Acute dizziness may signal a vestibular disorder which can be treated effectively
Dr Douglas Duffy, chartered physiotherapist, The Balance Centre, Dublin. Photograph: Dara Mac Dónaill
Dr Douglas Duffy, chartered physiotherapist, with a patient at The Balance Centre, Ranelagh Road, Dublin. Photograph: Dara Mac Dónaill
Ask anyone who has ever suffered an attack of vertigo and they will all stress the same point: it is, albeit momentarily, one of the most disconcerting sensations you are ever likely to experience.
If you haven’t felt it first-hand, you tend to think of it as that jarring, wobbly feeling you might get when you peer over the edge of a skyscraper. What you don’t expect is for the world to start spinning when you’re sitting comfortably on your couch in a stationary position with not a drink taken.
This was how my 2017 began. Just as I was coming out the other side of a two-week flu, I caught another viral infection, the symptoms of which declared war on my balance centre. For four insufferable weeks, I was in a permanent state of acute dizziness and, on top of that, I was dealing with intermittent hour-long attacks of what could only be vertigo.
It took a major toll on my quality of living; I couldn’t walk without feeling as though I might keel over. I couldn’t even lie there, binge-watching Netflix. No screens, no moving, no fun.
Though Irish statistics on the prevalence of balance disorders – viral or not – are thin on the ground, a US study concluded that 35.4 per cent of people over the age of 40 had suffered with their balance at some point in their lives.
In scientific terms, these conditions are more commonly referred to as vestibular disorders. The vestibular system refers to a series of structures in your inner ear that provide you with your sense of balance and an awareness of your spatial orientation. Simply put, its job is to consistently judge the precise position of your head during movement.
Almost overnight, my vestibular system had been swiftly replaced – or so it felt – by a dodgy handheld camera. And as is the case with all viral infections, regardless of the form they take, I was told by my GP to ride it out and take it easy (along with anti-sickness tablets for the associated nausea).
Having never experienced anything like this before, I couldn’t relax until I understood the delicate nuances of balance. Symptoms aside, the worst part was the absence of clarity, and, of course, not knowing how long I would have to deal with it. This filled me with stress and anxiety, which, as has been well documented, is never a friend of the immune system.
Eventually, through a physio friend, I happened upon Dr Doug Duffy who runs the Balance Centre, a specialised, Dublin-based physiotherapy clinic devoted exclusively to the evaluation and treatment of dizziness and balance problems.
I met Duffy in the hope of shedding light on something that many of us will experience with relatively little information to hand. Was I really best off lying low? Was I stuck with this forever?
Activity levels The Balance Centre
was an eye-opener. Most notably, the key to my recovery lay in movement, the very thing I had avoided.
“Because your vestibular system senses movement, people with vestibular disorders get symptoms with movement and they naturally move less in an effort not to provoke their symptoms,” Duffy says.
“The sudden nature of symptoms often triggers anxiety and can lead to people decreasing their activity levels to the point where they avoid going out on their own or leaving the house. Unfortunately, this prolongs their recovery. In general, people who move around more get better faster and have fewer recurrences.”
Next, I wanted to differentiate between the general feeling of dizziness and vertigo. The latter, according to Duffy, “is a symptom, not a diagnosis. It is the sensation that the world is spinning. But most of the time, when people say ‘vertigo’, what they are talking about is a vestibular disorder. Vestibular disorders are problems with your inner ear and brain that can cause vertigo, imbalance, blurred vision, nausea and disorientation among other things.”
With simple exercises and sophisticated testing methods, Duffy arrived at my diagnosis: acute vestibular neuritis, a viral infection of the inner ear wherein the delicate vestibular structures are compromised and your head can no longer keep up with your body’s movement.
All initial sessions at the Balance Centre will begin with an hour-long evaluation. During this time, Duffy tests for “dynamic visual acuity” in order to assess a person’s vestibular function while, at the same time, computerised dynamic posturography is used to measure various aspects of your balance. The technology employed is highly sophisticated.
All information is gathered and a diagnosis and an individualised exercise programme for each patient is presented.
Common triggers Duffy
says there were many varying vestibular conditions, all of which can yield symptoms of vertigo. The most common condition is benign paroxysmal positional vertigo (BPPV), which is often triggered by specific changes to the position of your head.
Common triggers for this more ongoing condition include lying down in bed or turning over on your side. This is something people can experience on an ongoing basis, but the vertigo subsides within seconds.
Migraines are the next most common vestibular disorder. With an increased awareness of migraine in recent years, the diagnosis of what’s known as vestibular migraine has risen.
Vestibular neuritis – what I had – and labyrinthitis (neuritis with the addition of a ringing in the ear) are the next most common but, for the most part, the virus will have left the body within four to eight weeks.
“The vertigo that you get from viral infections like these can last minutes, hours and sometimes days leading to imbalance, blurred vision, the sensation of things moving and disorientation,” Duffy says.
“The nystagmus [an involuntary eye movement] that you get with this is in a different pattern to BPPV and can be increased with head movement rather than positional movement.”
Viral vestibular conditions are followed by the more serious and chronic Meniere’s disease, in which all of the above can be experienced along with fluctuating hearing loss, sometimes leading to total hearing loss. There is no known cure for Meniere’s disease but vestibular rehabilitation can greatly improve symptoms.
“Lastly, there are also a number of people who experience vestibular disorders following traumatic brain injuries and concussions,” Duffy says.
Best treatment Typically, dizziness and balance problems of various origins increase with age. “Certainly, people with a history of migraine are more susceptible to various vestibular disorders and they are also more common in people with hearing loss,” Duffy says
While anti-dizziness or anti-nausea tablets will often be the first port of call, Duffy says physiotherapy is important.
“People with BPPV respond very quickly to treatment manoeuvres and often need only one or two visits to solve the problem,” he says.
“People with labyrinthitis benefit from specific exercises involving eye movement, head movement and balance exercises. People with migraines or Meniere’s disease may need medication or a combination of medication and physiotherapy. Not everyone with a vestibular disorder requires vestibular rehabilitation, so getting an accurate diagnosis first and foremost is key
Dr Doug Duffy DPT MISCP is the senior physiotherapist at the Royal Victoria Eye and Ear Hospital, Dublin, where he is clinical tutor on vestibular disorders.