As the COVID-19 virus and its ever evolving variants continue to infect, at times, hundreds of thousands of people a day worldwide, medical professionals and sufferers of the disease are still working to put together a comprehensive list of typical signs and symptoms. Two clinical manifestations that have arisen and distinguish the COVID-19 virus from many other respiratory viruses are the symptoms of dizziness and vertigo. 

Drs. Saniasiaya and Kulaseharah wrote in the Ear, Nose and Throat Journal in September of 2020 that dizziness has proven to be a “notable clinical manifestation among COVID-19 patients” (Saniasiaya, MD, MMED & Kulasegarah, MB Bch, BAO, MD, 2020). Several causative mechanisms were proposed amongst doctors and researchers but all agreed that when dizziness and vertigo are present, it is important to consider possible causes such as acute labyrinthitis, vestibular neuritis, acute otitis media or even secondary to stroke caused by COVID-19. Each of these potential causes of vertigo and dizziness require their own assessment and treatment by a healthcare professional.

Vestibular neuritis, for example, a condition in which the vestibular nerve that supplies the inner ear organs becomes inflamed, can cause severe (though typically temporary) dizziness and vertigo, feelings of imbalance and nausea. Recovery times can vary from days to months. In a case series published in the Le Infezioni in Medicina journal in March 2021 the authors describe 6 cases in which female patients with known or suspected COVID-19 infections experienced severe dizziness that was later diagnosed as vestibular neuritis (Malayala et al., 2021). The mechanism of this manifestation may be similar to the causes of other symptoms of COVID infection such as loss of smell, changes in vision and changes in the vascular system but can have a lasting impact on some people even once the initial infection seems to have resolved.  While the symptoms may be initially severe, treatment with medications to manage symptoms of nausea and dizziness and decrease inflammation are typical in the acute phase while physical therapy and vestibular rehabilitation can help immensely for any persisting symptoms.

How do I know if I need vestibular rehab?

Vestibular rehabilitation focuses on improving the effectiveness of our vestibular system, the sensory organs in our body that transmit information about how our head is oriented and moving in space. The vestibular system is one of three sensory systems in our body that help us to balance. The second system is the somatosensory system which consists of sensory nerves in the joints and skin, which transmit information such as whether you are standing with your feet flat on the ground or if part of your foot is lifted. The third system is our visual system. Our eyes reference the environment around us to understand better how our body is oriented in space. 

When the vestibular system is affected by an infection such as in vestibular neuritis, an injury like a concussion, or even when small crystals in the inner ear organs get displaced (a condition called BPPV), individuals can become over reliant on the other two sensory systems and sometimes that can persist, “uncompensated” for long periods of time. 

In these cases one might be left with persistent feelings of imbalance, dizziness and disequilibrium. Suddenly closing your eyes in the shower becomes a fight to keep from falling, turning your head to look at traffic while riding in the car makes your head spin and the thought of going on a hike makes you nervous for your safety. Not to worry though, a physical therapist who is experienced in vestibular rehabilitation can assess your symptoms and prescribe exercises to help reduce your residual symptoms and help to restore your function. In many cases the vestibular system can be trained to perform at a higher level again. There is no need to keep living with these symptoms long term!

So if you or someone you know is experiencing severe dizziness along with any of the other known symptoms of COVID (ie. sore throat, fever, cough, etc.), talk to your doctor about what treatment options are available to help reduce your symptoms quickly and to rule out more serious causes of dizziness like a stroke. If you find yourself struggling to get back to normal after COVID and are feeling off balance or dizzy, seek care from an experienced physical therapist and they will help get you back on the road to full recovery! 

Bibliography

Malayala, S. V., Mohan, G., Vasireddy, D., & Atluri, P. (2021). A case series of vestibular symptoms in positive or suspected COVID-19 patients. Le Infezioni in Medicina, 29(1), 117-122. https://www.infezmed.it/index.php/article?Anno=2021&numero=1&ArticoloDaVisualizzare=Vol_29_1_2021_117

Saniasiaya, MD, MMED, J., & Kulasegarah, MB Bch, BAO, MD, J. (2020, September 15). Dizziness and COVID-19. Ear Nose and Throat Journal, 100(1), 29-30. https://journals.sagepub.com/doi/10.1177/0145561320959573