Melanie Cole (Host):  If you’ve ever been dizzy and lost your balance, you know how frightening it can be. It’s very scary, but there is hope. My guest today is Jennifer Ballweg. She’s a physical therapist at Stoughton Hospital. Welcome to the show, Jennifer. Tell us a little bit about vertigo. People suffer from this. It’s frightening. It can come on at any time. But you do vestibular rehabilitation, and this is something that can really help with balance and dizziness. 

Jennifer Ballweg (Guest):  Right. You’re absolutely right. There a lot of people who do suffer from vertigo, dizziness, lightheadedness, and a common cause of that is what we call the vestibular system. The vestibular system is the balance system in the inner ear. Anything that’s involved inside of the ear can change and cause that dizzy symptoms, and there’s a lot of factors in place there that can create these dizzy symptoms. The vestibular system is also connected highly with your vision and the receptors in our joints. So, not always does the dizziness coming from the vestibular system, but it may be coming from your vision or your perception that your feet or your neck or the system is getting that information from that’s causing that dizzy symptoms. So with the vestibular rehabilitation, we take a look at all of this stuff and see what exactly it is that’s causing the dizzy symptoms. The vestibular system in itself, it tells you where you are in regards to linear or an angular accelerometer. It senses rotational movements of the head, it senses linear movements of the head, and it takes all of this information and it puts it in to your system, and it tries to keep everything in an equal balance along with the information that it’s getting from your vision and the receptors in our joints. It takes that information and provides us what we call with gaze stability, which means we can maintain and focus while objects are moving or while we’re moving. So say you’re in a car and you’re travelling along and there’s an object on the side of the road, because you’re moving, you’re still able to focus on that object and keep it in clear vision because of the interaction of the vestibular system. It also helps with our postural stability or our balance and our orientation in space. So again, all of this stuff is kind of coming into a common informational drop-off point, and our system is taking the bits and pieces of that information and providing us with our balance. And if any of that is little bit off, it can cause some dizziness, some lightheadedness some feelings of the vertigo. 

Melanie:  So what exactly do you do to get somebody to work on some of that dizziness and balance? What can they expect if they come to see you for this issue, and how long does it take before they would start to see results?

Jennifer:  Well, a lot of it depends upon what they tell me their symptoms are. So you had mentioned the BPPV, which is Benign Paroxysmal Positional Vertigo, and if patients come in and they tell me they have symptoms of they get dizzy when they roll over in bed, or if they get dizzy when they go from lying in bed to sitting up or turning their head quickly, that’s one of the conditions that we screen for and we test for to see if it is actually the Benign Paroxysmal Positional Vertigo, which means there are particles in your ear canals that are normally stable, and those particles occasionally can drop off into your ear canals. And you have three ear canals on each side. Those particles can drop off into an ear canal and cause this equilibrium feeling, so there’s a dizzy feeling. Because the canals are semicircular, many times we need to rotate the head to test it. And we intentionally bring on symptoms so that we can find out if there is actually a particle in the canal and which canal it is so that we can clear it. So we can actually clear it on the same day that we see a patient in usually one or two visits. With that particular case, the patients is cleared, and they don’t have to come back physical therapy at all. 

Melanie:  No, that’s great if it’s able to really work for somebody. Are there exercises and things? Your best advice, things that they can do at home and not just at the clinic with you. 

Jennifer:  There are exercises that they can do, and many times people have tried to locate these on the Internet. And those exercises that they find on the Internet are absolutely fabulous, but they may take a chance if they do this on their own. Again, there are the three canals in each ear. There’s an anterior or forward one, a horizontal or side one, and a posterior or backwards one. And if you do the exercises for the wrong canal, you can potentially dump the particle into another canal, making your symptoms worse. So, many times I caution people with using the exercises they find on the Internet. And again, they are perfectly legitimate exercises, and there are ones that I do use in the clinic, but we do like to screen first to make sure that we’re doing it for the appropriate canal so that we don’t make your symptoms worse. 

Melanie:  Is this something that can make it go away altogether Jennifer, or does it come back and recur at various points in your life and you just kind of never know?  

Jennifer:  Well, it does come back. So first of all, you have asked if it goes completely away. Yes, it does. So you can be symptom free and not ever have it again, and then there are cases where it will come back. In about 50 percent of the patients we see, it comes back within the first year, but then they do better after that first year. It does happen more frequently in older patients, so over the age of 65 has a tendency to have more of this particle redistribution in the canals. So as we all get older—and it’s not just because someone has a particular medical case or anything; it’s anyone who is getting older—they have a higher chance of having this happen. The reason being is that the particles—their technical name is called an otolift—the otolifts will regenerate every 28 to 30 days, just like your skin cells do. Normally, what they do is they just slough off and get reabsorbed back into the system. Occasionally, one of those particles get dislodged or moved, and it can fall into an ear canal, causing the dizziness. It’s very difficult to predict when this will happen or if it will happen. It’s sort of like the luck of the draw. 

Melanie:  Well that’s a little bit unnerving for people as they want to go to work and drive. So what do you tell your patients, Jennifer, about this ability of it to come back and living their normal quality of life, going to work, driving, these things that can even sort of set if off—you turn your head quickly to look behind you in the car, and all of a sudden you get that sort of vertigo feeling? What do you tell them your best advice about what they should do to get a quality of life and why they should come see you at Stoughton Hospital for their care? 

Jennifer:  Well, their good quality of life, they should keep doing everything that they can do and not be fearful of that happening. So yes, there is a recurrence rate of it happening again, but with the physical therapy and vestibular rehabilitation, we can clear that within one to two visits. We can get them seen, and we can get them back to their normal life. If they happen to turn their head quickly or somehow get that particle into the ear canal, causing the dizziness, basically what I say is if you’re doing something where you’re standing or driving or doing whatever and you’re getting your dizziness, stop and make sure you and everyone else is safe. Generally, with the particles being in the ear canals, the dizziness lasts less than one minute. So basically, if you’re walking, make sure you stop walking, make sure that you can stabilize yourself again, leaning on to something like a wall or sitting down in a chair. If you’re driving, if you can carefully pull over to the side and just wait for the dizziness to resolve, because again, it takes usually under a minute for that dizziness to resolve.  

Melanie:  And what about coming to see you at Stoughton? Tell them what your clinic is like. 

Jennifer:  Well, we are an outpatient physical therapy clinic. We have one in Stoughton, Wisconsin and one in Oregon, Wisconsin, where we do both vestibular rehabilitation at both places. When you come in, we do a formal assessment. We check if it is really the particle in your ear canal or if it is some other type of balance situation or vestibular situation that is going on. We do screening. We assess things like your gaze, speed, your balance, your eye tracking ability, if there happens to be what we call a central disorder or if we need to refer the patient to neurology. Generally, it is something that we can handle in our clinic. Depending upon our evaluation, we go through and find exercises to help with gaze stabilization, if that’s the issue. If it is a BPPV issue, which that’s the particle in the ear canal, then we do do treatment for that and we clear the particle out of the canal. So basically, when the patient comes in, we don’t just look for one thing. We want to make sure that we’re clearing everything that’s happening with the patient. Again, the information that they provide us regarding their symptoms is extremely helpful because it will help guide us in our evaluation. But again, it may not always be just that particle in the ear canal that is causing their dizziness. So doing that full, comprehensive evaluation is very important because we may run into some other issues that the patient is having. For example, just a normal balance issue, they could have medications that are making them feel dizzy. They could have other types of situations, say they have decreased feeling in their feet which is causing their dizzy sensations when they’re trying to walk. So we cover all of that and address our treatments appropriately to the symptoms the patient is having. 

Melanie:  Thank you so much. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.