What is vertigo?
Do you have vertigo? This is how doctors break down dizziness into three subcategories:
• presyncope – feeling faint or light headed
• disequilibrium – feeling off-balance
• and the more familiar vertigo, defined as the sensation of motion where none actually exists.
Different people experience vertigo in different ways; for some the world might be spiralling around them and others might be spiralling around the world.
Usually, vertigo sufferers can blame their ears, where the balance organs are located, for the unsettling sensations.
Approximately 40 percent of us will suffer from dizziness at some point, and within that group, as many as 42 percent will have benign paroxysmal positional vertigo (BPPV), which is the most common cause of ear-related spinning sensations. (Is your dizziness caused by drinking alcohol? Here’s what to do.)
“The median duration of a single episode of BPPV is two weeks,” says Dr. Matthew Bromwich, an ear, nose and throat (ENT) surgeon and assistant professor of otolaryngology at the University of Ottawa. “Basically, for two weeks, every time you look up, roll over or bend down, you get a spinning sensation lasting for seconds to minutes. It’s very irritating and it can be quite disabling.”
What causes vertigo, specifically BBPV?
What kick-starts this cranial merry-go-round is the balance system in our inner ears. It is made up of gravity sensors (called otolithic organs) and rotation sensors (semicircular canals). (Find out what it means about your health when your ears are ringing.)
Otolithic membranes called saccule sense acceleration through tiny crystals of calcium carbonate, which are stuck to a gelatinous mass containing hair cells. These hair cells bend in different ways, sending signals to your brain that indicate your body’s speed and orientation.
The semicircular canals are fluid-filled tubes with similar hair cells that sense rotation. The problem begins when those calcium crystals dislodge, sending your brain a clash of signals that tell it that you’re rotating even when you’re still.
For the one in 10 people over the age of 60 affected by BPPV, the calcium crystals dislodge because of age and general wear and tear on the ear.
BPPV is also quite common after a car accident or some form of head trauma – either the crystals have been shaken loose by the force of the accident, or the trauma leads to inflammation in the ear, which causes the crystals to dislodge. People with inner-ear infections have similarly inflamed ears and are also more likely to suffer from BPPV.
How to tell if you have BBPV
While Bromwich says BBPV causes no serious repercussions to your health, the spinning sensation can be annoying and debilitating. The good news is that the condition is fairly simple to resolve. So how do know if what you’re feeling is vertigo?
“People can almost make their own diagnosis,” says Bromwich. “There’s a manoeuvre called the Dix-Hallpike, where you lay down with your head hanging over the end of your bed. That’s the most stimulating position for this disease.” (Yoga has a lot of benefits, but here are the top three.)
If you turn your head to the right and experience dizziness, you likely have BPPV in your right ear. If you turn to the left and start spinning around: BPPV in the left ear. Keep in mind that this manoeuvre only works if the cause of your vertigo is BPPV, so it’s best to visit your doctor for an accurate diagnosis. (Don’t miss these thyroid facts everyone should know.)
Treatment for BBPV
Sedatives such as Ativan or Lorazepam are commonly prescribed, because they mask the symptoms of BPPV. They don’t, however, affect the course of the disease.
For people with severe vertigo, brain surgery may be required, although it’s only recommended for those with highly recurrent, entirely disabling episodes.
How to deal with vertigo
For up to 95 percent of sufferers, the most effective treatment is the Epley manoeuvre, a non-pharmaceutical procedure discovered fewer than 20 years ago. In fact, because the manoeuvre is still relatively new, patients see an average of three doctors and incur average costs of $2,600 in prescriptions and missed work before they receive the proper treatment, according to a U.S. study.
“The Epley manoeuvre is a way of rolling the patient such that you get those crystals from the semicircular canal back to the saccule, where they’re supposed to be,” Bromwich describes.
The entire process takes a matter of minutes and is so straightforward for a doctor to administer that Bromwich designed an iPhone app – called DizzyFix – that walks physicians through the manoeuvre.
“It’s exactly like that game with a maze and a ball in it, only instead of a maze, it’s a floor plan of your inner ear,” he explains. “The iPhone is gravity sensitive, so by placing the phone on the patient’s head, you get immediate feedback as to whether you’re doing the manoeuvre right.”
As recurrence rates for BPPV hover around 60 percent, Bromwich also developed a device that Health Canada has approved for home use (also called DizzyFix) that patients who suffer from the condition can purchase help them to complete the Epley manoeuvre independently.