Exercise Therapy Can Help Dizziness From Inner-Ear Ills

By MELINDA HENNEBERGER

Published: January 26, 1994

JEFFREY LEVIN was on a commuter train to Manhattan one morning in May 1992 when he suddenly felt unsteady and lightheaded, he said, as if "my head was in a bowl of Jell-O." Doctors told him the dizziness would probably pass, but Mr. Levin only felt worse as the weeks went by.

He began to have trouble negotiating the busy floor of the futures exchange, where he was the chief economist. He found it increasingly hard to concentrate in meetings and began to have memory problems, sometimes calling colleagues into his office and then forgetting why he had asked to see them.

"It was scary," said Mr. Levin, 44, who lives in Montclair, N.J. "I was afraid I was getting Alzheimer's."

Fortunately, it was not Alzheimer's disease. Mr. Levin later learned that his dizziness and memory problems were the result of an inner-ear disorder, possibly caused by a virus after a bad cold.

A Common Problem

Nearly 90 million Americans, or more than one-third of the population, report bouts of dizziness at some point in their lives, according to studies from the National Institutes of Health. Of those, 76 million suffer from inner-ear disorders, which can be caused by whiplash, blows to the head, viral infections, high doses of certain antibiotics, strokes or degeneration of the inner ear's balance function, also known as the vestibular system, which often deteriorates with age.

Because inner-ear problems cause such diverse symptoms as vertigo, nausea and blurred vision, many who suffer from the disorders spend years going from doctor to doctor, only to have their symptoms misdiagnosed as sinus, eye, neurological or psychological problems.

But Mr. Levin found help after a few months, when he was referred to New York University Medical Center/Rusk Institute's Vestibular Rehabilitation Program, which treats inner-ear problems with a relatively new form of physical therapy, vestibular rehabilitation. And after 15 months at Rusk, Mr. Levin "graduated," symptom-free, this month.

Studies show that 85 percent of patients with inner-ear problems get at least partial relief from vestibular rehabilitation, and 30 percent recover completely.

"We see people who've been dizzy for 20 years but there was never any help for them before," said Tara Denham, a physical therapist who runs the Rusk program. "I've never seen any patient who hasn't been to at least two physicians, and the average is five, because no one can pinpoint what's wrong with these people."

"The patients themselves have no idea what's wrong," said Jerry Underwood, managing director of the Vestibular Disorders Association in Portland, Ore. "When they get dizzy they don't necessarily associate it with the inner ear."

About 50 vestibular rehabilitation centers have opened around the country in recent years, said Dr. Ronald A. Hoffman, a specialist in otology and neurotology who helped develop Rusk's program in 1989.

Exercises Are Developed

The approach is based on research dating from the 1940's, which has been adopted and adapted by physical therapists only over the last decade. The therapy is rapidly gaining recognition now, as the country's population ages, in part because dizziness is a major problem for the elderly, said Dr. Anne Shumway-Cook, a physical therapist in Seattle who helped pioneer many of the exercises used in the new rehabilitation programs.

Balance is actually a complicated function, maintained by signals the brain receives from the eyes, muscles and joints and from the inner ear, which contains semicircular canals filled with moving fluid. Head movements stimulate the inner ear by moving the fluid through the canals, thus sending messages to the brain about the position of the head and the body.

When the inner ear sends the brain incorrect information, or conflicting signals, the person feels dizzy. The usual response is to limit movement so as to minimize the rocking or spinning sensations.

The therapy is based on the concept that the very movements that make the patient dizzy can eventually relieve the symptoms through repetition. By repeatedly bombarding the brain with the incorrect messages, the brain is ultimately forced to adapt, accepting and reinterpreting the faulty signals as correct. When that happens, the symptoms subside.

The treatment is a home-exercise program custom-designed for each patient; it includes habituation exercises, like jumping, sitting up and lying down rapidly and turning in circles. The exercises are so simple that many patients are skeptical at first that they can work.

Along with the habituation exercises, vestibular rehabilitation patients are given eye exercises that retrain the vestibular ocular reflex, an adjustment controlled by the inner ear that allows the eye to keep the field of vision steady as a person moves. The eye exercises, in which patients repeatedly move their heads from side to side or up and down while focusing on a specific target, like a letter taped to the wall, help patients steady their gaze.

Finally, patients do balance retraining exercises, standing on a thick piece of foam rubber with eyes closed, for example, and forcing the brain to rely on information from the inner ear rather than messages from the eyes and the feet.

"In the vast majority of cases of chronic balance disorders, the physical damage in the inner ear is permanent, but the effects don't have to be because of the compensation process," said Dr. Neil T. Shepard, of the Vestibular Testing Center at the University of Michigan Medical School.

The attendant problems of concentration, memory loss and fatigue, which can often accompany inner-ear problems, actually develop because the brain is working so hard simply to keep the body upright that other brain functions are compromised. These symptoms naturally disappear along with the dizziness.

One inner-ear problem, benign positional paroxysmal vertigo, can be relieved in a single session. This problem is caused by free-floating calcium "crystals" that irritate the inner ear after being knocked out of place by a blow to the head. In treating such cases, the therapist moves the patient's head in a way that causes the crystals to adhere to the inner ear.

Need for Monitoring

Most inner-ear disorders, though, require anywhere from 6 weeks to 18 months of physical therapy, with exercises performed once or twice a day at home and once or twice a week in therapy sessions. The program is constantly revised as the patient improves. The exercises must be carefully monitored by a physical therapist because too much activity too soon can be counterproductive.

Vestibular rehabilitation is not for everyone. Some inner-ear disorders require medication or surgery. But practitioners say the success rate of this drug-free, risk-free treatment has made it one of the fastest-growing areas of physical therapy.

More information about inner-ear disorders, vestibular rehabilitation and support groups is available from the Vestibular Disorders Association at (800) 837-8428.