Why am I dizzy? Is it BPPV?

Someone recently asked about the treatment for the other 2 canals in the inner ear and if the Epley maneuver work for those types of BPPV.

The quick answer is no the Epley maneuver does not work for horizontal or superior canal BPPV but only for the more common posterior canal form of BPPV. The good news about that, however, is that those other two types are easier to treat.

First – superior canal BPPV is theoretical and may not actually exist in any significant clinical form. This is because BPPV is caused by the settling of lose “otoconia” in the inner ear. This can only happen in the lowest areas of the inner ear. For example – dust does not settle on the ceiling, rather it settles on the floor. The same is true of the inner ear. The particles settle, typically in the posterior canal because it is the lowest area and it is not tipped upside down by regular activity. By contrast – the superior canal is emptied every time you lie down and stand up. So, while it is possible to have crystals in that canal, it is not possible to have then “get stuck” there and cause BPPV.

The same is true, to some degree, with the horizontal canal. Whenever you roll over (like a log roll) the canal is emptied. So many times simply sleeping at night (when you may roll over) is curative for that condition. It is, however, more intense vertigo than posterior BPPV. It is worth noting that horizontal BPPV can sometimes be induced by the treatment maneuvers for posterior BPPV as the crystals may fall out of the posterior canal and temporarily fall into the horizontal canal.

Finally, posterior BPPV is the most common kind as the anatomy of the canals allows for collection of the crystals in the lowest part of the ear. In addition, neither rolling over nor lying down and getting up again will cause the crystals to empty out. The main treatment for this condition is the “particle repositioning maneuver” or Epley maneuver.

If you are having symptoms which don’t fit the norm make sure you discuss them with your own physician.

We recently were asked: “I think that I have Mal de Debarquement syndrome. I believe this because I tend to get it after train travel. In the past it took 6 weeks for it to go away. Now, it seems to be taking longer. Does the Epley maneuver work for this?”

Until recently very few people knew about Mal de Debarquement syndrome. This syndrome can occur after any type of travel. The best analogy is sea sickness. When you first step onto a boat you might feel sea sick due to the constant motion of the boat. After a few days you get used to it and the sensation goes away. However, the same can happen when you get off the boat. The land may feel like it is moving. Anyone who has used roller skates, skis or ice skates can attest to how strange it feels after a few hours of skating or skiing and then returning to your street shoes. The same is true after getting off a boat. It may take hours to weeks to get used to land. In some people this adjustment never happens and they feel sea sick on land forever. We call this Mal de Debarquement, or sickness after disembarking.

Mal de Debarquement and BPPV can be differentiated in a couple of ways.

1)BPPV is positional in onset meaning that it will not occur unless you move into a certain position.
2)BPPV is also short lived rather than continuous. Mal de Debarquement syndrome should be continuous.
3)Mal de Debarquement can occur, and perhaps be worse, when stationary. It is the sensation of motion where there is no actual motion. This is different than BPPV which is the sensation of spinning (either you spinning or the world spinning around you)

The Epley maneuver or devices which assist with the treatment maneuver only work with BPPV. That is not to say that you cannot have both, but we always suggest you see your own doctor and get a diagnosis of BPPV prior to using any treatment method.