A simple solution to a common cause of vertigo is out there, you just have to know where to look

Cindy Hagenbaumer got up in the middle of the night and was heading toward the bathroom when a wave of dizziness almost knocked her off her feet.

“I had to sit on the edge of the bed because the room started spinning so much,” the 53-year-old Naperville woman said.

Hagenbaumer chalked up the swirling sensation to a dip in her blood pressure, something that had sparked dizzy spells in the past.

“I gently poked my husband and told him to go get the blood pressure cuff, it’s happening again,” she said.

A quick check proved Hagenhaumer’s blood pressure was normal.  She didn’t know it yet, but the real problem was buried deep in her inner ear, a part of the body that’s crucial in keeping us steady and balanced.

This portion of the ear contains many miniscule, salt-like crystals.  Injury, infection, aging or other factors can cause these crystals to break free from where they should be and wander into one of the fluid-filled canals in the inner ear.

Quick movements in certain directions can stir up these particles like snow in a snow globe.  Rollin over in bed or bending your head back to reach something on a high shelf can result in a parade of unpleasant symptoms – spinning, lightheadedness, imbalance and nausea.  The sensation might last for a few seconds or as long as a minute.

It’s called “benign paroxysmal positional vertigo,” or BPPB, a common syndrome that’s remarkably easy to diagnose and to treat but is overlooked by many physicians, who are used to breaking our the prescription pad when patients complain of dizziness.

“Doctors will tell you that dizzy patients are their bane – they hate them.  That’s because they don’t know what to do with them,” said Ronna Fisher, and audiologist who recently opened the Center for Balance Disorders at the Hearing Health Center in Naperville.  “The Patients keep coming back and saying they’re dizzy and the doctors keep giving them more medication.”

Drugs aren’t the answer to BPPV, but they’re often foisted on patients anyway.

“A lot of doctors will say, ‘Take Antivert or meclizine (antihistamines used for motion sickness and vertigo) and we’ll see you later,’” said Dr Robert Battista, and ear, nose and throat doctor with Chicago Otology Group in Hinsdale and Evanston.  “I hate to say it, but these are doctors who know about BPPV.  It unfortunately happens too often.”

Dozens and dozens of things can cause dizziness and, more specifically, vertigo, a spinning sensation akin to riding a Tilt-A-Whirl.

Treating and managing patients with vertigo can be “challenging and unrewarding,” wrote an ear, nose and throat doctor in an editorial published last year in the British Medical Journal – with BPPV being a “notable exception.”

“It is a well-defined clinical syndrome with a clear diagnostic test, and a sefe, simple treatment is available that takes five minutes to perform,” said the editorial’s author, Dr. Malcolm Hilton.  “However ‘benign’ the condition may sound, this is not an opportunity to overlook.”

That’s especially true for the elderly, who are particularly vulnerable to falling down due to a balance disorder, Fisher said.

The repercussions can be dire.  Statistics show that an older person who takes a spill and fractures a hip is likely to enter a nursing home within a year, she added.

“Once they fall, their lives are totally different,” Fisher said.  “It’s like it’s all downhill from there.”

In this age of complicated medical procedures and sophisticated pharmaceuticals, treatment of BPPV is almost laughably low-tech.

It calls for moving the patient’s head and body in certain positions to coax the runaway crystals out of the semicircular canal and back to their proper home in the inner ear.

If the treatment works – and medical literature is full of studies that says it does – the crystals stay put and the vertigo goes away.

“It seems hocus-pocus, no doubt about it,” admits James Walsh, a physical therapist with Central DuPage Hospital’s dizziness and balance program at LifeTime Fitness in Bloomingdale.  “But it does work.  I’ve treated hundreds of people.”

The therapy started to gain momentum in the ‘90s and it continues to prove its merit in clinical trials.

A study published in last month’s issue of the American Journal of Otolaryngoly looked at the effectiveness of these so-called repositioning maneuvers in 40 BPPV patients.  Half received legitimate therapy; the remainder, who served as a control group, got sham treatments.  Patients were followed for a year.

After the first week, 95 percent of those who had the real therapy saw their symptoms disappear, compared to only 15 percent of the control group.  At the end of one year, 18 out of 20 people who had genuine therapy had complete relief from vertigo, while the same could be said in only three of the 20 control patients.

Sometimes BPPV symptoms vanish without any treatment.  But they might crop up again months or even years later.

The physicians trained therapists who do the repositioning maneuvers say one or two sessions usually is all it takes to get rid of BPPV.

“Maybe 10 percent of the patients I’ve seen have had to come back,” Walsh said.  “We educate people on how they can actually do the position for themselves so they don’t have to continue to come back.”

While the success rate of repositioning treatments is high, a small fraction of those with BPPV resort to surgery.

There isn’t one single repositioning therapy that works for all patients.  Which maneuver gets used depends upon the location of the errant crystals.

Therapists are able to find the particles’ hiding place with remarkable accuracy thanks to clues that come not from the patients’ ears, but from the eyes.

Clinicians often will use goggles and a computer to track patients’ eye movements as they go from a seated position to lying down, for example.  Specific eye patterns point to which semicircular canal the crystals are in.  That information dictates which maneuver the therapist will use to get the crystals back to the right place.

“If you don’t diagnose it properly and you do the wrong maneuver, you can make it worse,” Fisher said.  “That’s why it’s so important to get the correct diagnosis.”

Even if it looks like a cut-and-dry case of BPPV, clinicians might want to do more balance and hearing tests to make sure there aren’t other problems causing dizziness, too.

Cindy Hagenbaumer was skeptical when her audiologist, Kara Houston, started the repositioning maneuvers on her last month.

“I’m thinking, ‘This is supposed to cure me?’” Hagenbaumer said, laughing.

That night, she lay down to go to bed.  And the room was steady instead of spinning.

“In the morning I got a little dizzy but it wasn’t nearly as bad as it had been,” Hagenbaumer said.

Her BPPV hasn’t been as easy to treat as most others’.  Earlier this month, she had her third session.  But as long as she continues to improve, she said she’ll stick with it.

“It’s just good to know that it’s not something that’s really scary,” she said, “and it’s fixable."

Back to top