what is a vestibular hypofunction/neuritis?
A vestibular hypofunction is typically caused by a viral or bacterial infection (vestibular neuritis) affecting the vestibular nerve, causing the affected nerve to send a weaker signal than the other side. The discrepancy between the weakened side and the strong side causes dizziness and imbalance.
Essentially, the brain is getting different signals as to where you are in space, causing disorientation.
A vestibular hypofunction can occur from anything that causes damage to the vestibular system. This could be a vestibular neuritis, head injury, tumor resection in that area, meniere’s disease, drugs that are toxic to the vestibular system, and others.
What does vestibular neuritis feel like?
People with vestibular neuritis typically experience a sudden onset of “room spinning” type of vertigo with imbalance. This is often accompanied by nausea and vomiting. This vertigo will be constant for hours, or even a day or two before progressively improving over the course of 1-2 weeks. After the acute phase of constant vertigo, symptoms are often brought on with quick head turns, typically described as “the world catching up” after turning your head. This may also be described as “jumping vision” where you have difficulty keeping your eyes on a target when moving. People may also notice more imbalance as one vestibular system is not sending as strong of a signal as the other side, and the brain has yet to compensate for that change. Imbalance will be most noticeable with quick head turns or with eyes closed. This is because the head turns stimulate the vestibular system, pushing the signal that is weakened to the brain. The brain has difficulty making sense of two different signals that are giving it different information on where you are in space.
If you are noticing more difficulty with your balance in dimly lit areas or when your eyes are closed, this is because you can no longer compensate for a weakened vestibular system by using your vision. After a vestibular dysfunction like a vestibular neuritis, the brain will prioritize information coming from your vision as it cannot trust the information from your vestibular system. This results in difficulty keeping your balance when your vision is removed (eyes closed).
A vestibular hypofunction will also lead to difficulty in spatial orientation and navigating around objects and trunk stability.
Hearing loss with Dizziness?
The cochlear nerve runs right next to the vestibular nerve and with a significant infection, both can be affected, causing vertigo and hearing loss. If this is what you are experiencing, it is important to get to an ENT who specializes in dizziness disorders as soon as possible. Steroids can often be given within the first couple days to reduce the long term effects of dizziness, imbalance, and hearing loss.
Keep in mind that there are other conditions that can present with dizziness and hearing loss including Ménière’s disease, vestibular migraines, CVA, vestibular schwannoma, etc.
What is recovery like with a vestibular hypofunction?
After a vestibular neuritis, some people may recover, but often symptoms of dizziness with turning your head and balance issues with head turns or eyes closed will persist. In these cases the brain is having difficulty compensating or adapting to the change in the signals it is being sent.
I often get asked by my patients, is there a medication to help? The answer is no (unless you are in the first couple of days then possibly steroids), the best prescription for a vestibular hypofunction is vestibular physical therapy!
Vestibular physical therapy focuses on helping your brain integrate all of your sensory information appropriately. Sometimes the brain just needs a little help! Through exercises challenging each of your sensory systems (somatosensory, visual, and vestibular systems), the brain is forced to reorganize how it processes information to become more efficient. The result is you feeling more stable, grounded, and less dizzy!
What exercises are helpful for a vestibular hypofunction?
Fill out the form below to get started with my Go To Vestibular Exercises! You’ll get regular emails with vertigo tips and my exercise PDF dropped into your inbox!
In the beginning, the gaze stabilization or x1 viewing exercise is going to be your best friend! Research shows that you need to do this exercise frequently and often to get the best results. You can learn more about this exercise in my YouTube Video below:
I’ve put together a table to help you determine just how often you need to do this exercise:
|
X1 Viewing/Gaze Stabilization Exercise Frequency and Duration for Vestibular Hypofunction |
||||
|
Diagnosis |
Total Min Per Day |
Sets and Reps |
Times per Day |
# of Weeks |
|
Acute Unilateral Vestibular Hypofunction (less than 3 months) |
12 min a day |
4 sets of 1 minute |
3 |
4-6 |
|
Chronic Unilateral Vestibular Hypofunction (longer than 3 months) |
20 min a day |
3-7 sets of 90 seconds |
3-5 |
4-6 |
|
Bilateral Vestibular Hypofunction |
20-40 min a day |
3-7 sets of 90 seconds |
3-5 |
5-7 |
*unilateral is one side, bilateral means both sides
If you are experiencing a vestibular dysfunction, you may also need to address other impairments that it might lead to. People frequently experience neck pain and stiffness with a vestibular hypofunction.
Why?
People with vertigo or dizziness stop moving their head to feel less dizzy, resulting in neck stiffness and pain. Impairments with the neck can also perpetuate or drive dizziness (cervicogenic dizziness).
Long term consequences of a vestibular hypofunction?
Without treating a vestibular hypofunction with vestibular physical therapy to recover, there is a higher risk of developing sensory integration problems as seen with chronic conditions like Persistent Postural Perceptual Dizziness (3PD). You will get more function back with the vestibular system through vestibular exercises if you do them sooner rather than waiting until it has already become a chronic condition. Risk of falling is higher without treating a vestibular hypofunction, as well as the risk for depression and anxiety, as a vestibular dysfunction can interfere with your ability to participate in your daily activities like showering, dressing, driving, and social activities.
If you need help, find a vestibular physical therapist near you!
