Frequently Asked Questions About Balance Disorders
Benign Paroxysmal Positional Vertigo (BPPV)
What is BPPV? Do I have loose ear crystals?
BPPV is an inner ear disorder. It's the most common cause of dizziness (spinning) that occurs with a change of head position. It runs in families and can cause people to fall.
The symptoms of BPPV come on quickly, lasting no longer than 60 seconds (although it seems like they last forever). People usually experience symptoms rolling over in or getting out of bed.
BPPV may affect anyone, but becomes more common in people around the average age of 60. The Dix-Hallpike test can confirm the diagnosis of loose ear crystals and BPPV.
I think that I have BPPV. Who do I need to see to have this problem fixed?
Several types of health care professionals can move the crystals that produce BPPV.
Experts at UPMC's Center for Balance Disorders can help manage and correct your BPPV with the Epley maneuver or particle repositioning maneuver.
In about 15 percent of people, BPPV returns each year. The chance of getting it back increases over time. Your risk of it returning also increases if head trauma caused your BPPV.
Dizziness and Vertigo
What are some common words to describe dizziness?
- Spinning (vertigo)
- Head pressure
Does the word “vertigo” mean something special?
To a health care professional, the specific medical meaning of vertigo describes the sensation that you, or the world around you, are spinning. An inner ear problem is often the cause of vertigo.
Physical Therapy for Treating Balance Disorders
How can physical therapy help to correct a balance problem?
There is evidence that physical therapy intervention can help people who are dizzy or have balance problems.
Eye/head, balance, and walking exercises can improve balance and dizziness problems.
Are all physical therapists able to help with balance and dizziness problems?
What happens at my first visit with a physical therapist that specializes in balance disorders?
The physical therapist will send you some forms to complete prior to your first visit. These forms help shorten the questions therapists will ask you and will serve as a systematic way to make sure they do not forget to ask you important questions.
You should expect to spend one hour with the physical therapist for your first visit.
The physical therapist will ask you questions about:
- How your problem interferes with your life (work, home, leisure, and social activities).
- Certain triggers that make you feel worse and what helps you feel better.
- Any other things from your completed forms to better appreciate and understand your problems.
If you brought results to past balance tests, the physical therapist will review the findings and explain them to you again. The balance test results can help the therapist determine how well you might recover from your balance disorder.
The physical therapist also will ask you the following:
- Have you fallen? If so, did you get hurt or have to see a doctor?
- Do you have weak bones?
- Do you have dizziness when you are not moving?
- Do you hear noises in your ear(s)?
- Do you ever experience any fullness in your ears?
- What is the best and worst your dizziness has been within the last 24 hours?
- Do you “spin” or feel “lightheaded” or “dizzy”?
After learning about your problem, the physical therapist will perform the Dix-Hallpike maneuver — a test to determine if you have any loose calcium carbonate crystals in your ear — and other painless procedures to test:
- Strength and motion
- Eye muscle movement
- Walking and standing balance
- The feeling sensation in your feet
After testing by the physical therapist, what comes next?
The physical therapist will decide the types of exercises that will best help you.
You will do most of the exercises at home since it's more convenient and less costly than frequent visits with the physical therapist. Your therapist will likely give you pictures of the exercises that you need to perform, as it's hard to remember everything from your visit.
He or she will also let you know how often you will need face-to-face visits.
How often will I need to see the physical therapist?
The number of physical therapy visits can range from once every week or two, up to two times a week. The duration of your care could range from one or two total visits up to many months, depending on your problem.
Generally, people with BPPV need fewer visits than do people with inner ear problems and dizziness caused by a brain disorder.
Your therapist will discuss the frequency of visits with you during your first appointment. Follow-up visits last around 45 minutes to one hour.
Why don’t some people improve with physical therapy?
Overall, about 80 percent of people living with balance and dizziness problems have some degree of improvement with physical therapy.
Some health conditions that make it harder to get better include:
- A problem with the brain
- Migraine headaches
- Eye problems as a child, such as crossed eyes
- Obsessive-compulsive disorder or a perfectionistic personality
- An anxiety problem
- Being afraid of falling
- Poor vision or a recent cataract operation
We don’t yet know why, but some people who do everything that the physical therapist prescribes still may not improve.
Recovering from Balance Disorders
Does my age or my gender make a difference in how I recover from a balance or dizziness problem?
No. There is no evidence that age or gender makes any difference in your recovery from a balance or dizziness disorder.
Hard work under the guidance of a health care provider offers the best chance of recovery.
Is there any hope for getting better if I haven't fully recovered after a trial of physical therapy?
Yes. There is hope for you in the future if you have not fully recovered from your dizziness and balance problem.
Researchers, sponsored by the National Institutes of Health, are studying the balance system. We are learning more about balance and dizziness problems every day, so do not lose hope.
What is the difference in prognosis among people who have an inner ear problem, a brain problem, or a problem of both the inner ear and the brain?
People with a problem limited to the inner ear tend to have a very good prognosis. Unfortunately, not all people fully heal from an inner ear problem because of damage to the ear structures.
Dizziness caused by a brain problem is harder to recover from and usually requires more physical therapy visits.
People who have both inner ear and brain problems can improve, but recovery is often less than those who have problems in just one system.