Understanding common vestibular pathologies: BPPV, Meniere's disease, vestibular neuritis and vestibular migraine

Vestibular disorders, affecting the inner ear and brain’s ability to process spatial information, can profoundly impact balance and spatial orientation.

Four common vestibular pathologies are benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis, and vestibular migraine.

Each presents with unique symptoms and requires distinct diagnostic approaches and treatments.

Benign paroxysmal positional vertigo (BPPV)

BPPV is characterised by brief, intense episodes of vertigo triggered by changes in head position.

This condition arises from tiny calcium carbonate crystals, or otoconia, becoming dislodged from their usual location in the utricle of the inner ear and migrating to the semi-circular canals.

The result is abnormal stimulation of the vestibular system.

Symptoms typically include vertigo when tilting the head or lying down.

Treatment often involves repositioning manoeuvres, like the Epley manoeuvre, designed to move the crystals back to their proper location.

Meniere’s disease

Meniere’s disease is a chronic condition marked by episodes of vertigo, fluctuating hearing loss, tinnitus (ringing in the ears), and a sensation of fullness in the ear.

The exact cause is unknown, but it is thought to involve fluid build-up in the inner ear.

This build-up affects the inner ear’s ability to maintain balance and process sound.

Management focuses on reducing symptoms and may include dietary changes (low salt intake to manage fluid levels), medications, and in some cases, surgery.

Vestibular neuritis

Vestibular neuritis involves inflammation of the vestibular nerve, usually due to a viral infection.

It typically presents as a sudden onset of severe vertigo, nausea, and imbalance, without hearing loss.

Unlike BPPV or Meniere’s disease, vestibular neuritis does not affect hearing.

Treatment often includes corticosteroids to reduce inflammation and vestibular rehabilitation therapy to help the brain compensate for the loss of vestibular input.

Vestibular migraine

Vestibular migraine is characterised by episodes of vertigo associated with migraine headaches, though some individuals may experience vertigo without a headache.

It can occur with or without typical migraine symptoms like auras or sensitivity to light and sound.

The vertigo can last from minutes to days and is often accompanied by nausea, imbalance, and motion sensitivity.

Treatment typically involves migraine management strategies, including medications and lifestyle changes to reduce migraine triggers.

Takeaway

Accurate diagnosis and effective management of vestibular disorders rely on a thorough assessment by a healthcare professional specialising in vestibular medicine or otolaryngology.

Understanding these conditions and their distinct characteristics can significantly improve the quality of life for those affected.

Seth Corwin
Physiotherapist