I had an episode of dizziness last week that was overwhelming. How humbling. My condition is called benign paroxysmal positional vertigo, BPPV.
What is BPPV? It is sudden onset of vertigo with head movements. Vertigo is a sensation of movement like a ship going down a drain. Triggers to vertigo are position changes, head movement or pressure changes. There can be associated symptoms of hearing loss, ringing in the ear, or headache. You may be more at risk for BPPV if you have diabetes, heart disease, high blood pressure or head trauma. Some medications can also cause increased incidence of BPPV; these are blood pressure medications and anti-seizure medicines.
What should your doctor look for? Any ear pathology like wax or infection or fluid behind the ear drum or hearing loss. Cardiac exam will also rule out heart murmur, carotid bruit (when the neck blood vessels are narrowed due to cholesterol placque) or signs of peripheral artery disease (when the extremities don’t get enough blood). A neurological exam will also help rule out stroke or brain abnormalities.
Why does this happen? There’s a great video to describe this, I showed it to my kids…
Why does this happen?… there can be calcium carbonate debris (like little pieces of sand) that float in the semicircular canals located in the inner ear. When the sand (also called “canaliths”) become lodged in the wrong part of the inner ear it causes the canaliths to move freely, triggering hair cells and then a false sense of motion. That sense of motion can cause nausea and vomiting.
Treatment consists of repositioning the otoliths… although most episodes of BPPV spontaneously improve in 4-6 weeks. But, treatment can help speed along recovery. A few methods are the Epley maneuver (or a modified Epley maneuver that you can accomplish by yourself). There are also fantastic vestibular rehabilitation exercises on you tube through the University of Michigan Health System.
So, I am one week into my 4-6 week recovery phase. . . and, at times I hold onto walls so that I do not fall. Humbling. Trying. Nauseating. But, I am pushing through.