Dizziness, balance disorders: the precious help of vestibular physiotherapy

Dizziness, balance disorders: the precious help of vestibular physiotherapy

Dizziness, feeling of dizziness, problems with balance, walking, nausea or even vomiting: all these signs reflect a problem with the vestibular system, provided by our inner ear. When crises repeat themselves and impact daily life, it is necessary to consult. Because although dizziness is often benign, it can be very difficult to bear in the long term, or even reveal a more serious pathology. Vestibular rehabilitation should then be considered. An update with Raynald Angot, masseur-physiotherapist, specialist on the subject.

How does the vestibular system work?

The vestibular system is a peripheral sensory organ. It is essential in all our daily actions because it is responsible for the general balance of our body. Thus, it is associated with sight and the somesthetic system, which each contribute to this balance. These two elements send information to the central nervous system, which adapts based on the information received. “The function of the vestibular system is really to stabilize the eyeunderlines Raynald Angot, masseur-physiotherapist, specialized in vestibular physiotherapy. However, it happens that a dysfunction occurs (whether the head is fixed or moving, the eyes have a jerking movement): in this case, our balance is threatened and this instantly results in a feeling of drowsiness. ‘instability and therefore, dizziness’.

What is vertigo?

Vertigo is a shift in the visual scene, which generates a sensation that everyone knows. We experience it by riding a “roller coaster” type ride or looking from a high point of view (building, cliff, etc.): the world revolves around us while we are perfectly still. But this phenomenon stops quickly, as soon as the activity in question is put to an end. “However, it happens that some people feel this sensation, without any particular situation, and that it lasts for hours, even days. These isolated or repeated crises are difficult to bear because they affect everyday life.notes the specialist.

Vertigo actually gives the illusion that our environment (walls, floors, ceilings, objects) is starting to move. “Most of the time, you feel a circular movement (like on a merry-go-round). It can also resemble a rocking, a feeling of drunkenness, instability (pitching, like in a boat) or a feeling of imminent fall., describes Raynal Angot. The duration and frequency of dizziness vary: from a few seconds to a few hours. It can be a single attack (but which repeats at regular intervals) or crises which repeat themselves day after day.

This dizziness can also be accompanied by other symptoms: nausea, vomiting, sweating, hearing loss, tinnitus, headaches, without discomfort or loss of consciousness. Certain movements (getting up, lying down, turning your head too quickly, etc.) can also trigger their appearance. In any case, all these manifestations, which occur while standing or walking, are a sign of a balance disorder and require consultation with a doctor.

What is the mechanism involved?

From a medical point of view, the feeling of dizziness is the manifestation of an attack on the center of balance of the body, that is to say the vestibular system which is located in the inner ear and which is made up of several sensory organs:

  • The semicircular canals: one is parallel to the ground, the second is parallel to the side of the head, and the third is parallel to the forehead or face. Responsible for the perception of head movements in three dimensions, these three semicircular canals occupy most of the inner ear. Each contains fluid and sensory cilia connected to receptor cells that transmit information to the cerebellum. When tilting the head, the liquid exerts pressure on the sensitive cilia of the receptor cells. Receptor cells transform this pressure into electrical signals that are sent to the brain using nerve impulses. All of these nerve impulses are essential in controlling balance. “In the inner ear, there is also the utricle (vesicle occupying the upper part of the vestibule) and the saccule (vesicle located in the lower part of the vestibule) which have receptor cells.specifies the physiotherapist.
  • The vestibular nerve: it is he who transmits movement information from the semicircular and macular canals to the corresponding cerebral nerve centers. Once this information is received, the brain then commands the body to take the actions necessary to maintain balance (e.g. reflex muscle movements). The vestibular nerve forms with the cochlear nerve the two parts of the cochleovestibular nerve or nerve VIII;
  • Vision and position awareness different parts of the body (called proprioception) also play an important role in balance function.

From a physiological point of view, each ear is made up of three parts:

  • The outer ear (from the pinna to the eardrum);
  • The middle ear (which includes three bones: hammer, stapes anvil and partly, the eustachian tube);
  • And the inner ear. This is divided into two parts: the cochlea and the vestibule. The cochlea is the organ of hearing and the vestibule is one of the sensors of balance (along with proprioception and sight).

Each vestibule is composed of the utricle and the saccule, as well as three semicircular canals). The role of the vestibules is to both stabilize gaze (vestibulo-ocular reflex) and posture (vestibulo-spinal reflex).

What are the signs that show an abnormality in the vestibular system?

Vertigo itself may be associated with other symptoms such as: loss of balance, feelings of dizziness (“head spinning”) difficulty walking, motion sickness, nausea, vomiting, impaired hearing (with or without tinnitus), nystagmus (involuntary and jerky oscillating movement of the eyes caused by a disruption of muscle coordination). We can also experience problems with concentration, memory, disorientation and anxiety when these episodes repeat several times during the day. If this is the case, speak quickly to your doctor or an ENT specialist to identify the cause of the problem. They will be able to redirect you, among other things, to vestibular physiotherapy.

Vestibular syndrome: what are the possible causes of this dizziness?

Different pathologies (traumatic, viral, autoimmune, hormonal, etc.) can impact the vestibular system. The most commonly encountered are:

  • Benign paroxysmal positional vertigo (BPPV): This is a rotational vertigo that occurs when changing head position. The sensation lasts only a few seconds and may be accompanied by nausea or vomiting. It represents 25 to 35% of the causes of rotational vertigo and is found at all ages (from 18 to 90 years old). The cause is the detachment of small crystals from the inner ear (the otoconia) which float inside the tubes of the inner ear (the semicircular canals). This disruption leads to dizziness. Sometimes benign paroxysmal positional vertigo occurs following a minor or severe blow to the head;
  • Functional disorders, like motion sickness, which corresponds to a sensory illusion or “visual addiction”. The cause: a desynchronization of perception between body movements and visual information. The feeling of vertigo comes from the difficulty in finding a fixed reference point that matches the information sent by the inner ear;
  • Hydrops or Ménière’s disease: This pathology comes from excessive accumulation of fluid in the inner ear. Sudden, long and intense attacks of dizziness, progressive loss of hearing, tinnitus, are telltale signs. Ménière’s disease is often linked to viral infections, allergies, head trauma, but also to hereditary factors. This disease must be monitored because it can develop into chronic lesions of the labyrinth, leading to progressive deafness;
  • La labyrinthite : generally caused by bacteria or a virus, this infection causes irritation and swelling of the inner ear. Sudden dizziness or hearing loss are signs that should not be ignored;
  • Acute vestibular deficit (including vestibular neuritis): this is an inflammation of viral or vascular origin of the vestibular nerve connected to the inner ear, i.e. a disorder in the routing of information to the brain. This disorder manifests itself as an intense and violent attack of dizziness which lasts several hours, even several days, before regressing; and is accompanied by nausea and vomiting.

Other pathologies, which will affect the central nervous system (such as stroke) or traumatic (fall on the head leading to a hematoma for example), can lead to the appearance of dizziness., finally notes the specialist. “Certain recurrent vestibulopathies, difficult to identify and poorly labeled, may also be involved. Motion sickness is another reason to seek medical advice.”

The older we get, the more frequent vestibular pathologies are, due to the natural aging of the inner ear: we even talk about…