Suzanne rolled over in the middle of the night, opened her eyes, and felt as if
the room was spinning. When she tried to get out of bed in the morning, she felt
dizzy, lightheaded and nauseated.
The next day, she visited her primary care doctor, who referred her to an ear, nose
and throat physician. After a complete exam, the specialist told her she had benign
paroxysmal positional vertigo (BPPV), a type of dizziness caused by particles in
the inner ear.
“These microscopic particles, called canaliths, are tiny particles of calcium
carbonate [or limestone], which are normally attached to the structure of the inner
ear canals,” says Roland F.S. Tam, M.D., an otolaryngologist, a specialist
in ear, nose and throat problems. “They detect motion. However, they can become
detached and float around, sending aberrant information and causing disorientation.
These false signals can cause non-persistent vertigo and nausea whenever the head
is moved into certain positions.”
BPPV is one of the most common causes of vertigo, says Tam. “It occurs most
often in people age 60 and older and is secondary to degeneration of the ear’s
vestibular system as one ages.
“Dizziness may happen to an auto mechanic who twists his head into a certain
position or to someone who reaches up to a high shelf to get a plate,” says
Tam. “In other words, it is positional, meaning you don’t suddenly get
it while watching TV. It might only last 10 to 15 seconds. If you change position,
it usually goes away for awhile.”
BPPV can also occur after a blow to your head or from a bacterial or viral infection.
Other causes of vertigo are associated with migraine headaches, Meniere’s
disease, tumors of the eighth cranial nerve, or minor strokes.
Suzanne’s doctor used a treatment called the Epley maneuver (or particle repositioning
maneuver), in which he briskly moved her head into three different positions, staying
in each position for about 30 seconds. She was instructed to avoid lying down for
the next two days and to wear a towel with a knot in it around her left ear at night
to avoid resting on the affected ear.
The Epley maneuver is effective in about 70 percent of patients with BPPV. In some
patients, the symptoms recur or the response is only partial. It’s not unusual
to experience the elimination of vertigo, but imbalance may persist. Working with
a physical therapist certified in vestibular/balance rehabilitation can decrease
the symptoms of dizziness and improve balance.
Suzanne was also given some routine exercises to practice at home to help improve
her balance. She was unable to work or drive for five days, but most of her symptoms
subsided in six weeks. Suzanne now practices yoga to improve her balance. Some people
with BPPV may take as long as six months to fully recover.
“BPPV can be a bothersome problem, but it’s rarely serious, except when
it increases the chance of falls,” says Tam, who took a course with John Epley,
M.D., the inventor of the maneuver. “Although most doctors can determine the
cause of BPPV, treatment may require a consultation with an ear, nose and throat
For more information about BPPV, go to www.american-hearing.org.
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