Sunday, September 13, 2009

A simple procedure for Dizziness/Vertigo

About 20% of all dizziness and 50% of all dizziness in older people is due to Benign Paroxysmal Positional Vertigo (BPPV). The symptoms of BPPV include dizziness or vertigo (spinning), imbalance, nausea, or lightheadedness with movement of the head. Many patients will tell me that they simply rolled over in bed or leaned their heads back and began to experience dizziness. The symptoms can last for a long time or they can come and go in short durations. The most common cause is head trauma, but much of the time there is no known cause.

In BPPV, the dizziness is thought to be due to the collection of debris or calcium carbonate crystals which form a plug in the inner ear canals. The calcium plugs don’t allow for the normal movement of fluid in the inner ear and the result is the sensation of spinning. This can be terrifying to someone to say the least. Imagine spinning around several times and having that feeling 24 hours a day!

The solution for this particular type of vertigo can be very simple and effective. Basically a practitioner places an infrared camera over the patients’ eyes and leans them back with their head off the table. If the person has true BPPV, the eyes will jump back and forth (nystagmus). This test is called the Dix Hallpike test. The procedure to move the calcium out of the canal is called the Epely Maneuver and can be performed right then in the office. Basically, the practitioner brings the patient backwards with their head back and observes their eyes with the camera. The patient is then rolled to one side slowly while the practitioner watches the eyes. When the nystagmus is reduced, they are rolled further, finally to a seated position. The patient then has to be careful to not lean their head back farther than 45 degrees for about 48 hours. This is usually a small price to pay for the benefits of the canal repositioning. Research has shown that the Epley Maneuver/Canal Repositioning is effective in about 80% of people with BPPV (Herdman et al, 1993). Please check out this website that does a great job of explaining the cause and treatments for BPPV:

Also, the Vestibular Disorders Association has a list of practitioners around the country who perform canal repositioning maneuvers and is a great resource for those suffering from dizziness/vertigo.

~ Dr. Reynolds

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