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Correct diagnosis is half the cure.
To make the correct diagnosis the clinician will need dizziness specific information from the patients. The aim of the "Know Your Dizziness-KnowledgeBase" section is to provide some basic information on dizziness and vertigo to equip the patients/family for their consultation with the clinician.
Balance control is a complex mechanism achieved by interactions between peripheral (sensory) and central (brain) structures.
Peripherally, vision, proprioception and vestibular (Inner ear) systems contribute to balance control. Centrally, structures within the brainstem, cerebellum and several other brain areas are involved in processing the balance signals.
The multi-sensory balance signals help achieve balance control out puts such as spatial orientation, gaze stability and postural stability. The vestibular system is exclusively responsible for sensing static position and dynamic movements of the head.
The vestibular system is located within the labyrinth/ inner ear along with the hearing apparatus. The vestibular system has a vestibule and 3 semicircular canals. Both the vestibule and semicircular canals have movement sensing jelly-like structures; however, Otoconia, the calcium carbonate crystals are present only within the vestibule, making the vestibule sensitive to gravity. Endolymph circulates within the vestibular system.
The vestibular nerve carries head position/ movement-related signals from the SCC and vestibule to the brainstem and cerebellum. The vestibular system receives its blood supply from the arteries that supply the above brain structures.
Dizziness is a non-specific term used to describe a range of sensations. It can mean a range of different descriptions. However, the clinicians will categorise the descriptions into one of the following subtypes.
While some descriptions are meaningful and easy to comprehend others can be confusing and difficult to describe. Do not worry/ do not spend too much time describing the type of dizziness. To diagnose the underlying condition cause(s) of dizziness other characteristics are more helpful than the type of dizziness. Please pay more attention to the following
Dizziness/vertigo is not a condition it is merely a symptom of an underlying condition. The causes of dizziness/vertigo can range from trivial causes such as feeling dizzy when we stand up quickly after sitting for a while to life-threatening conditions such as stroke and brain tumour. Fortunately, the most commonly occurring dizziness are due to benign conditions such as BPPV, Vestibular migraine, age-related multi-sensory balance issues and PPPD.
The vestibular-specific examination is helpful to diagnose most of the common vestibular disorders. Except in rare cases such as stroke and brain tumours, investigations such as MRI, CT scan and blood tests are not helpful to diagnose dizziness
Vestibular rehabilitation (VRT) is a specialised form of therapy intended to alleviate both the primary and secondary problems due to vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, reduce gaze instability, and/or reduce imbalance and fall risk as well as address any secondary impairments that are a consequence of the vestibular disorder (VeDA)
When it comes to the treatment of vestibular disorders “One-Size-Fits-All” will not work as each conditions will require specific treatments. Treatment needs to be customised and patient-centred.
Below are some condition-specific treatments
BPPV- Posterior canal- Canalithiasis- Epley manoeuvre
BPPV- Posterior canal- Cupulolithiasis- Semont liberatory manoeuvre
BPPV- Lateral canal- 360° BBQ roll
BPPV- Anterior canal - Deep Head Hanging Manoeuvre
Vestibular Hypofunction - VOR Adaptation
Bilateral Vestibular Hypofunction - Slow VOR, COR Substitution
PPPD- Customised VRT
Poor sensory integration - Customised balance exercises
Vestibular migraine - Customised VRT, Food & lifestyle modification
Risk of falls- Customised balance exercises
Medication therapy for dizziness
Harmful effect of vestibular medication
Long term use of vestibular medication can potentially ….
Vestibular Physiotherapy for dizziness
References