December 22


Vertigo Recurring with Iyad Salloum

By Wil Seto

December 22, 2023


Mark: Hi, it's Mark Bossert, I'm here with Iyad Salloum of Insync Physio in North Burnaby, BC, Canada, and we're talking about vertigo today. How you doing, Iyad? 

Iyad: Good, Mark. Thanks for doing this. 

Mark: So recurring vertigo or vertigo relapse, what's going on with this ailment?

Iyad: We've been seeing a lot of clients in our clinic recently who've had this and I thought it'd be a good idea for us to put a resource out for people to refer to.

So there's different types of vertigo and I think like one of the things that happens is most people will go to the ER because they think it's something relating to the brain and that's a good move. Generally you want to rule out any of the nasty stuff. The red flags, you know, that could need an urgent intervention.

But once we get the referral in from the ER, then we can kind of sort out what we're dealing with. So there's different types of conditions that could contribute and cause vertigo. So you have your very brief, short episode type ones, which are called BV. Which is related to a temporary distortion causing the inner ear when some crystals enter the canals that are inside the vestibular organ.

And then we have another one which is related to a viral infection and those tend to be a little more aggressive because the length of this episode lasts way longer and then they feel like way disoriented afterwards. So typically what I'm talking about here is when people finish their treatment and they're gone home and they're like, great, I did a really good job. And I recovered really well. And I'm back to functioning. And I could drive, I could do my sports and then all of a sudden, several months later, sometimes a year later they get this out of nowhere response where they're like, Oh my God, it's back. 

And this time, if you had like a viral infection before that caused this, they're like, I didn't even have a fever. I didn't have a cold. So why did this happen? And they do the same thing. They'll visit their family doctor or the ER. And they'll get looked over and like, well, good news is nothing scary. So then they come back to us. 

So these are called decompensation episodes sometimes if it's related to that previous viral infection and it's basically due to a couple of things. We think it's related to just like the body being a bit overwhelmed, could be stress, poor sleep or anything that you think about that could tax your body will contribute to this.

The other thing that we see kind of that happens around the same time is people will feel like, well, I'm better, you stop doing all the rehab. And then all of a sudden, boom, it gets to a point where the body can no longer cope with what it's dealing with, and then it kind of relapses again. 

So that's one subset of them. And then other things is like, people can get BPPV again. It's not like you have it once only in your life, and once that's corrected, it's gone forever. So you can easily have another episode of that. In which case we can easily diagnose it in the clinic by doing some tests, and we can also usually treat it right on the spot if it's that. 

If it's the former, which is related to that relapse that we talked about from a previous viral infection to the inner ear, we will reassess see where their functions that and then kind of like give them a another program to work on to help them where they're at.

Mark: So in general, what's the treatment that you prescribe the actions that people take? 

Iyad: So that's a really good question. There's different impairments. So like your BPPV it's really much more about trying to eliminate that one trigger, which is usually more of a, think of it like a mechanical thing. If you try to eliminate that distortion with one of the canalith repositioning maneuvers, which are kind of like you know, we place the head in different positions, which helps eliminate that temporary phenomenon. And that seems to be quite an effective strategy. Some people will still feel a bit off afterwards and we can just give them exercises to kind of fix that impairment. 

The other side where like you have different impairments and some people's main struggle is that if you are looking at one target and moving your head side to side that the eyes cannot fixate on that anymore. So the head moves and the eyes go with it.

We would try to work on some gaze stability. And then sometimes people get some motion sensitivity or motion sickness. We would try to give them some exercises on that. And then sometimes people just feel off and cannot balance because we use that vestibular organ to help us balance. So then we would try to address that. So it just depends on the impairment.

The problem is you as a person, you feel off. You feel like you're floating, you feel like you're on a boat sometimes, like that's a lot of the reported kind of symptoms are I just feel like something's not normal and I want to feel normal again. And that's usually the most common thing and it can be quite anxiety provoking to a lot of people.

So, you know, it is a bit scary when you're feeling like you're, you don't know what up and down are. And those tend to be even worse with eyes closed when you have vision removed for a bit. So yeah, like the most recent one was somebody was showering and they felt like, Oh my God, as soon as I put some shampoo over my head. And then, you know, as you're rinsing it so that you don't want to get in your eyes, their eyes shut down and then they started feeling like they're falling backwards.

So a lot of the treatment is based on where the struggle is. And then based on that, we would kind of put them on a program and then let's say, if you want to just get back to walking and doing some stuff around the house, there's one approach. But then let's say you want to get back to stand up paddleboarding. Well, we need to prepare your system for a little more, you know waviness and a little more kind of control that's needed for that task.

And so that's usually what dictates where the treatment goes. Where are you at? Where do you want to go? And typically I'd recommend that we build a bit of a buffer in there so that they don't just hit the bare minimum for function so that the buffer really tends to help if you get another, that's say a busy period in your life or stressful period that you can cope with it.

Mark: There you go. If you're looking for some help because the vertigo keeps coming back or you have vertigo, the people to see in North Burnaby, BC are Insync Physiotherapy. You can reach them online at You can book right there, either for the North Burnaby or the Vancouver office, or you can call the North Burnaby office to book your appointment at (604) 298-4878. Insync Physio. Thanks, Iyad. 

Iyad: Thank you.

Wil Seto

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