considered appropriate, so proper diagnosis of the cause of the symptoms is important.

ART exercises

If your physiotherapist determines that ART is right for you after the diagnosis is complete, he or she will prescribe a series of individual exercises for you to perform on a regular basis. These exercises will address your specific vestibular problem and related symptoms.

In addition, the exercises prescribed for you will focus on any day-to-day problems you face as a result of your symptoms. Some exercises will be done with your physiotherapist on a stabiloplatform, and others you will train so that you can do them yourself as part of a home exercise program.

Medications to treat your symptoms may be an adjunct to ART and should be discussed with your doctor.

Our approach to treatment (stabiloplatform exercises)


Stabilometry is a modern method that allows you to assess the state of balance of a person in various diseases.

The examination of the patient takes place on a special platform that registers the minimum vibrations of the human body with their subsequent computer processing. At the end of the study, a conclusion and recommendations for rehabilitation in the form of trainings are issued.

With the help of video games, a person, moving the fulcrum, "manages" the actions of the character on the screen, thereby training his vestibular apparatus. Repeated carrying out of such training increases the effectiveness of the therapy.


Treatment on a stabiloplatform with biofeedback is prescribed as part of complex therapy for such diseases and pathological conditions as:

  • imbalance, loss of coordination;
  • frequent dizziness and headaches;
  • diseases of the vestibular apparatus;
  • panic attacks accompanied by dizziness
  • polyneuropathy;
  • vascular diseases, conditions of impaired blood supply to the brain, incl. post-stroke
  • various injuries of the spine (displacement of the vertebrae, curvature)
  • flat feet

Neck care

Some patients who experience dizziness or balance problems have concurrent orthopedic neck problems that cause or exacerbate their symptoms. In these cases, your physiotherapist from the Health and Wellness Complex "Healthy Sport" can also perform a practical treatment in combination with other ART exercises described above.


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MedPath Group