Peripheral vestibular syndrome

Peripheral vestibular syndrome appears during disorder of the vestibular apparatus, which is responsible for perception of the balance and movement of the head. The illnesses, which are manifesting by dizziness, belong usually among these symptoms.


Vestibular disorders are divided according to the location of the problem to peripheral and central vestibular syndrome (vertigo). The problems are forming usually from a disorder of the vestibular nerve, connecting the receptors with vestibular cores in the brainstem. (Central dizziness is then caused by disorders in the brain - vestibular cores, vestibular areas and their connections).


Usually it is caused by insufficient blood supply, which can be connected with general disorders of the bloodstream, but also damage caused by certain drugs (for example antibiotic Streptomycin or acetylsalicylic acid which is richly used in Aspirin), alternatively it can be connected to infections caused by viruses or bacteria. That can lead to disorders of the vestibular system (organ in the inner ear, which secures balance), or to its complete elimination. The cause of peripheral vertigo can lie as well in the brainstem, in some of the nerve of the brain or cerebellum.

Benign paroxysmal positional vertigo occurs very often (the most common type of dizziness). It usually forms during certain movement and head or body positions: it manifests by dizziness with a spinning character, which can last for about 1 minute. It is caused by small crystals of calcium carbonate, which are released from otoliths - structure located in the inner ear in the saccules of the cochlea, and they get stuck in the semicircular canal of the cochlea. There it irritates the sensory receptors, which stops the function of coordination between the vestibular system (which reacts to changes of the position and speed) and sight and touch senses.


CLBolestiHlavyTypical symptom for peripheral vestibular vertigo is rhythmic nystagmus (involuntary eye movement) of horizontal character. There is also a direct rate between the intensity of the nystagmus and intensity of dizziness. The direction of spinning depends on the position of the head.

In case of acute labyrinthitis, the affected person can complain about nausea, sweating, alternatively also vomiting. Sometimes we find by the patients in acute phase, that they tilt their head towards the irritated cochlea.


We start examination with thorough anamnesis, when we are interested the most in the character of the vertigo. Next to general exclusion of other causes - (to see article about Balance disorder / Vertigo), we observe the spinning rotation which is typical for peripheral vertigo. Central vertigo is on the other hand defined by a rather unspecific uncertainty in the surrounding space during movement.
Furthermore we ask patients about how long have they been dealing with vertigo and whether it is just a short while since it occurred (to see article about Benign paroxysmal positional vertigo) or if it’s a permanent condition.
After performing the anamnesis, which should direct us correctly, we continue with clinical examination, where in case of peripheral disorder we trace after symptoms of static or dynamic balance between the right and left vestibular system. With specific tests we examine the nystagmus (involuntary eye movement) and tonic deviations (traction of the body towards one side).


During rehabilitation we take into account whether the stage of the emerged illness is acute - that is uncompensated stage of static dysbalance immediately after the formation of vestibular disorder or stage of compensation - when dynamic dysbalance prevails.
In acute stage it is true that “the worse, the better..”. Patient should get as soon as possible into vertical position/ standing and rehabilitation should be focused on speeding up the spontaneous compensation. We use an approach which dampens the spontaneous nystagmus, when we exercise the sight fixation on a stationary, later on moving objects. We try to improve the stability during standing and walking.
In a stage of compensated vestibular syndrome, we perform exercises to improve the vestibular visual interaction. Patient has a task to fix his eyes during the exercise on one object, and gradually without loosing the visual contact move the head in all kind of directions. The speed of the movement should also gradually increase, and at the same time it is important that the patient has during the exercise sharp view.


If you have problems with vertigo including nystagmus, the cause of your problems will be likely in the crystal - otoliths being “poured” from saccules into semicircular canals of the inner ear. Nystagmus presents involuntary, fast, rhythmical movement of the eyes, appearing during typical head movement, which can occur for example when we place our head on a pillow.
Professionally educated physiotherapist will use special technique during the treatment and “pour” the otoliths back from the semicircular canals back to the saccules to their original place. This process will prevent any further irritation of the hair cells in the semicircular canals.
Even though these physiotherapeutic skills are very easy, unfortunately not many professionals in the physiotherapeutic field knows about them and apply them. It happens often that the clients are treated wrongly, when the vertigo is being diagnosed incorrectly to wrong position of the cervical spine. But at the same time, when the diagnosis is determined correctly, the dizziness can be treated very fast and effectively.

 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience in private practice and physiotherapeutic field, FYZIOklinika

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