Vertigo is a particular form of dizziness or giddiness. Rather than just feeling faint or light headed, it is an illusion of motion. The sufferer feels as though they, or their surroundings, are turning, spinning, falling, or some other form of movement when in fact they are not. Like sea-sickness, vertigo is often accompanied by nausea and vomiting.
Vertigo does not mean fear of heights, that mistake was spread by Alfred Hitchcock’s 1958 film “Vertigo”.
After acute vertigo settles, it is often followed by disequilibrium (diss-eck-will-IB-ree-um), an uneasy feeling of imbalance, as though one might be about to fall over.
Vertigo and disequilibrium can be very frightening, but do not usually signify any serious or life-threatening disease
How damage to the inner ear causes vertigo
Vertigo can result from many causes, but is most often caused by damage to the balance organ of the inner ear. As well as the cochlea for hearing, the inner ear contains a very sensitive organ, the vestibular labyrinth, designed to help maintain balance.
- The vestibular labyrinth is made up of three semicircular canals – lateral, posterior and superior. They join together at the vestibule.
- The semicircular canals are arranged at right angles to one another. They can detect and measure movements and acceleration in all three planes of space.
- The inner ear balance organ can also detect the direction of gravity.
- The right and left balance organs work together, constantly sending signals via the audiovestibular nerves to the brain, telling you which way up you are, whether you are moving, turning, etc. and in which direction.
- When your inner ear balance organ is damaged, it sends a false signal to the brain.
- The commonest condition to affect the inner ear is labyrinthitis, which means inflammation of the labyrinth and causes severe rotatory vertigo.
- Labyrinthitis often causes permanent and irreversible damage to the inner ear. The recovery that follows is not because the inner ear gets better, but because the brain learns to ignore, adjust to or compensate for the false signal.
- The brain learning to make allowances for the faulty information coming from the inner ear is known as central compensation.
Exercises that help diminish vertigo.
1. In bed or sitting:
A. Eye movements (move eyes slowly at first, then quickly)
Up and down
From side to side
Focussing on finger moving from three feet to one foot away from face
B. Head movements (move head slowly at first, then quickly; with eyes open, then closed)
Bending forwards and backwards
Turning from side to side
A. Eye and head movements, as 1
B. Shrug and circle shoulders
C Bend forward and pick up objects from the ground
D Bend side to side and pick up objects from the ground
A. Eye, head and shoulder movements, as 1 and 2
B. Change from a sitting to a standing position with eyes open, then closed (please note this is not advised for the elderly with postural hypertension)
C. Throw a ball from hand to hand above eye level
D. Throw a ball from hand to hand under the knees
E. Change from a sitting to a standing position, turning around in between
4. Moving about:
A. Walk across the room with eyes open
B. Walk up and down a slope with eyes open
C. Walk up and down steps with eyes open
D. Throw and catch a ball
E. Any game involving stooping, stretching and aiming (for example, bowls or bowling)
Gaze stabilization exercises
The aim of gaze stabilization exercises is to improve vision and the ability to focus on a stationary object while the head is moving.
Your therapist should assess you and say which exercises are suitable for you.
1. Look straight ahead and focus on a letter (for example, an E) held at eye level in front of you.
2. Move your head from side to side, staying focussed on the target letter. Build up the speed of your head movement. It is crucial that the letter stays in focus. If you get too dizzy, slow down.
3. Try to continue for up to one minute (the brain needs this time in order to adapt). Build up gradually to repeat three to five times a day.
You can also do this exercise with an up and down (nodding) movement.
Canalith repositioning procedures (CRP)
1. Sit on the edge of the bed and turn your head 45 degrees to one side.
2. Quickly lie down on your opposite side (that is, to the left if you turned your head to the right, and vice versa) so that the back of your head behind your ear touches the bed.
3. Hold this position for about 30 seconds or until the dizziness symptoms stop.
4. Return to the sitting position.
Repeat on the on the other side, alternating until you have completed six repetitions on each side.