Vestibular disorders are among the nearly infinite causes of dizziness. In fact, dizziness is the symptom of nearly everything. But vestibular disorders encompass a very specific source of dizziness: the inner ear.
What’s A Vestibular Disorder?
Vestibular Disorders affect the inner ear where your body’s GPS is located. Because there are many moving pieces that make up our vestibular system, there are many ways it can disfunction. And therefore, many varieties of vestibular disorder. Notably, treating vestibular disorders is a science and a dizzy patient’s chance at a symptom-free life is quite high. So what are the varieties of vestibular disorders and what type of dizziness symptoms can one expect from them?
BPPV
Benign Paroxysmal Positional Vertigo might be the most common of all the vestibular disorders. In our clinic and other specialized dizziness clinics, BPPV accounts for 20-30% of all diagnoses of vestibular vertigo. BPPV is the result of particles that sense gravity (otoconia) getting dislodged in the inner ear and causing confusion in the vestibular system. More specifically, we have three semicircular canals in our inner ear which are filled with fluid. As we turn our heads, that fluid moves and helps inform our body of our head’s location in space. A part of the inner ear called the utricle is thought to be the location of “ear crystals” (otoconia). In people with BPPV, those crystals get dislodged, find themselves with the fluid in your semicircular canals, and throw off your body’s sense of position. The vertigo you feel is your body trying to understand this new information in the wrong part of your inner ear. In other words, your body is trying to make sense of mixed signals. The symptoms of BPPV are:
Vertigo – false sensation that you or the world around you is spinning
Occurs with head movements such as bending over or rolling out of bed
Occurs in shorts burst lasting just a few seconds to a minute
Vestibular Migraine
First of all, vestibular migraine (VM) doesn’t mean you must have a migraine to be diagnosed with this condition. Migraines present themselves in a variety of ways, far more than just the “splitting headache” version. Vestibular migraine is a nervous system issue. In other words, hypersensitivity to sensory input. For example, a person with vestibular migraine may experience sensitivity to fluorescent lighting, sound, noise, busy environments, and physical movements consequently resulting in motion intolerance and nausea. Specific food consumption (dairy, MSG, processed meats, alcohol, chocolate, caffeine, and nuts to name a few), hormone variations, changes in weather, lack of sleep, stress, and initiation and/or changes in medications may also be triggers to vestibular migraine. Approximately 40% of these patients will experience ear and/or vestibular related issues that include, but are not limited to:
Repeated dizziness (or vertigo) spells
Imbalance
Disequilibrium
Visual disorientation
Ear fullness/pressure
Lasts anywhere from seconds to days
Also, your doctor might call it Migraine-Associated Vertigo, Migrainous Vertigo, or Migraine-Related Vestibulopathy. Despite more of the general population beginning to understand that migraine attacks are far more than a simple headache, vestibular migraines are still relatively unknown even though an estimated 1% of people will get VM.
Meniere’s Disease
Meniere’s Disease is one of the trickiest inner ear vestibular disorders because so little is known about its origin, its signs, and its treatment. Therefore, it is very difficult to cope with and even more difficult for others to understand. Because there isn’t a cure, at best, you can get help in rehabilitating and alleviating your lingering symptoms after an attack. Meniere’s Disease affects about 0.2% of the population. The symptoms of Meniere’s Disease are:
A typical episode starts with fullness in one ear, hearing fluctuations, and tinnitus
It also will include severe true rotational vertigo, nausea, and vomiting
Typically lasts between two to four hours
Following the attack, most people are exhausted and need to sleep off the experience
Post-Concussion Syndrome
Although concussions aren’t new, our understanding of them has made leaps and bounds in the past few decades. Additionally, we know that a concussion’s effect on the vestibular system can be long-lasting. Post-Concussion Syndrome (PCS) is essentially the prolonged side-effects of a concussion that doesn’t properly heal. Again, it encompasses many of the same symptoms you experienced the days following your concussion. However, with PCS, your symptoms linger. PCS affects somewhere between 10-30% of people with a brain injury/concussion. Furthermore, PCS might present itself immediately after your concussion and be a constant in your life. Or PCS might not appear for weeks after your symptoms subsided. The symptoms of Post-Concussion Syndrome are:
Headaches and Migraines
Dizziness and Vertigo
Fatigue
Sensitivity to Light
Blurred Vision
Noise Sensitivity
Difficulty Concentrating
Memory Loss
Slow / Delayed Thinking
Anxiety
Depression
Sleep Disturbances
Vestibular Neuronitis
Vestibular neuronitis is a vestibular disorder characterized by a sudden severe attack of vertigo without hearing loss. It’s caused by inflammation of the vestibular nerve, occurs more often in spring and early summer, and as a result, is often associated with an upper respiratory tract infection developing around the same time. The symptoms of Vestibular Neuronitis are:
Sudden onset of vertigo
Single or multiple attacks
Typically includes nausea and vomiting
Lasts for a period of days with the gradual improvement the following over weeks
Often followed by episodes of BPPV
Labyrinthitis
Labyrinthitis is inflammation of the inner ear or the nerves that connect the inner ear to the brain – the membranous labyrinth. It’s etiology (cause) is either bacterial or viral, so it often follows a cold or the flu. Labyrinthitis usually goes away on its own. However, medications can help manage symptoms and vestibular rehabilitation therapy helps in some cases. Labyrinthitis affects less than 1% of the US population every year – with approximately 200,000 cases reported every year. The symptoms of Labrynthitis are:
Hearing loss
Dizziness
Vertigo
Mal de Debarquement Syndrome
Mal de Debarquement (MdDS), or disembarkment sickness, is quite common. Simply, MdDS is the continued sensation of motion, rocking, or swaying after disembarking a boat, car, bus, or train. Even though you’re on solid land, you’re still feeling the same motion sensations. Most people will experience these sensations after getting off a boat or something. But not all of it is classified as MdDS. The continued sensations must persist for a period of weeks or months before one should consider themselves at risk for MdDS. The symptoms of Mal de Debarquement Syndrome are:
Persistent rocking, swaying, or motion
Prolonged sensations of movement on solid ground for many weeks, often months
Other Vestibular Disorders
Of course, there are many more vestibular disorders and conditions that affect the inner ear. Too many to cover in detail. The vestibular disorders above are by far the more common ones. Below, we’ve listed some of the other vestibular disorders we encounter occasionally:
Labyrinthine Infarction
Cervicogenic Dizziness
Persistent Postural – Perceptual Dizziness (PPPD)
Superior Semicircular Canal Dehiscence (SSCD)
Perilymph Fistula
Vestibulopathy
Visual Vertigo
Ototoxicity
While the Dizzy & Vertigo Institute is located in Los Angeles, California we have options for those of you in other states. We look forward to hearing from you!
