There’s an easy fix for positional vertigo - Cape Cod Healthcare

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Published on October 22, 2019

There’s an easy fix for positional vertigo

Positional Vertigo

You get out of bed and, for a short while, it feels as if the whole room is spinning – day after day.

That’s what life can be like for people with benign paroxysmal positional vertigo, usually referred to as positional vertigo.

“For some people, they’re fine the rest of the day as long as they are careful to stay upright and don’t make the wrong move,” said Douglas Mann, MD, an otolaryngologist based in Falmouth. “For other people, it really makes them fearful to move at all, making this problem very limiting.”

Positional vertigo is brought on by changes in one’s position and lasts between 10 and 60 seconds.

“It stops as long as you maintain the new position and wait for the spinning to stop,” he said. “If you make another move, you may find that you’re again experiencing the spinning.”

Dr. Mann, who sees cases of positional vertigo on a daily basis, has seen people with positional vertigo that had lasted “for years and years and after we treated them it disappeared,” he said. “Left untreated, it will usually stay the way it is, although sometimes it’ll disappear spontaneously.

“Once you have it, you usually have it every day and you can usually predict the kind of movements that bring it on, like looking up or lying down and turning over in bed.”

Positional vertigo occurs when small crystals of calcium carbonate are floating in the fluid-filled semicircular canals. The canals are small tubes in the inner ears that send messages about movement to the brain and help us keep our balance.

“When you move to a new position and stop, the crystals may continue to move due to gravity, they create fluid movement that creates a sense of motion even though you’re not moving,” Dr. Mann said.

The crystals can form in the semicircular canals or enter from another part of the ear, breaking free because of trauma, age or disease.

“We’re seeing this in the older population, I would say over 50 or 60,” he said. “It happens equally to men and women.”

Diagnosis and Treatment

Positional vertigo differs from other types of vertigo in that episodes last a minute or less and are brought on by changes in position. Diagnosis is confirmed with a physical examination in an otolaryngologist’s (ear, nose and throat doctor) office.

“We have the person lie down with their head to one side and then to the other, and very frequently, that will bring on the vertigo,” said Dr. Mann. “It will also bring on certain bouncing eye movements, which are characteristic of this condition.

“There are six semicircular canals in the balance organs, three on each side. To make a diagnosis, one has to decide which of the semicircular canals has those crystals causing the problem. We learn that by observing the eye movement during the physical examination.”

An in-office treatment called the Epley maneuver “successfully and permanently eradicates the symptoms in about 70 percent of patients,” he said. The technique was developed by Dr. John Epley in 1979 and treats the most common form of positional vertigo, in the posterior semicircular canal.

“It’s amazingly simple,” he said. “The patient starts in a supine, lying down position, with the head turned to the side that makes them most dizzy.

“They gradually rotate their head and then their body to the opposite side, turning a total of 180 degrees. It’s pretty much rolling over in bed, and from there, they are brought back and then up into a sitting position.”

The maneuver works by moving the crystals from the semicircular canal to the vestibule of the inner ear. Once there, they’re harmless because the vestibule doesn’t sense turning.

People can be trained to do the Epley maneuver at home if positional vertigo recurs.

When the Epley maneuver is not successful, an otolaryngologist may try a vibrator on the head to help jiggle the crystals out of the canal.

For some patients, the only solution is surgery. It involves opening the inner ear and putting a little plug of wax or bone dust into the canal to prevent that canal from having any fluid movement at all.

“No one should have to live with vertigo long-term,” said Dr. Mann. “It's limiting, but people are amazing at what they're able to manage to live with. The problem with trying to live with it is that sometimes you make a move that you didn’t plan to make because of some external factor. If that move brings on your vertigo, you can suddenly find yourself on the floor with a broken hip.

“So even if you feel like you're living with the problem and managing it, we always recommend trying to treat it.”

People who experience intermittent or daily vertigo episodes should have an examination by an otolaryngologist, he said.

Warning: If you or someone you know is having sudden balance issues combined with other signs of stroke, call 9-1-1 immediately.