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Medical Edge Newspaper Column from Mayo Clinic
TECHNIQUES FOR UNDOING DIZZINESS
DEAR MAYO CLINIC: I have BPPV (benign paroxysmal positional vertigo) and have not responded to treatment. What are the next steps regarding further evaluation and treatment? — Bremerton, Wash.
ANSWER: The “V” in this abbreviation stands for vertigo — dizziness that comes from the false sensation that you or your surroundings are moving — and it can have lots of causes, such as damage to the nervous system or the inner ear. But BPPV specifically results from particles normally located in the inner ear shaking loose and creating disturbances nearby.
These crystalline particles usually are housed in a sac (utricle) that helps detect back-and-forth motion. When dislodged — possibly from a blow to the head but often simply from aging or other unknown causes — they enter the fluid of an ear canal, whose function is to detect turning motion and maintain balance. The particles can then stimulate the canal’s fine, hairlike sensory tissues, which signal the brain that the body is in motion and out of balance when it is not. This dizziness is especially likely to occur after a change in head position, and thus the term “positional” in the disorder’s name.
“Paroxysmal” refers to the abrupt onset of intense vertigo, which usually lasts less than a minute; while “benign” indicates that the condition is not life-threatening, though it certainly can make life miserable.
The first thing you should do is make sure you indeed have BPPV — that the vertigo is not caused by some other problem. A second opinion may be in order. If you are not sure where to turn, a good source of doctors highly experienced in diagnosing and treating BPPV is the Vestibular Disorders Association Web site (www.vestibular.org).
In most cases, BPPV can be successfully treated in a doctor’s office by going through a series of exercises called the Epley maneuver or the canalith repositioning procedure. This treatment is designed to shift the particles back where they belong, or at least dislodge those that have invaded the ear canal. One session may be enough, though repeat visits may be needed.
If you undergo this procedure, you will need to keep your head upright for 48 hours afterward so the particles do not return to the ear canal. This means sleeping in a propped-up position, avoiding tasks such as tying your shoelaces, and maybe even wearing a neck collar to prevent any tilting of the head.
If the Epley maneuver doesn’t work, there are alternatives. At Mayo Clinic, we often recommend adaptation exercises — a set of longer-duration and more forceful maneuvers that need to be done several times a day at home.
In very rare cases, when none of the maneuvers works and a patient is in extreme discomfort, surgery can provide relief. One option is to cut a branch of the ear’s balance nerve so that the particles’ impacts in the canal are not transmitted to the brain. An easier alternative is to block the canal to prevent the misplaced particles from moving in it. Both options are serious procedures, however, and should only be performed under exceptional circumstances.
— Otorhinolaryngology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Benign Paroxysmal Positional Vertigo (BPPV)
Appointment Information
More Information on BPPV
Information on Dizziness
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© 2005 TRIBUNE MEDIA SERVICES, INC.
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