What is Vestibular Dysfunction?

Have you ever experienced dizziness/vertigo or the room spinning when you rolled over in bed, nauseated or too off balance to stand or get out of bed? Or, have you ever been stopped at a stoplight and noticed out of the corner of your eye, the car next to you was moving so you stomped on your brakes because you thought your car was moving only to realize you were not? These are misperceptions of motion, symptoms possibly of a dysfunctional vestibular system.

Dizziness and balance deficits are the primary symptoms of vestibular dysfunction, but other symptoms can include muscle tension, headache, decrease range of motion, and/or weakness.

Click the headings below to learn more about vestibular dysfunction and vestibular rehabilitation.

What are the Facts about Vestibular Dysfunction?
  • Dizziness/imbalance is the #1 reason for someone over 65 to consult a physician.
  • 42% of the population will complain of dizziness/imbalance at least once in their lifetime.
  • 38% of people less than 65 years of age have vestibular pathology as the cause of their dizziness complaints.
  • Dizziness/imbalance is secondary only to headache in prevalence of the complaint.
  • Dizziness is a common adverse effect of most medications.
  • Incidence of vestibular dysfunction increases 50-60% with age.
  • There is a strong correlation of vestibular dysfunction to incidence of falling.
  • The relationship of loss of vestibular function to fall incidence is dependent on age and if the loss is bilateral (both sides) or unilateral (one side).


Fall Incidence

Under 65 with bilateral vestibular dysfunction


Under 65 with unilateral vestibular dysfunction


65-74 with bilateral vestibular dysfunction


65-74 with unilateral vestibular dysfunction


Over 75 with bilateral vestibular dysfunction


Over 75 with unilateral vestibular dysfunction


  • People with benign paroxysmal positional vertigo (BPPV) can have balance dysfunction and are at risk for falls 3 months following successful treatment of dizziness.
What is the Vestibular System?

It is divided into 3 parts:

  • Your inner ears which house the sensory organs that detect motion (see diagram 1) is the peripheral vestibular system,
  • Your brainstem and cerebellum, the central processing system that transmits the information,
  • To your eyes, trunk and limbs (somatosensory) to generate compensatory movement for posture and locomotion.

Integration of all three parts is necessary for normal function.

The ear is a sensory organ comprising the auditory system, involved with the detection of sound and the vestibular system, which plays a major role in the sense of balance and body position. Ears are located symmetrically on opposite sides of the face to aid in the ability to localize sound sources. The ear is divided anatomically and functionally into three regions: the outer (external) ear, middle ear and inner ear. Click the numbers and labels in the above diagram to learn more about the ear.

What Causes Vestibular Dysfunction?
  • Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness originating in the peripheral vestibular system. One theory is that loose particles, "otoconia" are displaced. The receptors in the canals, which normally are sensitive to changes in rotational movement, become sensitive to gravity causing the sensation of dizziness/vertigo.
    • Can result following post surgical procedures, head trauma, whiplash, vestibular neuritis, or the cause can be idiopathic (unknown).
    • It can be unilateral (one side) or bilateral (both sides). Women tend to be affected by BPPV 2.3 times more often than men if idiopathic.
    • It is more common over the age of 40 and is rare in people under 20.
    • Peak incidence of onset is in the 5-6th decades of life.
  • Labyrinthitis- ear disorder that involves irritation and swelling of the inner ear.
  • Vestibular neuritis - ear disorder that involves irritation and swelling of the inner ear. 2nd most common cause of vertigo, targeting adults between the ages of 20-60.
  • Neuromas
  • Drug toxicity that causes direct damage to the vestibular nerve, laybryinth, or hair cells within the inner ear
  • Vascular disorders such as stroke, brain trauma, tumors of the brainstem or cerebellum, or multiple sclerosis. Longer rehabilitation/slower progress should be expected.
  • Dizziness due to altered proprioceptive input from the upper neck can also cause dizziness.
  • Meniere's Disease is a vestibular system "plumbing problem" causing abnormal inner ear fluid dynamics.
    • Symptoms include recurrent spontaneous spells of intense vertigo (dizziness) lasting usually minutes to hours accompanied by roaring tinnitus (ringing in the ears), ear fullness and hearing loss.
    • It occurs most commonly in 30-60 year olds, women greater than men.
    • The fluctuating nature of this type of vestibular dysfunction makes it less amenable to vestibular rehabilitation.
  • Perilymphatic fistulas are characterized by pressure changes within the inner ear resulting in hearing loss and dizziness. This condition is not amenable to vestibular rehabilitation.
I think I am experiencing vestibular dysfunction, what should I do?

There are a multitude of neurological, cardiovascular, metabolic or psychological conditions that can affect the vestibular system so it is important to see your physician if you are experiencing symptoms of dizziness or loss of balance. Ask your doctor whether vestibular rehabilitation through physical therapy is appropriate for you.

What is Vestibular Rehabilitation?

Vestibular Rehabilitation is a comprehensive assessment and exercise-based approach to manage dizziness and balance disorders. The goal of vestibular rehabilitation is to "retrain" the brain to more effectively process sensory information to improve balance and postural stability.

Vestibular rehabilitation was developed during the 1940s when Dr. Cawthorne and Dr. Cooksey devised a treatment program for an emerging population struck with "giddiness". Dix and Hallpike (also physicians) developed their procedure in 1952. The research has continued to grow with new treatment interventions and testing. Treatments used at Body Awareness Physical Therapy have been widely documented and are well known within the medical community. 

How does Body Awareness Physical Therapy determine proper treatment for vestibular dysfunction?

A comprehensive evaluation that compares history, symptoms and results of specific tests will be performed by your physical therapist to differentiate the cause of dizziness and be treated in most cases with high success. Your physical therapist will then develop an individualized program to meet your needs.

What kind of physical therapy treatments are used in Vestibular Rehabilitation?
  • Particle repositioning: Through a series of positional changes known as a canalith repositioning procedure (CRP), the floating debris or particles are moved from the semicircular canal to the utricle where it no longer causes symptoms. 
  • Gaze stabilization training: Adaptation exercises to retrain the vestibular ocular (eye) reflex so that the speed of eye movement matches the speed of head movements.
  • Customized habituation training may be used when a person has abnormal motion sensitivity which are reduced with repetitive exposure to the symptom causing movement/positions.
  • Balance Retraining
  • Fall Prevention and Recovery
  • Posture Re-Education
  • Address Secondary Symptoms such as neck range of motion limitations due to soft tissue or joint restrictions

Jane Galusha, PT is our Vestibular Rehabilitation Specialist at Body Awareness. She has extensive knowledge in the area of vestibular dysfunction and rehabilitation. Her manual therapy background in orthopedics allows her to treat the whole body for the best results in obtaining optimal function. Click here to read her biography in our staff section.