Los Altos, CA
What are the different types of Vestibular Disorders?
Understanding the different types of Vestibular Disorders and how to best treat them.
Acoustic Neuroma
An acoustic neuroma, also known as a vestibular schwannoma, is a significant yet noncancerous growth that emerges on the protective covering of the vestibulocochlear nerve within the inner ear. This nerve, commonly referred to as the acoustic nerve, plays a crucial role in transmitting both auditory and balance signals to the brain. The progressive enlargement of an acoustic neuroma, exerts pressure on the vestibulocochlear nerve, typically resulting in symptoms such as hearing impairment, tinnitus, and episodes of dizziness or unsteadiness.
Autoimmune Inner Ear Disease
When a virus invades the body, the immune system springs into action to protect it. However, there are instances when the immune system malfunctions and mistakenly identifies the body’s own cells as foreign invaders like viruses or bacteria. Autoimmunity can lead to the immune system attacking various parts of the body, including the ear. When the immune system targets the ear specifically, it is referred to as autoimmune inner ear disease (AIED). The damage and functional deterioration caused by AIED can occur swiftly, with the progression being rapid.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a common problem with the inner ear that can make you feel dizzy and off-balance. It happens when tiny calcium crystals, called otoconia or “ear rocks,” gather in the inner ear. These crystals can get jostled around when you move your head, tricking your brain into thinking you’re moving when you’re not. This leads to feelings of vertigo and dizziness.
Bilateral Vestibular Hypofunction
When both sides of the vestibular system are affected, it becomes challenging to maintain balance, particularly in low-light conditions or on uneven ground. Additionally, the person may experience blurred vision when moving their head. Bilateral vestibular hypofunction or loss can happen due to various underlying issues.
CANVAS Syndrome
CANVAS is an acronym that helps remember a combination of three conditions: cerebellar ataxia, neuropathy, and vestibular areflexia. It is very rare to find patients with all three of these conditions together. CANVAS patients experience problems with coordination (cerebellar ataxia), damage to peripheral nerves (neuropathy), and loss of vestibular function (vestibular areflexia). Each of these conditions individually affects balance, but when they occur together, balance disturbances become more severe.
Cervicogenic Dizziness
Neck pain and dizziness often occur together, but it can be challenging to determine if they are connected or simply coincidental. While true spinning vertigo is uncommon in this syndrome, a more precise term for it is “Cervicogenic dizziness.” However, diagnosing Cervicogenic dizziness can be controversial as there are no specific tests to confirm it as the underlying cause of dizziness.
Cholesteatoma
A cholesteatoma is an abnormal skin growth that develops in the middle ear behind the eardrum. It typically forms as a result of frequent infections and appears as a cyst or pouch that accumulates layers of old skin within the ear. As the cholesteatoma grows, it can damage the fragile bones of the middle ear. This can lead to hearing loss, dizziness, and even facial muscle paralysis.
Concussion & Traumatic Brain Injury (TBI)
Traumatic Brain Injury (TBI) can disrupt or damage the vestibular system, leading to vestibular dysfunction. This can result in symptoms such as dizziness, imbalance, and difficulty with coordination and spatial awareness. Treatment options, including vestibular rehabilitation therapy, aim to improve balance and alleviate these symptoms.
Enlarged Vestibular Aqueduct Syndrome (EVAS)
An enlarged vestibular aqueduct is usually accompanied by an enlargement of the endolymphatic duct and sac, which help maintain the volume and ionic composition of the endolymph necessary for transmitting hearing and nerve signals to the brain. When EVA causes hearing loss or balance symptoms, it is referred to as enlarged vestibular aqueduct syndrome (EVAS).
Labyrinthitis and Vestibular Neuritis
Labyrinthitis and vestibular neuritis are disorders resulting from an infection that inflames the inner ear or the vestibulocochlear nerve (the eighth cranial nerve), which connects the inner ear to the brain. Neuritis (inflammation of the nerve) affects the vestibular branch of the vestibulocochlear nerve, resulting in dizziness or vertigo but no change in hearing. Labyrinthitis (inflammation of the labyrinth) occurs when an infection affects both branches of the nerve, resulting in hearing changes as well as dizziness or vertigo.
Ménière’s Disease
Ménière’s disease is a vestibular disorder that produces a recurring set of symptoms as a result of abnormally large amounts of a fluid called endolymph collecting in the inner ear. The four classic symptoms are vertigo, tinnitus, a feeling of fullness or pressure in the ear, and fluctuating hearing.
Neurotoxicity
Neurotoxic vestibulopathy is a poisoning of neurons in the brain that help control balance. As a result of exposure to a neurotoxin (naturally occurring substance), such as lead, or a neurotoxicant (synthetic substance), such as the anti-malarial drug, mefloquine (a.k.a. Lariam).
Otosclerosis
Otosclerosis is the abnormal growth of bone in the inner ear. This bone prevents structures within the ear from working properly. Hearing loss depends on which structure within the ear is affected. In addition to hearing loss, some people with otosclerosis experience dizziness and balance problems.
Ototoxicity
“ear poisoning” is due to exposure to drugs or chemicals that damage the inner ear. This can also happen to the vestibulocochlear nerve, which sends balance and hearing information from the inner ear to the brain. Ototoxicity can result in temporary or permanent disturbances of hearing, balance, or both. Many chemicals have ototoxic potential
Pediatric Vestibular Disorders
Until recently, most medical professionals assumed that problems with vestibular function primarily affect adults. However, there is growing evidence of vestibular system dysfunction in children, with consequent problems with gaze stability (seeing clearly with head movement), balance ability and/or the development of balance abilities, and dizziness.
Perilymph Fistula
A perilymph fistula is a tear or defect in one of the small, thin membranes that separate the middle ear from the fluid-filled inner ear. When a fistula is present, changes in middle ear pressure will directly affect the inner ear, stimulating the balance and/or hearing structures and causing symptoms.
What is Persistent Postural Perceptual Dizziness (PPPD)?
PPPD – formerly known as Chronic Subjective Dizziness (CSD) – symptoms include non-vertiginous dizziness and unsteadiness that is increased by a person’s own motion, exposure to environments with complex or moving stimuli (e.g., stores, crowds), and performance of tasks that required precise visual focus (e.g., reading, using a computer). PPPV is NOT a psychiatric disorder, but rather a neuro-otologic condition with behavioral elements.
Presbyvestibulopathy (PVP)
Presbyvestibulopathy is a type of vestibular disorder that occurs with aging. PVP may be a cause of such symptoms for many individuals. Studies demonstrate that age-related breakdown of cells in the vestibular system can cause dizziness, imbalance, and other symptoms of PVP. Vestibular rehabilitation (VR) with a physical therapist is the primary treatment approach.
Secondary Endolymphatic Hydrops (SEH)
Secondary endolymphatic hydrops involve abnormalities in the quantity, composition, and pressure of an inner-ear fluid called endolymph, apparently in response to an event or underlying condition such as head trauma or ear surgery. It can occur with other inner ear disorders, allergies, or systemic disorders.
Superior Semicircular Canal Dehiscence
Superior semicircular canal dehiscence syndrome results from an opening (dehiscence) in the bone overlying the superior (uppermost) semicircular canal within the inner ear. With this dehiscence, the fluid in the membranous superior canal (which is located within the tubular cavity of the bony canal) can be displaced by sound and pressure stimuli, creating certain vestibular and/or auditory signs and symptoms.
Vestibular Migraine
Migraine, a disorder usually associated with headache, is extremely common and can cause several vestibular syndromes. Studies suggest that about 25 percent of migraineurs experience dizziness or migraines during attacks. Migraine-associated vertigo (MAV) or vestibular migraine can occur with or without pain.
Vestibular Paroxysmia
Vestibular paroxysmia is an episodic vestibular disorder that usually presents with a high frequency of attacks. It is assumed that vestibular paroxysmia occurs due to compression of the eighth cranial nerve (otherwise known as the vestibulocochlear nerve). This nerve supplies the inner ear (which assists with balance) and the cochlea (the organ of hearing). Diagnosis of this condition is often based on the patient’s symptoms.
Vertebrobasilar Insufficiency
The vertebral and basilar arteries carry blood to the inner ear labyrinth, the vestibulocochlear nerve, and the brainstem. When blood flow through these vessels is restricted for any reason, it is called vertebrobasilar insufficiency. This is a common cause of vertigo in the elderly. Vertigo occurs suddenly without warning and usually lasts for several minutes. It can also be accompanied by nausea, vomiting, headache, and impaired vision.
ABOUT THE AUTHOR
Kim Gladfelter, MPT, OCS, FAAOMPT
Women's Health Physical Therapy Specialist at PhysioFit Physical Therapy & Wellness
Kim Gladfelter is a physical therapist, Pilates instructor, educator, author, and co-founder of PhysioFit Physical Therapy & Wellness. She is known as a keen, well-rounded expert of healing through movement and women’s health specialist in the Silicon Valley area.
Kim has helped men and women of all ages to stay active and feel their best. She also writes about managing pain in her health columns, blogs and the local Los Altos Town Crier newspaper as well as reaches out to the local community, support groups, schools, libraries, and sports centers to advise and educate on body awareness and therapeutic exercise.