As the World Turns

Remember when, as a child, you spun yourself around and around and around until you couldn’t walk or see straight? As adults we sometimes do the same, but because repeatedly spinning seems a bit immature for a grownup, we take the socially acceptable route: alcohol. Either way you get there, the result is the same – the world is spinning, you can’t see straight, you’re at risk of falling over, and nausea is an unwanted companion.

Now, imagine this feeling not being fixed by sitting down for a few seconds (after spinning yourself dizzy) or detoxing and suffering through a hangover (after drinking yourself dizzy). There is such a condition and it affects approximately 5% of the adult population. It’s referred to as Vertigo, defined as the feeling of movement when one is stationary. And it doesn’t just refer to a feeling of spinning, in fact, many clients report it feels more like they’re on a small boat in stormy water. If you’re really curious, you could always try spinning yourself repeatedly for some temporary vertigo.

The dizzying culprit is the vestibular system in the inner ear (note: vertigo can be the result of dysfunction in the balance centers of the brain, but this form is usually accompanied by other neurological symptoms). The vestibular system looks kind of like a wild roller coaster or a weird snail-like creature. It is in fact a tiny, complicated organ that, when dysfunctional, wreaks havoc on the affected individual’s life. It can be a complicated system to diagnose a problem in because symptoms may include any of the following: issues with vision, hearing (ringing in ears), nausea, memory, coordination, emotions and more. The fear of a vertigo attack often keeps people at home, in bed, near a bucket.

There are a number of specific conditions that can cause vertigo, but I’d like to discuss one in particular – the one that responds incredibly well to a simple treatment.

Benign Paroxysmal Positional Vertigo (BPPV), or simply known as positional vertigo, is the most common cause of vertigo AND the easiest one to fix. The vertigo occurs because of tiny crystals of calcium carbonate (or “ear rocks”) that are normally stationary within the labyrinth of the vestibular system but have come loose. These ear rocks can be dislodged from their normal resting position by head trauma, infection, age-related degeneration, or other disorders of the inner ear. Once loose, the ear rocks interfere with the normal function of the inner ear and confuse the balance centre resulting in the symptoms of vertigo. To treat BPPV, one needs only to get those darn rocks to go back where they came from.

That’s where your trained health professional comes in. If your doctor, physiotherapist or other health care practitioner is familiar with the assessment and treatment of BPPV, relief can be yours. The treatment technique, known as the Epley maneuver (or the Canalith Repositioning Procedure), is a series of movements of the head that aim to get the ear rocks back where they belong. The Epley maneuver will “fix” over 80% of BPPV cases, BUT not necessarily forever. The problem is, once those ear rocks come loose, they stay loose, and even though this treatment will put the rocks in an area of the inner ear that won’t mess with the balance system, the rocks may drift back into the wrong area. Time to recurrence is very hard to predict, and sometimes there is never a recurrence.

Regardless, the fact that there is a simple, effective treatment for this debilitating condition is great news. There is also a home exercise (Semont exercise) that can be prescribed to help give immediate relief for recurring episodes of BPPV. Awareness of a BPPV treatment technique among physicians and rehab specialists is not as widespread as you would expect, and many people continue to suffer. If you suspect that you or anyone you know may have positional vertigo, consult your physician or physiotherapist. If you are diagnosed with BPPV, make sure the Epley maneuver is performed!

I am curious as to whether any of our readers have experienced positional vertigo. We would love to hear your story!

If you have any clinical questions regarding vertigo diagnosis and treatment, please send them to matt@aim2walk.ca

7 responses

  1. I have never experienced it, but have a relative who has. I also read the severe case history in THE BRAIN THAT CHANGES ITSELF. So glad you are making a difference for people! Those of us who are not afflicted tend to take balance for granted!

    • Thanks Pam! I’m happy you’ve never experienced vertigo an hope you never have to. The tongue stimulation treatment for the severe case of vertigo from THE BRAIN THAT CHANGES ITSELF was also very interesting and I hope to wright a post on that subject in the near future.

  2. Was diagnosed last week with benign positional vertigo. It has been 3 weeks now with dizziness mostly when I lay down or get up after laying down. I also if I turn my head fast or look up or down and then change head position. My doctor said to give it a few more weeks and that using medicine can sometimes make it worse and prolong it. She said if it doesn’t resolve in a few weeks I may have to go to therapy. Last year at this time I developed tinnitus and mild hearing loss I was wondering if this could have anything to do with it.

    • Hi Denise. If the diagnosis of BPV is correct (which, from your description, definitely sounds correct) I would seek out therapy ASAP. The effectiveness of this simple treatment technique is VERY high if performed by a trained therapist – and there is no reason to try and “wait it out”. Usually, the challenge is finding a therapist near you with the proper experience. Your symptoms would likely be resolved within 1-3 sessions. If you are in Ontario and want to find a therapist with experience with Positional Vertigo, you can go to http://www.opa.on.ca/OPANewFind.opx and enter your city, then click the check box that reads “Dizziness, BPPV, Vertigo” under the ‘Neurological’ Heading, and then click ‘Search’. Otherwise, feel free to email me (matt@aim2walk.ca) to discuss further.

  3. I was diagnosed with labyrinthitis almost 5 weeks ago. I had the feeling of spinning for a week and a half. It has since gone away. However I have lost hearing in my left ear and now it rings constantly. I have been to several ENTs and taken several medications. Last week I called my chiropractor who has been doing the Epley maneuver on me. I’ve been 3 times with no real improvement. Is it helpful to continue the Epley maneuver? My dizziness is gone, it’s Just the ringing that’s driving me crazy. My chiropractor also suggested a low sodium diet. Any other suggestions? Thank you!

  4. I have had bouts of dizziness since a kid when I turned 42 I woke to let the dog out and hit the floor , I went to the doctor for 3 years it started slowly , lasting only a few hours then lasting a few days to lasting weeks and only going away a few days. My daughters ENT noticed my eye jump and saw that I turned pale. She asked if I was ok and when I said no I get dizzy spells she said you have VBBP. you need a specialist, that at the time was 8 years after the first therapy. It lasted 5 years then one morning I woke sick to my stomach. I called the specialist ent and went in they put me in therapy , it lasted 2 months , now it is controlled by home exercise and antivert as the eye will not jump with the test. It also has cause migraines telling my brain I have BVVP when I am on the edge of it. I now am very emotional and lose my temper at times at the drop of a hat. I have read They have anti anxiety pills . that would make my prescription drugs at two for this condition. I do find some relief with vitamin b-12 and omega 3, along with my meccline. I am at the point I can not work I can not drive at night the lights irate my ear and eye and headache. I have had cat scans and nothing is wrong with my head. it all stems from the ear , when I can get the ear pain and sinus pain to stop it seems to let up. This has affected my whole family and working on my marriage as I can no longer do the things I did before in the yard or house. I am currently 56 and every time I get a cold or bad allergies it goes right to my ear on the right side , if I lay down on that side I feel like I am going into a hole. I am going back again to the doctor for an anti anxiety pill hopefully to feel happier and less frustration.

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