Treatment for dizziness might sound strange but at Cilliers & Swart we treat patients who experience vertigo on regular basis. Ask yourself the following questions: Does your dizziness increase when you stop taking your medication? Does is feel like your head is spinning after you visit an Ear-nose-and-throat (ENT) specialist? Have you had a caloric test (to test the function of your inner ears) done and do you find yourself thrown off balance for no apparent reason?
Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.
Why does it feel as if my head is spinning?
Our ears do not only give us the ability to hear sound, but also play an important role in maintaining our balance and helping our eyes focus. This is done by our vestibular system. The vestibular system forms part of your inner ear. It notices when your body moves in different directions and works together with your eyes to let you know where your head is in relation to your body. These combined systems can tell you if you are standing still, jumping up and down, or spinning around like a ballerina. Both systems need to work together in harmony to give you accurate information when you need it, for example when you stand up from a sitting position. If there’s a problem with the vestibular system, you will feel dizzy, off balance or even sick.
If your eyes are working perfectly, they will be providing normal feedback to your brain. In this moment, they are telling your brain that you are sitting at a desk looking at your computer or you are glancing at your phone. At the same time, your inner ear (vestibular system) however, could be giving abnormal feedback. It could be telling your brain that you are moving or swaying when. This distortion creates the feeling of dizziness, lightheadedness, or spinning.
When you move while keeping your eyes fixed on something, for example looking at a billboard on the highway while driving, you may experience a strange sensation of not being able to read the billboard. The letters seem to swim, and dizziness comes over you. This is because the information from your ears (vestibular system) and eyes are not in sync with each other and your brain is struggling to make sense of it, like an echo on a Skype or international call.
What is vertigo?
Dizziness is used to describe several symptoms which for example, when your blood pressure drops, and you get up from a seated position too fast. Another example is the lightheaded feeling after climbing off a roller-coaster or a long flight – when your legs feel weak and your stomach queasy. People describe the feeling as “Something feels off”. It may influence the way you walk. To an observer, it may look as if you had one too many alcoholic drinks. All the above, describes the feeling of vertigo. True vertigo is your brain tricking itself into believing that you, or your environment, or a stationary object is moving, when it is standing still.
What should I do?
Give us a call and talk us through the history of your problem. We, as physiotherapists, will examine you and asses your vestibular system, eyes and balance to confirm the problem. We don’t repeat caloric tests (by spraying fluid into your ear to reproduce your symptoms).
Based on your diagnosis, we begin treatment. Treatment includes physiotherapists working (e.g. massaging) on your neck, while carefully moving or controlling the position of your head and showing balancing exercises.
When your inner ear and eyes are out of sync, you experience vertigo.
Dizziness or vertigo is a result of:
1. Vestibular neuritis
A viral infection of the vestibular nerve. This nerve transmits information from the inner ear to the brain. This type of infection impacts 3 out of 100 000 people per year and can cause Benign Paroxysmal Positional Vertigo (BPPV).
2. Acoustic neuroma/Vestibular Schwannoma
A rare, benign (non-cancerous) tumor that grows slowly on the vestibular nerve. It is reported in only 2 out of 100 000 people per year. This causes subtle loss of hearing and sometimes also ringing in the ear (tinnitus).
3. Ototoxic medication
Some medications are harmful to the ear, including aminoglycocites. Aminoglycocites from part of a group of antibiotics used to treat gram negative bacteria, like pseudomonas.
4. Menierre’s disease
This disease targets the hair cells within the inner ear. It affects 20 to 200 out of a 100 000 people per year. It causes episodes of vertigo that come and go. These dizzy spells can last between 20 minutes to 24 hours. It also causes hearing loss and tinnitus.
5. Aging
It is normal to experience a loss of balance as you age. 50% of people over the age of 65 may suffer from Benign Paroxysmal Positional Vertigo (BPPV). As you age, fewer of the hair cells in the inner ear function. Therefore, your balance will become unsteady. Regular exercise helps maintain a certain degree of balance and can reduce your risk of falling and injuring yourself.
6. Benign Paroxysmal Positional Vertigo (BPPV)
BPPV affects 64 out of 100 000 people per year. It is identified by short periods (less than a minute) of vertigo (you or the room spinning) when moving your head. The feeling of dizziness happens because crystals are moving within your inner ear.
The vestibular system consists of three semicircular canals, at right angles to each other. The semicircular canals transmit information about the direction your head is moving and how fast your head is moving (e.g. turning and shaking your head when saying “No”).
The oolith organs lie at the base of the semicircular canals. They send information about flexion/extension (nodding yes) movement and speed of movement. Octonia are calcium carbonate crystals on the oolith organ.
BPPV is when these crystals are knocked out of place keep moving from one position to the next. These crystals can move into a semicircular canal (canalisthiasis) or stick to the cupula (cupulolisthiasis). This can happen after head trauma, labyrinthitis or a drop in the blood supply to the vestibular system.
Episodes of vertigo are then triggered by lying down, rolling, bending or looking up. This explains the feeling of spinning and nausea when turning in bed, bending over to pick something up, looking up when hanging washing or rinsing your hair. An episode only lasts a few seconds, but the feeling of unsteadiness can linger for days.
An episode would follow a head injury, ear infection or having held a strange head position for a long time, like sitting with your head held back at the hair salon. BPPV is more common in women, because of the lower bone mineral density.
Diagnosis
We are able to assess your vestibular system and find the root of the problem. We will discuss your history of experiencing vertigo in depth (from when it started, how long it lasts etc.). We will test your ability to identify letters while moving your head, balancing on one spot and moving your eyes.
BPPV can be diagnosed by means of the Dix-Hallpike Manoeuvre. This test takes the head through specific movements, while the physiotherapist assesses your eyes and makes inquiries about your dizziness.
Treatment
Treatment includes physiotherapists working (e.g. massaging) on your neck, while carefully moving or controlling the position of your head. A physiotherapist guides you through specific head positions to reposition the crystals (mentioned in the previous section). This practice is best carried out by a trained medical professional.
Research has shown that treatment manoeuvres (carefully controlled movements) achieve a 94% success rate by the 6 months’ follow up session with patients (Peggy, 2005). You can expect myofascial work (deep massage and improved joint movements) to the neck. Home exercises to improve your balance might be required when necessary.
What you can expect after the treatment
After treatment you may feel unwell. We advise you ask someone to drive you or catch an Uber. We don’t recommend driving after treatment.
How many treatments are necessary?
Unfortunately, there is no quick fix. We recommend 2 to 3 treatments for the first 3 weeks. Each person’s case is unique and could respond to treatment in a different way. We can give you a clearer indication of how long it will take to make a full recovery, once we’ve seen how you respond to treatment and how fast you progress.
Test yourself with the Romberg test
Stand in the corner of a room. Don’t let your body touch the walls. Stand with your feet comfortably (a hip distance) away from each other. Keep your arms next to your sides and keep your eyes open.
Now, close your eyes and count how many seconds you can hold that position without losing your balance. When feel as if you might topple over, open your eyes and (if necessary) press against the walls. The walls are there to ‘catch’ you. Pay attention to which side you lose your balance.
Next, bring your feet together so that they touch. Again, close your eyes and count how many seconds you can hold the position. Did you lose your balance to the same side again?
Now, place your right foot in front of the left (as if you are taking a step). Close your eyes again and count. Repeat with your left foot in front of the right.
