The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult vestibular-trained physical therapist, neuro-optometrist, or concussion specialist for individualized guidance. Concussion causes peripheral vestibular dysfunction through direct labyrinth injury, otoconia displacement, endolymphatic disruption, and vestibular nerve trauma (Silverberg et al., 2020). Peripheral dysfunction affects the inner ear (labyrinth) and vestibular nerve, distinguishing it from central (brain) dysfunction. Specific peripheral conditions include BPPV (most common), labyrinthine concussion, perilymph fistula, endolymphatic hydrops, superior canal dehiscence, and rarely labyrinth hemorrhage. Symptoms include episodic vertigo, hearing changes, tinnitus, and imbalance. Diagnosis includes Dix-Hallpike test, head impulse test, audiometry, VEMP testing, and imaging when indicated. Treatment varies by specific diagnosis: canalith repositioning for BPPV, vestibular rehabilitation for labyrinthine concussion, and surgical intervention rarely. Concussion damages labyrinth and vestibular nerve. Damages labyrinth and vestibular nerve. Peripheral dysfunction affects inner ear. Affects inner ear. Multiple specific conditions possible. Multiple specific conditions. Peripheral Vestibular Structures Affected Semicircular canals (posterior, horizontal, anterior). Semicircular canals. Utricle (linear acceleration horizontal). Utricle. Saccule (linear acceleration vertical). Saccule. Otoconia (calcium carbonate crystals). Otoconia. Vestibular hair cells. Vestibular hair cells. Vestibular nerve (VIII cranial nerve). Vestibular nerve. Cochlea (hearing). Cochlea hearing. Endolymph and perilymph fluids. Endolymph and perilymph fluids. Specific Peripheral Conditions BPPV (most common 15-30% of concussions). BPPV most common 15-30%. Labyrinthine concussion. Labyrinthine concussion. Perilymph fistula. Perilymph fistula. Endolymphatic hydrops (post-traumatic Meniere's). Endolymphatic hydrops post-traumatic Meniere's. Superior canal dehiscence unmasking. Superior canal dehiscence unmasking. Vestibular nerve injury. Vestibular nerve injury. Labyrinth hemorrhage (rare). Labyrinth hemorrhage rare. Temporal bone fracture. Temporal bone fracture. Labyrinthine Concussion Direct injury to labyrinth from head trauma. Direct injury to labyrinth. Vestibular hair cell damage. Vestibular hair cell damage. Cochlear hair cell damage possible. Cochlear hair cell damage possible. Vertigo and hearing loss. Vertigo and hearing loss. Tinnitus. Tinnitus. Imbalance. Imbalance. Nystagmus. Nystagmus. Recovery over weeks to months. Recovery over weeks to months. Perilymph Fistula Abnormal opening between inner ear and middle ear. Abnormal opening between inner ear and middle ear. Round window rupture common. Round window rupture common. Oval window rupture possible. Oval window rupture possible. Perilymph fluid leakage. Perilymph fluid leakage. Pressure-induced vertigo. Pressure-induced vertigo. Straining-induced vertigo. Straining-induced vertigo. Fluctuating hearing loss. Fluctuating hearing loss. Surgical repair sometimes needed. Surgical repair sometimes needed. Endolymphatic Hydrops (Post-Traumatic Meniere's) Endolymph fluid accumulation. Endolymph fluid accumulation. Episodic vertigo 20 minutes to hours. Episodic vertigo 20 minutes to hours. Fluctuating hearing loss. Fluctuating hearing loss. Tinnitus. Tinnitus. Aural fullness. Aural fullness. Delayed onset weeks to years. Delayed onset weeks to years. Diuretic and low-salt diet treatment. Diuretic and low-salt diet treatment. Peripheral Signs on Examination Horizontal nystagmus with torsional component. Horizontal nystagmus with torsional component. Nystagmus fatigues with repeated testing. Nystagmus fatigues. Nystagmus suppressed by visual fixation. Nystagmus suppressed by visual fixation. Positive head impulse test on affected side. Positive head impulse test on affected side. Positive Dix-Hallpike for BPPV. Positive Dix-Hallpike for BPPV. Preserved VOR cancellation. Preserved VOR cancellation. No coexisting neurological signs. No coexisting neurological signs. Diagnostic Testing Dix-Hallpike test. Dix-Hallpike test. Roll test. Roll test. Head impulse test. Head impulse test. Audiometry. Audiometry. Tympanometry. Tympanometry. VEMP testing. VEMP testing. Electronystagmography (ENG). Electronystagmography ENG. Videonystagmography (VNG). Videonystagmography VNG. Video head impulse test (vHIT). Video head impulse test vHIT. Temporal bone CT if indicated. Temporal bone CT if indicated. Treatment Canalith repositioning for BPPV. Canalith repositioning for BPPV. Vestibular rehabilitation for compensation. Vestibular rehabilitation for compensation. Bed rest for suspected perilymph fistula. Bed rest for suspected perilymph fistula. Surgical repair for perilymph fistula. Surgical repair for perilymph fistula. Diuretic for endolymphatic hydrops. Diuretic for endolymphatic hydrops. Low-salt diet for endolymphatic hydrops. Low-salt diet for endolymphatic hydrops. Meclizine for symptomatic relief. Meclizine for symptomatic relief. Ondansetron for nausea. Ondansetron for nausea. Prognosis Better than central dysfunction. Better than central dysfunction. BPPV highly treatable. BPPV highly treatable. Labyrinthine concussion recovery 4-12 weeks. Labyrinthine concussion recovery 4-12 weeks. Perilymph fistula variable outcome. Perilymph fistula variable outcome. Endolymphatic hydrops chronic condition. Endolymphatic hydrops chronic condition. Supporting Mobility Routine These exercises support peripheral vestibular recovery through cervical mobility and nervous system regulation. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. How is peripheral vestibular dysfunction different from central? Peripheral dysfunction affects inner ear and vestibular nerve. Central dysfunction affects brainstem, cerebellum, and cortex. Peripheral features horizontal nystagmus with torsional component, fatiguing nystagmus, suppression by visual fixation, and isolated vestibular symptoms. Central features vertical or direction-changing nystagmus, non-fatiguing nystagmus, and coexisting neurological symptoms. What is the most common peripheral vestibular condition after concussion? BPPV is most common peripheral vestibular condition after concussion, affecting 15-30% of concussion patients. Post-traumatic BPPV involves multiple canals more commonly than idiopathic BPPV. Labyrinthine concussion second most common. Perilymph fistula and endolymphatic hydrops less common. Superior canal dehiscence unmasking rare but important to identify. Can peripheral vestibular dysfunction after concussion resolve completely? Yes. BPPV resolves completely with Epley maneuver in 70-90% within 1-3 treatments. Labyrinthine concussion often resolves over 4-12 weeks with vestibular rehabilitation. Vestibular compensation restores function. Perilymph fistula variable outcome. Endolymphatic hydrops usually chronic but manageable. Peripheral dysfunction generally better prognosis than central dysfunction. Do I need audiometry for post-concussion vestibular symptoms? Yes. Audiometry recommended for post-concussion vestibular symptoms to identify hearing changes suggesting labyrinthine concussion, perilymph fistula, or endolymphatic hydrops. Air-bone gap suggests superior canal dehiscence. Fluctuating hearing loss suggests endolymphatic hydrops or perilymph fistula. Baseline audiometry supports treatment planning and monitoring. Should I see an otolaryngologist for post-concussion vestibular symptoms? Yes. Otolaryngologist or neuro-otologist supports diagnosis of peripheral vestibular conditions. Comprehensive vestibular testing available. Rules out surgical conditions. Coordinates with vestibular therapist. Second opinion if diagnosis unclear. Concussion clinic coordination essential. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed