BPPV is caused by the displacement of otoliths in the inner ear and is characterised by brief episodes of intense dizziness, triggered by changes in head position, such as turning over in bed or getting up quickly, hanging out clothes, or picking up an object from the floor. Vestibular neuritis is an acute inflammation of the vestibular nerve, which can cause intense vertigo, nausea, and vomiting for a few days. There are also more complex situations that require additional study and more in-depth monitoring, such as Ménière's disease (classically, patients present deafness, vertigo, and tinnitus) and other conditions falling within the domain of other specialties, such as vestibular migraine, for example.

In the treatment of vertigo and balance disorders, vestibular rehabilitation is essential. It involves a multidisciplinary approach with the articulation of the ENT specialty with Physiatry and Physiotherapists. The goal is to rehabilitate the function of the inner ear and balance system and improve spatial orientation of the body. This includes a wide variety of exercises, from the simplest to the most complex and specific technology, to help improve the patient's ability to deal with symptoms and compensate for the absence of a certain function, which must be detected in exams performed beforehand.

This helps the patient understand their condition, recognise symptoms, and master techniques that significantly improve their quality of life. In some cases, such as BPPV, patients can recover quickly and effectively after a correct diagnosis, where manoeuvres are performed to “replace the inner ear crystals in their usual location”.

The approach to vestibular rehabilitation varies according to the specific needs of each patient. After a detailed assessment of the patient's clinical condition and symptoms, a personalised rehabilitation plan can be developed, including head and body movement exercises, visual stabilisation techniques, at home or clinical physiotherapy sessions, and specific rehabilitation instruments. The goal is to help the patient readapt to balance and compromised vestibular function, reducing vertigo symptoms and improving their quality of life.

It is important to remember that a vertigo/dizziness/imbalance attack may or may not be caused by an ear problem; they can also be urgent neurological situations. Differential diagnosis with appropriate complementary exams is crucial, such as videonystagmography, video head impulse test, vestibular evoked potentials, and computerised dynamic posturography. This allows us to analyse each patient in detail, work closely with physiotherapists specialising in vestibular rehabilitation, and observe the patients' improvement. An accurate diagnosis is essential for effective treatment, helping the person regain balance and quality of life, and in many cases, maintain functioning, as in the case of chronic dysfunctions.

by Dr. João Filipe Simões, Otorhinolaryngologist at HPA – Alvor & Gambelas

For more information please contact Grupo HPA Saude on (+351) 282 420 400.