Going round in circles

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Ever turned over in bed and the room began to spin?  It might have been Benign Paroxysmal Positional Vertigo (BPPV).  This is a very distressing condition, and much more common than you imagine.  If you have it, after you move in a particular way, you feel that the room spins around you and you cannot stop it.  It is like being so drunk that when you lie down on the bed the spinning rotation is so bad you grip the edges of the bed to stop falling off?  That is what BPPV is like – but without the hangover the next morning!

The symptoms of BPPV include the dizziness (vertigo), lightheadedness, imbalance, and nausea.  Activities that bring on symptoms will vary, but are almost always produced by a rapid change of position of the head.  Getting out of bed or turning over in bed are common ‘problem’ motions.  Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, BPPV is sometimes called ‘top shelf vertigo.’  Women with BPPV may find that having a shampoo can bring on the symptoms.  It also tends to be recurrent.  So until you read further, don’t look up or get your hair washed!

To understand BPPV, you have to understand the workings of your inner ear.  You have three semi-circular canals aligned in different directions, which act like spirit levels (the builders type, not the three fingers on the glass barman type) which have cells with fine hairs bathed with fluid as your head moves in different directions.  The movement of the fine hairs sends electrical impulses to the brain to tell it (and you) which way is “up”.

However, with BPPV, the natural movement inside the semi-circular canals is disrupted, so the fine hairs send the wrong signals to the brain, and being unable to work out which way is really “up” the sufferer falls over, totally unable to save themselves from hitting the floor.  Debilitating and embarrassing!  Ask anyone who has had BPPV.

The commonest cause of interruption to the normal ebb and flow in the semi-circular canals is produced by something we have called “ear rocks”.  These are made up of crystals of calcium carbonate, and we medicos call these ear rocks “otoconia”.  Imagine these rocks to be like sugar crystals in the bottom of your coffee cup.  These now swish around every time you move your cup, and likewise your “ear rocks” swish around every time you move your head.

However, it is not all that simple (it never is, is it?) as the commonest cause of BPPV in people under 50 is head injury.  In older people, the most common cause is degeneration in the semi-circular canals of the inner ear.  BPPV becomes much more common with advancing age, but in 50 percent of all cases, BPPV is called ‘idiopathic’, which is a fancy word we use when we don’t know!

Viruses can be accused too, such as those causing vestibular neuritis, minor strokes such as those involving anterior inferior cerebellar artery (AICA) syndrome, and Meniere’s disease are significant but unusual causes.  Occasionally BPPV follows surgery, where the cause is felt to be from a prolonged period of lying on the back with the chin raised (for the anaesthetic tubes to slip down your throat), or ear trauma when the surgery is to the inner ear.  The simple situation is that we can make the diagnosis, but it can be harder for us to exactly pinpoint the cause.  To make it even harder, an intermittent pattern is common.  Your BPPV may be present for a few weeks, then stop, but then come back again.

Is there any treatment?  Yes there is, if ear rocks are the cause.  Treatment usually consists of a series of maneuvers you are put through which are designed to move the ‘ear rocks’ around till they no longer cause problems.  These are demonstrated by the Ear, Nose and Throat (ENT) specialists and usually result in around a 90 percent cure rate.  The most common is called the Epley maneuver or the particle repositioning or canalith repositioning procedure, but have your ENT specialist show you how to do this.