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Doctor, everything is spinning! Why am I so dizzy?

Dear friends.


Welcome Back to TGIF Dr Euan's blogpost!



Have you ever been affected by sudden short bursts of VERTIGO? Like the whole room starts to spin when you get up from bed? Sometimes, it can be triggered by sudden head/neck positional changes, e.g., during a hair shampoo at your hairdresser.


It may be due to BPPV or Benign Paroxysmal Positional Vertigo.


Q: WHAT IS BPPV?


Benign paroxysmal positional vertigo (BPPV) is characterised by paroxysms of vertigo triggered by head position changes in the direction of gravity. BPPV is explained by the migration of degenerated otoconia into the semicircular canals, rendering them sensitive to head motion.


BPPV is the most common cause of dizziness/vertigo worldwide with a lifetime prevalence of 2.4%, a 1-year prevalence of 1.6%, and a 1-year incidence of 0.6%. BPPV accounts for 24.1% of all hospital visits due to dizziness/vertigo. BPPV is most common in elderly women with a peak incidence in their sixties and a women-to-men ratio of 2.4:1. Recurrences of BPPV are frequent with an annual recurrence rate of 15–20%


or year

Q: WHAT ARE THE SYMPTOMS OF BPPV?


BPPV symptoms include any of the following:


  • Feeling like you are spinning or moving

  • Feeling like the world is spinning around you

  • Loss of balance

  • Nausea and vomiting

  • Hearing loss

  • Vision problems, such as a feeling that things are jumping or moving


The spinning sensation:

  • Is usually triggered by moving your head

  • Often starts suddenly

  • Lasts a few seconds to minutes


Certain positions can trigger the spinning feeling:

  • Rolling over in bed

  • Tilting your head up to look at something


Image of a patient feeling giddy


Q: WHAT CAUSES BPPV?


In many people, especially older adults, there is no specific event that causes BPPV to occur, but there are some things that may bring on an attack, such as:


  • Mild to severe head trauma

  • Keeping the head in the same position for a long time, such as in the dentist's chair, at the beauty salon or during strict bed rest

  • Bike riding on rough trails

  • High-intensity aerobics

  • Other inner ear disease (ischaemic, inflammatory, infectious)


Q. HOW IS BPPV DIAGNOSED?


Diagnosing BPPV involves taking a detailed history of a person’s health.


The doctor confirms the diagnosis by observing nystagmus — jerking of the person’s eyes that accompanies the vertigo caused by changing head position. This is accomplished through a diagnostic test called the Dix-Hallpike manoeuvre.


Image of Dr Euan examining a patient's ear


The Dix Hallpike manoeuvre targets the posterior semi-circular canal, the most commonly affected canal.


First, the person’s head is turned about 45 degrees to one side while sitting up. Next, the patient is quickly laid down backwards with the head just over the edge of the examining table. This move can often bring on vertigo and the doctor can observe if the person’s eyes show the jerking pattern of nystagmus. A positive response confirms the diagnosis of BPPV.


An MRI or CT scan of the brain is usually unnecessary unless there are other unexplained signs or symptoms.


A doctor’s diagnosis of BPPV can be reassuring, especially when the patient understands that help is available to relieve the symptoms. Even without treatment, the usual course of the illness is that of improvement of symptoms over a period of days to weeks, and sometimes there is spontaneous resolution of the condition.


Q: HOW IS BPPV TREATED?


Your Doctor / Vestibular Therapist may perform a procedure called the Epley manoeuvre. It is a series of head movements to reposition the canaliths of your inner ear. The procedure may need to be repeated if symptoms re-occur, but this treatment works best to cure BPPV.


The Epley Maneuver for BPPV:

BPPV with the most common variant (crystals in the posterior SCC) can be treated successfully — with no tests, pills, surgery or special equipment — by using the Epley manoeuvre.


This simple, effective approach to addressing BPPV involves sequentially turning the head in a way that helps remove the crystals and help them float out of the semicircular canal. Several repositioning manoeuvres performed in the same visit may be necessary.


The Epley manoeuvre and other bedside physical therapy manoeuvres and exercise programs can help reposition the crystals from the semicircular canals. Recurrences can occur, and repeat repositioning treatments are often necessary.


After the Epley manoeuvre treatment, the patient may begin walking with caution. He or she should avoid putting the head back or bending far forward (for example, to tie shoes) for the remainder of the day. Sleeping on the side of the affected ear should be avoided for several days.


If the crystals are in a location other than the posterior semicircular canal, slightly different manoeuvres may be used, but they are based on the same principle of moving the stones out of the offending semicircular canal. BPPV of the anterior canal is exceedingly rare since debris in this canal (located at the top of the inner ear) easily falls out on its own.


Image of Dix Hallpike Manoeuvre


Your Doctor or Vestibular Therapist may also teach you other repositioning exercises that you can do at home but may take longer than the Epley manoeuvre to work. Other exercises, such as balance therapy, may help some people.


Some medicines may help relieve spinning sensations:

  • Antihistamines

  • Anticholinergics

  • Sedative-hypnotics

However, these medicines do not correct the underlying mechanisms of the vertigo.


Vestibular Therapy is STILL the best remedy for BPPV.


Well, I hope this information has been helpful to you and your friends and family.


If you or a loved one are experiencing dizziness or symptoms of Benign Paroxysmal Positional Vertigo (BPPV), don't hesitate to reach out. Early diagnosis and treatment can significantly improve your quality of life and prevent further complications. Contact us today at Euan's ENT Surgery & Clinic  or call 66944282 to schedule an appointment and take the first step towards regaining your balance and well-being.


If you would like to delve deeper into the topic of BPPV, here are some useful references for you!


Have a great weekend!


References:


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