The vestibular system is the very first system to develop during embryological development. Because of this, the vestibular system plays an important functional role into almost every area of the brain and nervous system. It is a very complex and multifactorial system.
The feeling of dizziness can be sudden or more chronic, both are debilitating. Patients will often describe their dizziness experience as being off balance, spinning, lightheaded, unsteady, or anxious.
What is vertigo?
We have all heard of the term “vertigo.” Vertigo is the descriptive word for the sensation of spinning. This can manifest two ways:
- Egocentric, meaning you feel you are spinning
- Ecocentric, the world is moving
On the other hand, when the term “dizziness” is used, this can include the sensation of being off-balance, lightheaded, unsteady, anxious, the feeling of being on a boat, etc.
What does this mean? It means that when someone is experiencing vertigo, this typically indicates that there is a dysfunction located in the inner ear. When someone is experiencing dizziness, it can be caused by a dysfunction that is located in other areas of the brain. When experiencing dizziness of any kind it is important to understand the difference. Often many patients get diagnosed with vertigo, when they may actually be describing dizziness.
Why is it important to understand the difference? When someone is experiencing true vertigo, the Dix Hallpike test and Epleys Maneuver will be an effective test and treatment for this condition. When someone is dizzy, Epleys maneuver is not effective in this case, this then requires additional tests to uncover the cause of the dizziness.
In the case that someone has experienced vertigo in the past and has had a recurrence of dizziness a few months or years later; this tells us that this is not the same etiology as before. In this case, the Epleys maneuver is not an effective treatment for the new experienced dizziness and there is a new etiology for the dizziness.
What is Dizziness?
Dizziness is described as the sensation of being off-balance, lightheaded, unsteady, anxious, or the feeling of being on a boat. Oftentimes, when dizziness is present, it means that the site of dysfunction is no longer in the periphery (the inner ear). The affected location is either in the central nervous system or has another etiology. With chronic dizziness, it is common for the dysfunction to be located within the balance centers in the brain. Balance is achieved by three systems:
- Input from our inner ear
- Our visual system
- Proprioceptive input from the joints in our body
We only need two of these systems to be functioning optimally to maintain our balance. If any of these systems have dysfunction, in addition to feeling unbalanced and dizzy, it can negatively affect the other areas that are functionally related to these systems.
Additionally, dizziness can be caused by the below conditions:
- Unresolved vertigo
- Spinal stenosis
- Dysfunctional eye movements
- Post-concussion syndrome
- Central nervous system disorders
- Metabolic disorders
- Autonomic dysfunction
When dizziness has been occurring chronically, the brain begins to create maladaptive changes to its other systems in order to compensate and maintain balance and equilibrium. This is a perpetuating cycle that will worsen as the etiology of the dizziness is not addressed.
At CFNC, our approach with each patient allows us to take a comprehensive look at all of the systems involved. This allows us to peer into and examine the peripheral, central, autonomic, metabolic and higher cognitive components of the vestibular system. This allows us to address the areas of dysfunction and create an individualized treatment plan for the patient’s needs. The understanding of the difference between dizziness and vertigo and a proper evaluation of all the systems involved is crucial in uncovering the cause of someone’s dizziness. Once that is uncovered, we then utilize targeted rehabilitation and therapies to help create positive neuroplastic changes to enable healing.