What are the Symptoms of Inner Ear Vestibular Pathology?

• Dizziness/vertigo
• Imbalance/unsteadiness
• Visual motor disturbances/nausea

Because the vestibular system interacts with so many other parts of the nervous system, secondary symptoms of memory problems, muscular stiffness/imbalance/weakness, fatigue, headaches and anxiety may be experienced.

What are some of the Causes of Inner Ear Vertigo and Imbalance?

• Viral/bacterial infections
• Trauma
• Meniere's Disease
• Neuromas
• Ototoxicity
• Vascular ischemia
• Benign positional vertigo

Who would benefit from vestibular rehabilitation and balance retraining?

• Persons suffering from vertigo and imbalance that do not demonstrate a spontaneous resolution of symptoms within 3-4 weeks.

What is involved in the therapy?

• A thorough evaluation process is conducted to determine a comprehensive problem list affecting the person's ability to function. 4 main areas are addressed:

1. Neuromuscular evaluation
2. Visual Motor Assessment - measured by infrared video goggles and visual observation
3. Balance Assessment - measured by standardized tests and a computerized forceplate
4. Vertigo Assessment

• Specific goals for the patient are developed and the exercise/movement program is initiated.

* Vestibular habituation/adaptation exercises:

Specific movements or positions that provoke the patient's dizziness are provided and the patient is asked to repeat these movements until the brain habituates the response or adapts to the conflicting information. This process resolves the conflict between the brain and the ear.

* Visual motor exercises:

The ear nerve has a connection that goes to the eye muscles and can affect the person's ability to maintain their gaze and focus. If dysfunction is identified in this mechanism, visual motor exercises for gaze stabilization and eye-head coordination are included.

* Canalith Repositioning Procedures for Benign Positional Vertigo:

A specific maneuver involves moving the patient's head in a sequence of positions for a certain time period in order to move the "ear rocks" or otoconia around the semicircular canals to reposition them into the proper place in the inner ear. This procedure is 95% effective in eliminating benign positional vertigo in 1-4 visits.

* Balance retraining exercises:

Exercises designed to improve coordination of muscle responses as well as the organization of sensory information from eyes, ears and tactile/muscle receptors for balance control (measured by a computerized forceplate).

* Frequency

Patients are typically seen on an outpatient basis once every 1-2 weeks and provided a specific daily home program that is upgraded as appropriate. This program addresses the specific problems and goals of the individual patient.

* Outcomes of Vestibular Therapy at the Atlanta Ear Clinic

Diagnosis Outcome

• Benign Positional Vertigo 95% (N=10,000 patients)
• Vestibular neuronitis 75% (N=1,500 patients)
• Disequilibrium of Aging 85% (N=500, includes fall reduction)
• Labyrinthine concussion 90% (dizziness) 75% (imbalance)
  (N=400 patients)
• Acoustic neuroma 90% (N=100 patients)
• Ototoxicity 60% (N=45 patients)