COVID-19 infection can cause a range of symptoms including respiratory, cardiovascular, gastrointestinal and neurological.

Recent studies have shown that the most common neurological symptom post COVID-19 is dizziness followed by headaches. Loss of hearing has also been documented.

It is believed the COVID-19 infection causes damage to the inner ear. This often leads to vertigo (a feeling as though you are spinning or that the world is spinning around you), dizziness, imbalance and hearing loss. Prevalence of these symptoms are more common among COVID patients than the general population. Early estimates shows ~20% prevalence of vertigo/dizziness, 6%hearing loss and ~15% tinnitus.

Common Causes of Vertigo

There are 3 common causes of vertigo:

1. Benign Paroxysmal Positional Vertigo (BPPV)

2. Neuritis

3. Meniere’s Disease

BPPV

This is the most common cause of vertigo. It occurs when small calcium crystals break free and float into the tubes of your inner ear called the semicircular canals. Vertigo resulting from BPPV usually lasts anywhere from a few seconds to a few minutes. Vertigo is brought on by certain head or body movements such as getting in and out of bed, looking down or up, or rolling over in bed. There may also be complaints of blurred vision, light-headedness, nausea and vomiting.

Post COVID-19 infection, BPPV is thought to be brought on possibly due to prolonged bed rest, direct inflammatory action on the macula or the formation of microthrombi in the circulation, causing the degeneration and detachment of otoliths.

Neurtitis

Neuritis occur as a result of inflammation and irritation of the inner ear and its nerve, most commonly due to an inner ear virus or COVID-19. They are characterized by sudden onset of constant vertigo. Many people will recover from neuritis over a couple of weeks, without any need for treatment. However, some people will continue to have symptoms such as dizziness and unsteadiness when moving or turning quickly. They may also have difficulty tolerating busy environments, for example, the shopping centre or supermarket, or complain of visual blurring. 

In current studies, the association between vestibular neuritis and COVID-19 vaccination is unclear. There have been case reports documented of patients developing vestibular neuritis post vaccination.

Meniere’s Disease

This disease is caused by excess fluid build-up in your inner ear. People with Meniere's disease often have vertigo episodes that are sudden and intense that last for several hours at a time. They may also complain of fullness/heaviness in the ear, tinnitus (ringing in the ears) or hearing changes.

How can Vestibular Physiotherapists help?

Depending on the cause of the vertigo, a vestibular physiotherapist will use different interventions.

BPPV

In cases of BPPV, therapists can use particle repositioning manoeuvres (PRM) or specific exercises to move the crystals back to their normal location. BPPV is diagnosed by the presence of characteristic vertigo and nystagmus (rapid involuntary eye movement) when the person is rapidly moved from sitting to lying (i.e. Dix-Hallpike). There is an 80% chance of complete resolution of BPPV following one PRM.

Neuritis

As the virus affects the inner ear and its nerve, the sensory input from the affected ear will be reduced.  The brain usually receives information from both inner ears that is equal and opposite. When one side is compromised, we call this a vestibulopathy.
Vestibular physiotherapy aims to promote the brain's ability to compensate for the reduced sensory input from the affected ear. Compensation takes time, weeks and months rather than just one treatment. This can be done through:

• Gaze stability exercises

• Habituation exercises

• Balance and gait retraining

Meniere's Disease

Acute attacks of Meniere's disease will require medical intervention for management, and most of the time people with Meniere's will have no symptoms in between attacks. However, in some cases with repetitive attacks, people may develop imbalance and dizziness with head movements between attacks, which will respond to vestibular physiotherapy in the same manner as those with a vestibulopathy.

If we can help you with any of your vertigo symptoms, please feel free to contact us:

Phone: 9553 8145
Website: www.eqphysio.com.au
Or if you're in the area, drop on by and have a chat with us to see if we can help in any way.
We're located at 1/45 Montgomery St, Kogarah NSW 2217.