Today we’ll talk about the most common cause of vertigo. Vertigo is a symptom, the same as pain or nausea. It is not a disease or diagnosis. Vertigo is the sensation of spinning or moving when you are not actually moving. Vertigo can be caused by many underlying problems, some of which are based in the inner ears.
The most common cause of vertigo is a disorder called Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a problem with the balance organ in the inner ear. The inner ear is filled with fluid. If you remember from the ear anatomy post a few months ago, you’ll remember that the inner ear is composed of the cochlea (the hearing organ) and the balance organ. The balance organ has 3 semicircular canals, all placed at right angles to each other.
As we move our heads around, the fluid in the inner ear lags behind the head movement because of inertia. This fluid lag stimulates cells in the lining of the semicircular canals which then relay messages to the brain that we are moving around.
The problem in BPPV is that small calcium crystals (which normally are attached to the walls of the canal) break off and start floating freely in the inner ear fluid. When this happens, certain head movements and positional changes will cause the calcium crystals to move within the semicircular canal. This creates abnormal signals from the inner ear to the brain that cause you to feel like you are spinning.
Patients with BPPV typically describe spells of spinning vertigo that last a few seconds up to a minute or two. These vertigo spells occur after specific head movements (rolling over in bed is a common trigger). People will frequently complain of associated nausea but not always.
BPPV is diagnosed by the patient history and by physical exam findings, specifically the Dix-Hallpike maneuver. The video below shows the maneuver (ignore the jargon). If you have BPPV, doing this maneuver will cause you to feel dizzy and I will be able to see jerking eye movements (nystagmus). This confirms the diagnosis of BPPV.
If a diagnosis of BPPV is confirmed, I will then perform the Epley maneuver to treat the problem. The Epley is a series of 4 positions which use gravity to move the floating calcium crystals out of the semicircular canal into the utricle/saccule area where they will no longer cause the vertigo symptoms.
I usually instruct patients to repeat the Epley maneuver 1-2 times a day at home on their bed until the vertigo completely resolves. In the vast majority of patients this will not take long.
You should be aware that the crystals can fall back into the semicircular canals due to gravity. The posterior canal is the lowest point in the inner ear when we are laying flat. If this occurs and the vertigo comes back, just repeat the Epley maneuver and it will usually resolve. Over time, the crystals will eventually dissolve away.