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What is the Vestibular System?
The vestibular system is composed of several structures, including the inner ear, located in the periphery. Its main role is to help us perceive the sensations of body movement in space, allowing us to orient ourselves and maintain our balance, even with our eyes closed.
Inside the ear are small canals filled with fluid. When we turn our head, the fluid moves and sends a message to the brain about the direction of the movement. There are also tiny crystals, attached to a gel-like structure, which signal to our brain that our head is moving in a straight line (e.g., getting on and off in an elevator, leaning forward and backward). With this information, the brain can adjust our posture and movements to keep us upright and prevent us from falling.
What is Benign Paroxysmal Positional Vertigo (BPPV)?
The most common vestibular disorder is benign paroxysmal positional vertigo (BPPV). In this condition, the tiny crystals detach from their gel-like structure and become free in the canals of the inner ear. The displacement of the crystals causes a sensation of often intense spinning vertigo during certain head movements (e.g., looking up or down, or turning over in bed).
The vertigo usually lasts less than a minute but may be accompanied by nausea or vomiting depending on its severity. BPPV affects approximately 10% of the population, more frequently women, especially older women. In about 60% of cases, no specific cause is identified.
What is the treatment for BPPV?
Fortunately, vestibular disorders can be treated with physiotherapy. If BPPV is detected during the initial evaluation, specific techniques are used to reposition the crystals to their original location. Using precise head and body movements, this treatment can be taught and practiced at home as self-treatment. In most cases, BPPV can be resolved in just a few sessions!
What is peripheral unilateral hypofunction?
Another possible pathology of the vestibular system is peripheral unilateral hypofunction. This can be caused by an infection affecting the inner ear, such as vestibular neuritis, labyrinthitis, Ménière’s disease, or other conditions. Since the inner ear plays a crucial role in balance, decreased function on one side can create an imbalance in the integration of necessary information. This asymmetry between the two inner ears can lead to various symptoms, including vertigo or dizziness, loss of balance, or blurred vision when the eyes have to process a large amount of moving visual information.
How can physiotherapy help?
Physiotherapy rehabilitation aims to improve the impaired function of the inner ear in order to reduce symptoms. Through visual and habituation exercises, it is possible to lessen symptoms by promoting compensation through other systems (sensory and visual) and by training the vestibular system.
However, rehabilitation for this type of condition is generally longer, as it is important to respect the intensity of symptoms experienced throughout the exercises.
References
Koshi, E. J., & Sutton, A. E. (2025). Benign paroxysmal positional vertigo. In StatPearls [Internet]. StatPearls Publishing. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470308/
Pérez-Vázquez, P., & Franco-Gutiérrez, V. (2017). Treatment of benign paroxysmal positional vertigo: A clinical review. Journal of Otology, 12(4), 165–173. https://doi.org/10.1016/j.joto.2017.08.004
Herdman, S. J. (Ed.). (2007). Vestibular rehabilitation (3rd ed.). F.A. Davis Company. French National Authority for Health (HAS). (2018). Benign paroxysmal positional vertigo:Diagnostic and therapeutic maneuvers. HAS. https://www.hassante.fr/jcms/c_2819896/fr/vertiges-positionnels-paroxystiques-benins-manoeuvresdiagnostiques-et-therapeutiques
Dougherty, J. M., Carney, M., Hohman, M. H., & Emmady, P. D. (2023). Vestibular dysfunction. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558926/
MacDowell, S., Farrell, L., & D’Silva, L. J. (2021). Vestibular rehabilitation in cases of peripheral vestibular hypofunction: CPG patient fact sheet (2022 translated update). Academy of Neurologic Physical Therapy – Vestibular Rehabilitation SIG. https://www.neuropt.org/docs/default-source/default-document-library/cpg-patient-factsheet-(f)-(1).pdf?sfvrsn=6a445b43_0
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