Navigating Peripheral Vertigo: Understanding Causes and Treatment Options
Peripheral vertigo
Vertigo, the sensation of a spinning dizziness, can be caused by a variety of issues in several different areas. One common location that can contribute to vertigo symptoms is the vestibular nerve, which control the sensation of balance. Issues within the vestibular nerve are classified as peripheral vertigo, and have multiple causes such as infection, Meniere’s disease, and benign paroxysmal positional vertigo (BPPV).
Meniere’s disease
Meniere’s disease is a condition that affects the inner ear, which has functions in both hearing and sense of balance. As such, symptoms can include vertigo episodes lasting up to 24 hours, a ringing sensation in 1 ear (also known as “tinnitus”), a sense of “fullness” or “stuffiness” in the ear, and/or hearing loss. The exact cause of Meniere’s disease is currently unknown, but remission can happen spontaneously, although it may take several years. A diagnosis may be reached through several test including, but not limited to: hearing tests, balances tests, further imaging such as CT scans or MRIs, and/or other investigative tests to rule out other conditions that may have similar presentations.
In patients with Meniere’s disease, lifestyle adjustments in addition to medication and vestibular rehabilitation have shown to be effective. Some lifestyle factors may include diet modification, as some patients may be particularly sensitive to diets high in salt, caffeine, and/or alcohol. Avoiding known triggers in these cases can help to alleviate symptoms and reduce the frequencies of episodes.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is the most common type of peripheral vertigo. It is characterized by the sensation of rotational spinning and dizziness, often brought on by head movement or changes in head position such as tilting your head up or down, lying down, turning over, or getting up. It is thought to occur due to the displacement of small crystals in the inner ear. This displacement sends signals to the brain, making it think that the head is moving or changing position when it is not. The discrepancy between the signals from the inner ear and other balance centers, such as the visual system or musculoskeletal system, cause symptoms vertigo and dizziness seen in BPPV.
BPPV is typically diagnosed through a test called the Dix-Hallpike test. It involves a series of movements to recreate the vertigo symptoms in order to confirm the diagnosis. Once diagnosed, physical therapy treatment can be provided and home exercises can be performed for resolution of the vertigo symptoms. To read more about the Dix-Hallpike maneuver and diagnosis procedure, click here.
The most widely used physical therapy procedure to treat BPPV is the Epley maneuver. It involves going through a series of positions - in hopes that the displaced crystals can settle back. Full relief can take several hours, and the procedure may need to be repeated over the course of a few days or weeks. It can be performed as a home exercise, but only when prescribed by a qualified medical professional. For more details on the Epley maneuver, please see below. Although physical therapy can provide relief of symptoms, the recurrence of BPPV episodes is common and often sudden, and may require repeat physiotherapy sessions in the future.
“To perform a modified Epley maneuver (as shown in the image), instruct the patient to position themselves upright on a bed with their head turned 45 degrees to the left and a pillow behind them. The pillow should be positioned so that when supine, the pillow is directly under their shoulders. Once the patient is in position, they should like back quickly onto the pillow, so the head is reclined onto the bed. They should hold this position for 30 seconds. Without raising their head, they should then turn their head 90 degrees to the opposite side (right) and hold this position for another 30 seconds. After 30 seconds, they should turn their body and head another 90 degrees to the right and wait for another 30 seconds. Finally, they should sit up on the right side of the bed. This maneuver can be repeated starting on the opposite side and should be performed at least three times a day until the patient has no further episodes of positional vertigo for 24 hours.” (Frothingham, 2023).
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References
Frothingham, S. (Updated 18 Jan 2023). Understanding and Using the Semont Maneuver. Accessed from: https://www.healthline.com/health/semont-maneuver.
Martel, J. (Updated 28 Sept 2018). Meniere’s Disease. Accessed from: https://www.healthline.com/health/menieres-disease.
Martel, J. (Updated 29 Sept 2018). I Feel Dizzy: Peripheral Vertigo. Accessed from: https://www.healthline.com/health/peripheral-vertigo.
Stanton M, Freeman AM. Vertigo. [Updated 2022 Mar 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482356/.
Watson, K. (Updated 4 Nov 2019). How the Dix-Hallpike Maneuver Is Used to Identify and Diagnose Vertigo. Accessed from: https://www.healthline.com/health/dix-hallpike-maneuver.
