Understanding Vestibular Disorders and Dizziness: Causes, Symptoms, and Rehabilitation

Dizziness is one of the most common and unsettling complaints in healthcare, accounting for a significant number of GP visits and specialist referrals each year. It can appear suddenly after illness or injury, or develop gradually over time, affecting confidence, independence, and overall quality of life.

At the centre of many dizziness problems is the vestibular system—a finely tuned sensory network in the inner ear and brain. This system tells us where we are in space, helps stabilise our gaze when we move, and works with vision and body position sensors to maintain balance.

When the vestibular system is disrupted, even simple daily activities such as walking down the supermarket aisle, turning your head to cross the road, or riding in a car can trigger symptoms. Fortunately, with accurate diagnosis and targeted vestibular rehabilitation, many people can make a full recovery.

What is the Vestibular System?

The vestibular system includes:

• Semicircular canals – detecting rotational head movements such as turning, tilting, or nodding.

• Otolith organs (utricle and saccule) – sensing gravity and linear acceleration.

• Neural connections – linking the inner ear to the brainstem, cerebellum, and higher brain centres, integrating motion, balance, and visual input.

When working correctly, the vestibular system keeps vision clear during head movement through the vestibulo-ocular reflex (VOR), while helping maintain steady posture and orientation.

Common Causes of Vestibular Dysfunction

Vestibular problems may be peripheral (originating in the inner ear) or central (caused by issues in the brain). Common causes include:

• Concussion or mild traumatic brain injury (mTBI) – affecting both peripheral and central vestibular pathways.

• Benign paroxysmal positional vertigo (BPPV) – caused by tiny calcium carbonate crystals (otoconia) moving into the wrong inner ear canal, producing short bursts of vertigo with head movement.

• Vestibular neuritis or labyrinthitis – viral or bacterial infection causing inflammation of vestibular structures.

• Ménière’s disease – a chronic condition causing episodic vertigo, fluctuating hearing loss, and tinnitus.

• Age-related decline – gradual reduction in vestibular function over time.

• Other neurological conditions – such as stroke, migraine-associated vertigo, or multiple sclerosis.

How Vestibular Dysfunction Affects Daily Life

When vestibular function is impaired, the brain receives incomplete or conflicting information about head movement and position. This can result in:

• Vertigo – a spinning or whirling sensation.

• Dizziness or light-headedness – particularly in busy, visually complex environments.

• Imbalance and unsteadiness – with increased risk of falls.

• Motion sensitivity – discomfort in cars, lifts, or moving crowds.

• Blurred or unstable vision (oscillopsia) – when moving the head.

• Anxiety and fatigue – caused by the constant effort to stay oriented.

These effects can limit physical activity, reduce confidence, and make social or work situations more difficult.

Rehabilitation: Restoring Stability and Confidence

Vestibular rehabilitation uses targeted, progressive exercises to help the brain adapt, compensate, or recover. A personalised programme may include:

1. Vestibulo-Ocular Reflex (VOR) Training

VOR exercises keep vision stable during head movement. Patients focus on a fixed or moving target while turning the head, gradually increasing speed and complexity. Some clinicians use visual feedback tools such as the HeadX Kross to help patients track eye–head coordination with precision and gradually progress their training.

2. Motion Habituation

Gradual exposure to movements that provoke symptoms—such as bending down, turning quickly, or walking through busy spaces—reduces over-sensitivity and helps normalise brain responses.

3. Visual-Vestibular Integration

Exercises that combine eye tracking, head movement, and balance help the sensory systems work together. Structured targets and feedback tools can make this process more measurable and engaging.

4. Balance and Postural Control Training

From static stance to dynamic challenges on unstable surfaces, balance training rebuilds stability. Dual-task activities, such as balancing while reciting words or solving simple puzzles, prepare patients for real-life demands.

5. Canalith Repositioning

For BPPV, manoeuvres like the Epley technique reposition the crystals in the inner ear, often resolving vertigo within one or two sessions.

Why Early Intervention Matters

The longer vestibular symptoms persist, the more they can impact physical condition, mental health, and day-to-day function. Early assessment and rehabilitation not only improve outcomes but can prevent secondary problems such as deconditioning, anxiety, and reduced independence.

Living Well with Vestibular Disorders

While some vestibular conditions resolve entirely, others may require ongoing management. With consistent rehabilitation, many patients regain the stability, confidence, and mobility they thought they had lost. Whether it is walking outdoors on uneven ground, playing sport, or simply moving comfortably through a busy environment, recovery is often possible with the right support and tools.