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Types of Peripheral Vestibular Disorders

According to the Vestibular Disorders Association (VEDA), the peripheral vestibular system is responsible for relaying information about head positioning to the brain and is a critical component of the body's ability to maintain balance. If there is a dysfunction of the peripheral vestibular system, you can develop dizziness, vertigo, a sensation of "lopsidedness," clumsiness, vertigo, hearing loss and visual problems. There are several types of peripheral vestibular disorders---such as benign paroxysmal positional vertigo (BPPV), Ménière's disease and perilymph fistula---which makes it more challenging to correctly diagnose patients displaying symptoms.

  1. Benign Paroxysmal Positional Vertigo (BPPV)

    • Benign paroxysmal positional vertigo (BPPV) is caused by an accumulation of debris, composed of calcium carbonate, in the inner ear. The tiny crystals of calcium carbonate are called ocotonia, or sometimes "ear rocks." According to VEDA, BPPV causes about 20 percent of all cases of dizziness. BPPV is triggered or aggravated by moving your head, such as when rolling over in bed. Many times, no cause for BPPV is discovered. Particle-repositioning maneuvers that dislodge ocotonia are often an effective treatment, along with vestibular physical therapy exercises to remind your brain how to maintain balance.

    Ménière's Disease

    • When the inner ear accumulates excessively large amounts of fluid, called endolymph, it can result in Ménière's disease. Ménière's causes many of the same symptoms as other peripheral vestibular disorders, including nausea, tinnitus and dizziness. Extreme vertigo is a common feature of the disease, and attacks can last up to 24 hours, according to VEDA. Hearing loss is also common with Ménière's, and the severity increases as the disease progresses. According to Dr. Gerald Gianoli, M.D., Ménière's tends to become chronically present after 10 to 15 years of flare-ups. Treatment includes eating a low-sodium diet, medications for the side effects and diuretics to help clear away excess fluid. Up to 40 percent of patients fail to respond to diet and medication, and a surgical or chemical labyrinthectomy to destroy the affected vestibular nerve is sometimes warranted.

    Perilymph Fistula

    • Perilymph fistula is caused by a tear in the delicate membrane separating the middle and inner ear. A "heavy" feeling in the ear, or ringing, along with intermittent hearing loss, are common symptoms of perilymph fistula. Changes in altitude often worsen the symptoms. According to VEDA, head injuries cause most cases of perilymph fistula, though scuba diving, weightlifting and childbirth can also cause intracranial pressure that leads to a fistula. Typical treatment is strict bed rest to allow the fistula to heal. If the fistula persists, or if there is progressive hearing loss, your physician might recommend surgery to close the tear.

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