Why am I dizzy? Is it BPPV?

BPPV can affect people of any age as everyone has the otoconia (ear crystals) which causes BPPV.  These otoconia are a normal part of the balance system.  Most children with BPPV have recently been in some kind of accident where there is a degree of head injury. It is not clear if the injury shakes these crystals loose or if blood gets into the canals and causes the crystals to come loose, or if the blood itself causes the symptoms.  Most children with post traumatic BPPV seem to do well and accommodate quickly to the symptoms and respond well to treatment.

BPPV (Benign paroxysmal positional vertigo) in children can easily be confused with BPV of Childhood (Bengin paroxysmal vertigo) which is actually a migraine related phenomenon.  It is unfortunate that the names are so close as they are not related disorders.  The primary distinguishing difference is that BPPV can be brought on with position change and is due to otoconia whereas BPV is often associated with headache and not affected by position.

BPPV is most commonly seen in people over the age of 60 as they are most likely to have age related changes to their ears which causes the otoconia to come loose.  While it is possible to see BPPV in children it is uncommon and often short lived.  Careful attention should be paid to differentiate causes of vertigo in all patients.

After being diagnosed with BPPV many people report mixed feelings.  First – relief at not having a brain tumor or stroke, second – happiness that there is a treatment and third – discomfort with having a chronic disease.

BPPV is indeed a chronic disease.  The otoconia, (normal balance crystals) which cause the symptoms of BPPV when in the wrong place, do not disappear when treated with the Epley Maneuver or with home BPPV treatment, rather the particles are moved.  More than 50% of people will have BPPV more than once and many will have it on a regular basis and some will even have it daily, even if treated properly.

The key to successful treatment of BPPV is to understand how to identify it and how to properly treat it.  BPPV is characterized by sudden spinning, which is short lived and comes on only in certain positions.

Following treatment most people obtain resolution of symptoms immediately.  Even in the worst of cases some duration of symptom free period can be achieved.  Many people report recurrent symptoms within weeks or months of the original attack.

Patients with BPPV on one side often are at risk of having it on the second side. There is no know family predeliction to BPPV.  Rates of BPPV also increase dramatically with age to more than 1 in 10 over the age of 60.

Although most people with BPPV can be treated with the Epley maneuver or a home treatment device.  About 5-12% of people cannot be treated.  There are several reasons which should be carefully considered.

1) You do not have BPPV.  There are many kinds of vertigo and only BPPV will respond to the Epley maneuver.  You should always get a proper diagnosis from a physician qualified to diagnose BPPV.  Several serious conditions can cause vertigo as part of their symptom complex and these other conditions should be ruled out.

2) You have BPPV but are doing the maneuver incorrectly.    This is actually the most common reason for treatment failure in people with BPPV.  This may be because you are treating the wrong side or may be because you are performing the maneuver too quickly, with the wrong angles or in the wrong order.  The maneuver is only effective when performed totally correctly.  A BPPV treatment device to assist in the correct performance of the maneuver is available and will visually guide a person through the maneuver.

3) You may have a resistant form of BPPV.  This may be due to the fact that the otoconia, or ear crystals, get stuck in the balance canal or that they get glued to the end of the canal. It is not clear which is true but it seems that some people don’t respond whatever they do.

4) You may have BPPV in both ears.  Due to the nature of BPPV if you have it in one ear it is certainly possible to get it in both ears.  Typically this will present with symptoms on both sides.  A physician can tell you if this is the case.  The Epley maneuver will still work but you will have to do it on both sides.  People often ask if doing one side and then the other will reverse the benefit of the first maneuver. It is not clear that this is true however, we always tell people to treat one side one week then the other side the next week.

With these issues in mind it doesn’t hurt to perform an Epley maneuver in a repeated fashion, it might help but this cannot be guaranteed.    The only caution is that if you have symptoms which do not seem related to BPPV such as weakness or confusion you should seek medical attention.

As we have talked about there are various kinds of “Dizziness”. Sometimes people confuse positional vertigo with motion sickness, because they both happen when in motion.

BPPV is characterized by spinning vertigo when changing into certain positions.  These are typically rolling over in bed, looking up and to the side, or looking under something.  Often it happens on a specific side, either left or right, although some unlucky people have BPPV on both sides.  Many people who have BPPV are afraid to travel in case an attack comes on while away from their own physician.  Devices for the treatment of BPPV are available to take with you when away from home.

Motion sickness is a sensation of “Disequilibrium” or being off balance, or feeling like you are moving when you are not.  It is caused by a disjunction between what you see and what you feel, or between what you feel and what your ear is telling you.  A good example of this is when the car beside you at a traffic light rolls backward and it makes you feel like you are rolling into the intersection (your eyes tell you that you are moving but your body and balance organ say you are still).  Not only is this a bit anxiety provoking but it often causes an uncomfortable sickness feeling of disequilibrium.  Another good example is the familiar sensation of reading in a moving car.  Your eyes tell you that you are sitting still, since you are looking at a book, but your ear and body tell you that you are moving.  It is this disjunction that is the culprit in motion sickness.

There is also an under-diagnosed but interesting phenomenon called “Mal de Debarquement” syndrome.  Everyone has heard of sea-sickness (a type of motion sickness) but this happens when you get off the boat.  Typically the individual has not had sea-sickness and is the envy of everyone else until they step back onto dry land. Then they still feel like they are on a boat.  In some cases this is temporary but in others it is permanent.  These people may be seen swaying down the streets as if on board a boat in rough seas.  It is a difficult and very frustrating problem for which there is currently no cure.

In general, traveling with vertigo can be scary.  Tips on traveling can be found at http://jetseventravel.com.  In order to overcome vertigo and get back to living your life, learn as much as you can about your own condition and travel with adequate preparation.  For example, if you get motion sick bring anti-nauseant medication (Gravol/Antivert/Dramamine), if you have Menieres disease, Serc can be useful, and if you have BPPV learn the treatment maneuver or take a self treatment device with you.