Vertigo and Dizziness

Vertigo and Dizziness are unpleasant sensations that can cause disorientation, discomfort, and unsteadiness. Vertigo is a specific kind of dizziness in which it feels like the room and the surroundings are spinning. Vertigo and Dizziness have the potential to affect anyone during the course of their lives. Depending on the severity of the symptoms, the discomfort can be mildly inconveniencing or severely limiting. Balance, orientation and a sense of equilibrium are all important in navigating the world, and Vertigo and Dizziness have the potential to impact all of these.


Vertigo and Dizziness arise from irritation to the inner ear, specifically the parts of the inner ear which are responsible for balance; the vestibular apparatus and the semicircular canals of the ear. The vestibular apparatus of the inner ear sits between the cochlea, which is responsible for converting air vibrations into perceived sounds, and the semicircular canals of the inner ear. The semicircular canals of the inner ear are filled with fluid, and each of the semicircular canals, three on either side of the head for six in total, are oriented so that the fluid within them flows at different rates depending on the angle and rotational movement of the head. The different rates of fluid flowing through the canals is compared within the brain, and combined with information provided by the eyes, the skin and the joints, and the body's own sense of equilibrium to produce balance. Balance is therefore the result of the integration of a large amount of sensory information which is detected through multiple means. While disruption to those sensors, integrators and effectors can produced dizziness-like symptoms, vertigo and dizziness can be caused by a few specific factors.


Dizziness is commonly experienced when standing up abruptly after a long period of time spent lying down or sitting. This sensation can be intensified on hot days or when a person is dehydrated, such as when they have been exercising for extended periods of time or they have lost fluid volume due to sweating. This dizziness is a result of rapidly changing blood pressure that produces a sensation of light-headedness, and in severe cases, fainting. This dizziness is described as orthostatic hypotension: low blood pressure due to changed body orientation. While this dizziness may clear rapidly as blood pressure equalises, experiencing orthostatic hypotension is not ideal. This condition is best addressed through a combination of blood pressure assessment, exercise, and review of diet in the event of sodium insufficiency. Nevertheless, it is a common experience to have after a long period of time sitting at a desk or on a long-haul flight. 


Dizziness can also be experienced after a blow to a head. A sharp strike to the front, side or back of the head such as may be encountered accidentally or as a result of a workplace accident, or a strike to the front of the head that produces a rotational force such as that experienced in boxing can rattle and irritate the inner ear. The skull is composed of bone whose primary function is to conduct shock force around the vulnerable viscera of the brain and the soft tissues of the mouth, but in doing so this force can be inadvertently transmitted to the delicate structures of the inner ear and produce irritation. A sharp clap to either side of the head can be quite disorienting as well, whether delivered by a fist, the flat of a hand, or a fighting stick. Dizziness can also be experienced following rapid back-and-forth movement of the head such as that which may be experienced in a car accident, which also has the potential to irritate the inner ear as well as the muscles around it. These are all common causes of dizziness and dizziness-like symptoms. 


Dizziness can be experienced after periods of unwellness such as a cold, or during illnesses that disrupt the fluid flow within the semicircular canals such as Meniere's disease, or after the ingestion of drugs like Vancomycin that have the potential to be toxic to the cells of the inner ear. The pressure of the fluid within the semicircular canals, the vestibule and the cochlea needs to be maintained within a specific range so that the organ can function properly. Additionally, the health of the cells responsible for detecting the movement of the fluid must be preserved as well. If the pressure of the fluid is too high or too low, or the cells responsible for detecting its movement are injured or damaged, the ear cannot appropriately do the work of converting mechanical vibrations in the air to appreciable sensation, or balance the body appropriately. This sensation may be isolated to one ear or experienced in both, and so the irritation may be greater or lesser depending on the relative contribution of the sides of the head to the overall problem. The problem can persist following the resolution of the illness, and can fluctuate in intensity and the extent to which it affects the life of the person experiencing it. 


A specific kind of dizziness called Benign Paroxysmal Positional Vertigo (BPPV) arises due to the accumulation of debris within the semicircular canals, which circulates within the fluid and irritates the fine detector cells of the ear, producing sensations that are inconsistent with the movement that the body may or may not be doing, and which therefore produce discomfort. In BPPV, small or large pieces of debris move within the semicircular canals, and the irritation of the detector calls is experienced as movement of the head. The problem is that the head is not moving, either at all or not moving with the speed and orientation that the cells are indicating, and this produces mild discomfort at best or vomitous nausea at worse. BPPV can be a totally debilitating condition depending on the severity of its onset and the ease with which it may produce irritation. Ordinarily, BPPV is managed with a simple clearance maneuver in which the physiotherapist moves the head through specific postures, allowing the irritant to be rolled out of the canal in which it has settled and moved to a resting position where it is unlikely to cause further discomfort. BPPV comes on spontaneously and can resolve spontaneously, but if it has come on once it is generally best to have it managed closely rather than let it sit. 


Dizziness and vertigo can also be caused by irritation or spasm of the postural muscles of the neck, irritation of the bite muscles of the jaw, and irritation of the joint of the jaw itself. This is due to the close proximity of these structures to the facial nerve and the trigeminal nerve, which has been observed to become involved during episodes of neck and jaw muscle or joint irritation. These nerves are close to the structures and nerves serving the inner ear, and due to their complex interrelation the aggravation of one can lead to the discomfort of another. The close spatial relationship of these nerves means that inflammation of one structure can result in the irrtation of another, and cause a cascading effect that can lead to discomfort. Migraines with aura have been noted to produce dizziness as well as ringing in the ears. In this case, management of the dizziness will equally involve management of the neck and the jaw. 


Management of your discomfort depends on its causative factors, how it feels and changes during the day, what makes it better and worse, and the length of time you have been experiencing that pain. All of these factors will be addressed in your initial assessment, which is the first step toward managing and minimising any pain or discomfort. The treatment you receive will be tailored to address the specific cause of your discomfort, and will focus on minimising pain, maximising your ability to move pain-free, and developing a plan to minimise the risk of a flare-up in the future.


At Atlas Physio, we will provide you with education, structured management, and ongoing monitoring of your pain both in-clinic and out. Contact us to arrange an assessment, and to take the first step on a course of corrective care today.