Vertigo – what causes it?
“Every time I look up, the room spins”
“Whenever I turn my head to the right in bed everything begins to swirl”
“Quick movements of my head bring on intense dizziness”
Does this sound familiar? The most likely cause is a condition called Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a mechanical disorder of the vestibular system in which fragmented Calcium Carbonite “crystals” called Otoconia normally held within gel-like material of Utricle interfere with semicircular canal’s ability to sense rotation.
Complexity of the inner ear
Otoconia are responsible for the “butterflies in your belly” sensation when on a roller coaster, or descending in an elevator quickly as they are designed to tell the brain what is happening during linear acceleration. The semicircular canals sense angular acceleration such as turning your neck side to side. The vestibulo-occular reflex (VOR) is how the inner ear communicates with the eyes in order for you to fix your eyes on something and move your head side to side. For example, when turning the head to the left, the semicircular canals in the right and left ear simultaneously send a signal at the same time telling the brain “head turning to the left,” as well as a direct connection to the eyes saying “turn eyes to the right.”
When it goes wrong (BPPV)
When otoconia find their way into the semicircular canal, they settle along the highly sensitive nerve cells that detect rotation (see image). In a person with BPPV, when turning their head to the left, the fluid in the inner ear shifts like normal, but the more dense and slower moving otoconia gradually drift along the semicircular canal providing constant stimulus to the brain and to the eyes saying “head is turning to the left.” This can be frightening as the patient is not moving but has a very real sense that the entire world is spinning or that they are themselves spinning. Depending on the location, size, amount of otoconia symptoms will vary but often last less than 60 seconds once head movement has stopped. It is also common to have a delay in symptom onset, meaning after head movement, it takes 5-10 seconds before the dizziness starts.
What can be done?
This is where the good news begins. Gold standard treatment is canalith repositioning or Epley’s maneuver, an easy, brief, non-invasive technique that can be performed in clinic in a few short minutes. It is up to 95% effective and does not take long to administer. Occasionally, additional vestibular exercises are prescribed.
Can’t I just take a pill?
STRONG evidence against medication as treatment for BPPV (Clinical practice guideline in Otolaryngology). No evidence suggests that vestibular suppressants (Meclizine, diazepam, clonazepan, scopolomine, etc) are effective as primary treatment for BPPV.
Where do I go?
BPPV is most commonly treated either by a Physical Therapist, or an ENT physician. Here at Odom Health and Wellness Minnetonka MN, we are prepared to assess and treat your vertigo and have you back to normal in a jiffy.
Please call (952) 224-1919 to schedule an evaluation
Author: Trent Stensrud, DPT, COMT, CMTPT, CSCS