• Benign Positional Vertigo

    (the following text is a reprint of an article appearing in a Lahey Hospital & Medical Center newsletter)

    For people with a common form of dizziness called benign positional vertigo, everyday activities can send their heads spinning and their stomachs churning. Fortunately, two new simple procedures can cure about 80 percent of cases.

    Dizziness is one of the most frequent reasons patients visit the doctor, especially patients over the age of 75. Between eight and 25 percent of people who suffer from dizziness have benign positional vertigo, which accounts for 160,000 new cases of dizziness in the United States each year. Those afflicted with it experience abnormal sensation of movement, which is described as a spinning sensation often accompanied by nausea. The symptoms may be brought on by bending over, lying in bed looking upward or rolling over. While not life-threatening, the condition can severely affect the quality of life. "People have trouble sleeping if every time they turn over, they get dizzy," says Lahey Medical Center otolaryngologist Judith White, M.D., Ph.D. "They often begin to limit their activities because they're not entirely sure what's making them dizzy."

    Benign positional vertigo is caused by a problem in the inner ear. In the ear, three fluid filled semicircular canals shaped like Hula Hoops are positioned along the three axis on which the head turns: up and down, side to side and front to back. As the head turns, the fluid moves against hair-like sensor cells, which tell the brain the head's position and help give us a sense of balance. In benign positional vertigo, due to a blow to the head or just the natural aging process, particles in the inner ear break off and accumulate in one of these semicircular canals, where they tug on the sensor cells and cause the sensation of dizziness.

    Anyone experiencing dizziness should visit his or her doctor. Physicians diagnose benign positional vertigo by having patients perform a number of positional maneuvers to see if they provoke dizziness. They also try to rule out other conditions that might be causing dizziness, such as inner ear inflammation, strokes, certain heart problems and certain blood pressure abnormalities.

    Until recently, there was little that doctors could do to treat benign positional vertigo. Since the condition is self-limiting, lasting about six weeks on average, doctors often told patients to "ride it out" and the symptoms would eventually go away. Sometimes sedatives would ease the symptoms, but they often left patients feeling sleepy.

    Canalith Repositioning Procedure 

    In the last few years, understanding of the condition has improved dramatically and there are now two highly effective treatments. One is the canalith repositioning procedure (see image), which moves particles out of the semicircular canal. It can be done in the doctor's office in about ten minutes, but for the next 48 hours, the patient must keep his or her head upright, even during sleep, to allow the ears' natural enzyme system to remove the particles. The procedure cures about 80 percent of cases.

    The other treatment is an ongoing exercise program prescribed by a licensed and trained physical therapist. The therapist assesses the patient's overall balance and the severity of the patient's dizziness in various positions. An individualized program of exercises is developed for the patient to perform at home for ten minutes, twice a day. These exercises help the patient adapt to various positions and also improve balance and hand and-vision coordination. Although this approach takes longer to relieve symptoms, it is just as effective as the canalith repositioning procedure over the long run.

    According to Dr. White, the choice of treatment usually depends on the patient's preference: "Some patients, particularly those who have traveled a long distance, are interested in having their symptoms fixed immediately. And in that case, the canalith repositioning maneuver is usually what they're interested in," she says. "However, it does involve a change in lifestyle for the following 48 hours, mainly because of the alterations in normal sleeping, where you have to be semi-upright. For some, that isn't very practical and they prefer the exercise route."

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