Vestibular Clinic

BPPV is the most common form of dizziness. The condition occurs when small crystals of calcium carbonate, known as otoliths or canaliths, are dislodged and migrate to the semi-circular canals within the inner ear. This causes episodes of vertigo which is a false sensation of spinning. BPPV is considered "benign" because it is not a life-threatening condition, and "paroxysmal" because the symptoms typically occur suddenly and can be episodic. While BPPV is more common in older adults, it can affect anyone at any age.

The most common and characteristic symptoms of BPPV include:

• Vertigo: usually experienced as an intense spinning or whirling sensation.


• Imbalance or unsteadiness: most common during or immediately after vertigo episodes.


• Nausea: some people may experience nausea or a general feeling of discomfort during or after a vertigo episode.


• Blurred Vision: temporary blurred vision may also occur alongside episodes of vertigo.


• Difficulty Focusing: some people can also find it challenging to maintain their focus on objects.


• Headaches and neck tension: it is not uncommon to experience a reduced range of motion or pain in the neck which may be accompanied by a headache.


• Nystagmus: rapid, involuntary eye movements.

BPPV is also often linked with changes in head position, such as rolling over in bed, tilting the head back, looking up, or from making quick head movements. The positive news is that it is a treatable condition, and with proper diagnosis and canalith repositioning manoeuvres, the symptoms can often be effectively managed or resolved.

Vestibular hypofunction is a type of balance disorder that occurs when part of the balance system, located in the inner ear, is not working properly. The condition can be considered as unilateral which means it occurs on one side, or bilateral, meaning it is present on both sides – or in both ears. It can cause any of the following symptoms:

• A persistent feeling of dizziness or unsteadiness.


• Vertigo: or the sensation of spinning or whirling, may occur, particularly with certain head movements.


• Difficulty maintaining balance, especially when walking or standing.


• Some people may experience nausea and, in severe cases, vomiting, particularly during episodes of vertigo.


• Problems with gaze stability, keeping the eyes focused on a target while moving your head.


• Increased sensitivity to motion, leading to discomfort in certain environments (e.g., crowded spaces, or when travelling in a car.)

Vestibular hypofunction can be caused by several factors and treatment will be tailored to each individual after a thorough assessment.

Labyrinthitis is a condition characterised by inflammation of the labyrinth, a part of the inner ear responsible for balance and hearing. The inner ear contains the cochlea, which is involved in hearing, and the vestibular system, which contributes to balance and spatial orientation. When the labyrinth becomes inflamed, it can disrupt normal functioning, leading to symptoms such as:

• Vertigo, a sensation of spinning or whirling.


• Dizziness, light-headedness or unsteadiness.


• Nausea and vomiting


• Hearing impairment


• Tinnitus, a ringing or buzzing sound in the ear.


• Ear pain or discomfort in the affected ear.

With appropriate treatment, labyrinthitis usually clears within a few weeks.

Our vestibular physiotherapist, a specialised physiotherapist who focuses on the assessment and treatment of individuals with vestibular system disorder, will perform a thorough evaluation. This will include:

1. Assessment and Evaluation:

The physiotherapist will begin by gathering information about your medical history, including any current or past issues related to dizziness, vertigo, balance problems, or ear-related conditions.

2. Symptom Assessment:

You will be asked to describe your symptoms, including the frequency, duration, and triggers of dizziness or imbalance.

3. Functional Evaluation:

The physiotherapist will assess your functional abilities, including your ability to walk, stand, turn, and perform other daily activities that may be affected by vestibular dysfunction.

4. Eye and Head Movement Testing:

May be performed to assess your vestibulo-ocular reflex, cervico-ocular reflex, optokinetic reflex and other signs of vestibular dysfunction.

5. Canalith Repositioning Manoeuvres:

Specific Manoeuvres: For certain vestibular conditions, such as benign paroxysmal positional vertigo (BPPV), canalith repositioning manoeuvres may be used. This involves a series of head and body movements to reposition displaced inner ear crystals (otoconia) and alleviate vertigo.

6. Development of a Customised Treatment Plan:

Based on the outcome of the assessment, the physiotherapist will design a customised exercise program to address your specific vestibular issues. These exercises are aimed at reducing dizziness, promoting gaze stability and improving balance.

In some cases, vestibular physiotherapy exercises may initially provoke or worsen your symptoms. This is known as "exacerbation" and is completely normal. This temporary increase in symptoms is often part of the therapeutic process, and in the long run, vestibular physiotherapy is intended to alleviate symptoms and improve overall function.

7. Education:

Knowledge is power! To help you better understand the cause of your condition and the symptoms you are experiencing, your physiotherapist will explain how the vestibular system works and its role in balance. This will help you understand any potential triggers that may impact your condition and give you strategies to cope with and manage these triggers in your day-to-day life.

8. Follow-Up and Progress Monitoring:

Depending on the severity of your symptoms and individual needs, you will have follow-up appointments to monitor progress, adjust exercises if necessary, and address any new or lingering concerns. You will also be given a home exercise program to continue your exercises between appointments.

9. Lifestyle Recommendations:

For some people, dietary recommendations or lifestyle modifications may also be suggested, especially if certain factors, such as caffeine or dehydration, contribute to symptoms.

As with all our physiotherapy treatments, we adopt a patient-centred approach. Your treatment plan will be uniquely tailored to address your specific needs with the overall goal of addressing and improving vestibular function, reducing symptoms, and enhancing your quality of life.