Your inner ear contains the vestibular system, a complex structure that works together with your eyes and sensation in your lower limbs to keep you balanced and your vision clear when you are up moving about. If one of those systems isn’t working properly it can cause problems with your balance.

UPV occurs when the balance system in one of your inner ears (also known as the vestibular system) is not working properly. We have 2 balance systems (one in each ear) and they normally work together. When one fails to work properly it can lead to a variety of symptoms such as dizziness, nausea and imbalance.<

UPV can be caused by a variety of conditions;

• >A viral infection of the inner ear balance is called vestibular neuritis. When it also affects hearing, it is called labyrinthitis. This usually comes on very suddenly and the acute symptoms can last for a few days or weeks. As the brain gradually adjusts the symptoms are expected to get better. However, around 50% of people can experience symptoms for a longer period of time and need physiotherapy to fully recover.
• Occasionally a restriction to the normal flow of blood to the inner ear can cause damage.
• Certain drugs that affect the working of the balance system can cause a weakness on one side.
• Some other vestibular or neurological conditions can affect the functioning of the vestibular system. This is why it is important to see a specialist who can rule out other causes.

Vertigo. The main symptom is usually vertigo which is dizziness that gives a spinning sensation. At the beginning it may be severe enough to cause nausea and vomiting and will be constant. As time passes the dizziness will reduce and is likely to be present only with head movements or when up moving around.

Nausea and vomiting. This usually happens at the onset of other symptoms but the nausea can persist and is usually related to movement of the head.

Decreased balance.  Initially balance can be severely affected and you may have problems walking unaided but as the body begins to recover you may notice that you feel slightly off balance when up walking around or when moving your head

Walking: You may notice some difficulties with walking especially when outside or in busy environments

Blurry vision: You may experience blurred vision when turning your head quickly or moving fast. Others can describe a “catch up feeling” as their vision catches up to their head movement.

In the early days when your symptoms are very severe, your GP may prescribe some medication to suppress the vestibular system and alleviate any nausea.  However, beyond this very early stage, medication has limited benefit and may actually prolong the recovery.

Often, the brain recognises that there is an imbalance in the system and makes adjustments for it over the early stage so that the symptoms resolve.  This is a process called compensation and is most likely to occur if you keep as active as possible despite feeling dizzy.

Unfortunately, some people fail to compensate for the UPV and their symptoms persist.  This is when Vestibular Rehabilitation(VR) can have a positive effect on recovery.  Our aim is to speed up the compensation process by exposing your balance system to many different tasks that bring on your symptoms This stimulates the brain to recognise the problem and adjust appropriately so that your symptoms lessen.

Your physiotherapist will take a comprehensive history and examine your head and eye movements and assess your balance to help establish how well your vestibular system is working with your visual and other sensory systems. Your physio will then devise an exercise programme to help the compensation process and settle your symptoms. Occasionally these exercises may initially flare up your symptoms but this is need to help establish the compensation and is entirely normal.

Exercises that you may be given include the following;

Gaze stability exercises: You will be asked to look at a target ahead of you and move your head side to side or up and down. This helps your eyes and vestibular system to work better and reduce symptoms provoked by head movements

Balance exercises: These are designed to increase your confidence when up on your feet and to improve the over reliance of your vision and feet to help keep you balanced.

Walking exercises: These are generally more challenging and may include walking with head turns, throwing a ball or completing a mental task whilst walking and will help you to feel more balanced when out and about.

Anxiety: Often people with balance problems have anxiety surrounding their symptoms. Usually the exercises boost confidence with balance and walking and anxiety settles by itself but your therapist may offer advice and guidance to help manage these symptoms if this facilitates recovery.

Your therapist will progress you through your programme, making the exercises more challenging as your symptoms settle and your activity increases. This may happen over a few sessions or if symptoms have been present for a long time may require longer to treat.

Vestibular rehabilitation has been proven to be very effective in helping patients with a UPV and most will return to a good quality of life and manage their condition well.