This week is Balance Awareness Week, Sept 12-18th, 2016. Please join me and others in our fight to stop dizziness in its tracks. If you would like to learn more about your specific type of inner ear balance problem, the Vestibular Disorders Association website has very good patient information. Let’s continue working together to defeat dizziness!!!
Recently, I wrote an article about Labyrinthitis, and mentioned that with this type of inner ear problem, when it affects only one ear, the expectation is for full functional recovery. I received some feedback from some frustrated readers who had this problem but did not recover. They felt that I made it seem like everyone gets 100% better, and they were living proof that this is not always the case!
My training tells me that when a patient is not making progress as expected, it is time to stop and reassess what is going on, and why?
First off, could something have been missed? If so, this is the time to readjust the treatment plan to address the issue. If nothing was missed, then why is the patient not improving?
Here is a list of potential reasons that I have seen with patients over the years:
1. The patient is doing their exercises, but they are not doing the exercises correctly.
2. The patient is not compliant with their home exercises. They know how to do the exercises, but for whatever reason they are not doing the exercises, or not doing them as frequently as they were prescribed.
3. The patient is avoiding exercises that cause dizziness or nausea, and therefore the brain cannot learn how to adjust and recover.
4. The patient has many other health problems that are compounding their problem, and causing them not to fully recover.
5. The patient has memory and cognition problems, and has no social support network to help bridge the gap and assist them with their home exercise program.
6. The patient’s exercise program does not address all of the patient’s issues.
7. The patient has not been given the right exercises, or the right exercise progression.
If you are not improving with your vestibular therapy, it’s time to talk to your therapist. I can tell you, the therapist wants you to get better! Sometimes a good review will allow the patient to get back on track with their recovery.
If recovery is not occurring as expected based on your diagnosis, then you need to go to another professional for a second opinion.
Artwork: Reflection, a pastel by Odilon Redon
BPPV is a condition of the inner ear where the crystals in the ear that are supposed to be sitting on top of the nerve fibers become dislodged and start floating in the semi circular canals. When this happens, it can trigger symptoms of vertigo (a spinning sensation), dizziness, or imbalance. Unlike other inner ear symptoms, vertigo caused by BPPV lasts seconds, not for extended minutes, hours or days.
Top 5 Motions that can trigger BPPV listed in no particular order:
1. Vertigo or dizziness when getting in or out of bed.
2. Vertigo or dizziness when rolling over in bed.
3. Vertigo or dizziness when tipping your head back to look overhead.
4. Vertigo or dizziness when bending over.
5. Vertigo or dizziness when moving your head or body quickly.
Motion, 1962 an Abstract Painting by Ernst Wilhelm Nay
Labyrinthitis is a condition that affects the inner ear hearing and balance system. It is caused by an infection to the inner ear that can result in temporary or permanent damage to the inner ear. Symptoms associated with labyrinthitis include complaints of severe and sudden vertigo, dizziness, nausea, imbalance, veering during ambulation, difficulty walking, and sensitivity to head motions. Patients who have had labyrinthitis may be sent to a physical therapist that specializes in treating inner ear problems. This therapy is sometimes referred to as Vestibular Rehabilitation. The therapist is sometimes referred to as a “vestibular therapist”. This therapy is very specialized. Vestibular therapists must go for specialized continuing education after completing their degree and obtaining their license, in order to become competent. My physical therapy practice in Sarasota, Florida specializes in treating people with vestibular inner ear problems.
When it comes to labyrinthitis, the good news is that it is not very common for a labyrinthitis to affect both ears. What does this mean for the brain? It means that the good ear is sending the full amount of information that it always did, but the bad ear is not. Testing by an audiologist can confirm how much information each ear is sending. Patients with labyrinthitis can lose up to 100% of their inner ear balance function, or just a portion. Testing for this is done with video nystagmography (VNG). For there to be considered a clinically significant difference in the two ears, one ear must show a reduced responsiveness to testing of at least 21% to 100%. Even if the bad ear is 100% damaged, with therapy the brain will adjust and learn to depend on the good ear, and whatever amount of information the affected ear is capable of sending. Once the brain recalibrates itself to this difference in information that it is receiving from each ear, the symptoms will stop. The patient will regain their balance, and no longer be dizzy, nauseated, or sensitive to movement. They will be able to turn their head quickly, turn quickly, bend over, walk and look to the side, and basically return to life as normal. For many people, this recovery happens on its own. As the person gets back to life as normal and resumes their normal activities, the brain gradually adjusts. That is why it is really important once you are over the worst of things that you start moving your head again, and become active! The patients that come to see me for physical therapy in Sarasota somehow were unable to make this transition on their own, and need a therapist to guide them in exercises and activities to help them recalibrate their balance system and get back to life as normal. In general, a person suffering from labyrinthitis should get completely better within 8-12 weeks of the proper therapy. If you are having these types of problems, please know that there are treatments that can help!
Clissa Turned Left with her Hand to her Ear, pastel portrait by Mary Cassatt, 1895.
In this self-portrait of Vincent van Gogh, we can look at it and see that he has his right ear bandaged, and without even knowing him, we can surmise that something is wrong with his ear. He has a bandage on his outer ear, and looking at the painting, one can has some empathy for him. But when a person has an inner ear disorder, there is no bandage one can wear that alerts others that we are having a problem. I think it is fair to say that Inner Ear Disorders are “invisible” to others. What do I mean by that? Well, if you had a broken arm, every one would see the cast on your arm, and they could relate to that. I you had a cold, or the flu, even without a bandage, others can understand that because they know what it feels like themselves to have this type of illness. But with inner ear disorders, for those friends and family members who have never had an inner ear balance problem, it can be hard to understand what if feels like to have vertigo, dizziness, or imbalance. Some patients tell me that they feel as though their family doesn’t understand their problem, because they don’t “look” sick.
For the person with the inner ear problem, this can add to their stress and sometimes cause added depression. Hang in there!!! If it is possible (and you want them to), having a spouse, grown child, or your best friend come with you to your doctor or physical therapy sessions can help that person better understand your condition, and in so doing, be better able to offer you the empathy, support, and understanding you could use. I have also had physical therapy patients in Sarasota, Florida who did not have this support network. They may live alone, or have no children or friends near by. This is not uncommon here, where many people come only for the winter months to escape the cold northern winters. Some of these individuals decided to take the bull by the horns, and go and see a psychologist who helped them learn better coping skills that they could apply on their own. I really admired these patients and their commitment to do whatever it takes to help themselves learn ways to better deal with their “invisible disease”. Whatever the case, don’t be afraid to ask those around you for help. We all need a helping hand at some point in our lives...
Painting by Vincent van Gogh, Self Portrait with Bandaged Ear, 1889