Vertigo – The Dilemma And The Cure

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Rolling over to get up out of bed – you’ve done it countless times. Only this time, as you plant your feet on the floor and stand up, it feels like the world is spinning tipped on its side.

You call it dizziness, that sense that you or your surroundings are spinning or moving. Your doctor calls it vertigo, which is the medical term to describe an illusion of movement – often rotating – of the person or the person’s surroundings. And after you answer a few questions, your doctor suspects you may be encountering one of the most common forms of vertigo called benign paroxysmal positional vertigo (BPPV).

The good new is BPPV is generally treatable with a simple in-office procedure. Your sense of balance relies on several images sent to your brain from different locations. Your eyes process visual signals that help you determine where your body is relative to your surroundings. The sensory nerves in your skin, muscles, and joints relay messages to your brain about your movements. And then there is the inner ear, which sends signals to the part of the brain that controls the eye movement so that the image you are looking at stays in focus. It also lets your brain know if you are moving.

Within the inner ear is the organ of balance – the vestibular labyrinth. It consists of the three loop-shaped tubes (semicircular canals) containing fluid and fine, hair-like detectors that monitor head rotation. The semicircular canals attach to a sac-like structure (utricle). Within the utricle are the tiny granules called otoconia which is attached to sensors that help you detect gravity and straight-line motion.

Your balancemay be compromised if: first, your brain is unable to appropriately process signals from your eyes, sensory nerves, and inner ears; second, the message your brain receives from the eyes, sensory nerves, or inner ears are conflicting; and lastly, your sensory system are not functioning properly.

In the case of BPPV, what sets things spinning is the displacement of those tiny otoconia particles come loose, they end up floating in the fluid of semicircular canals, usually in the posterior semicircular canal. It can occur at any adult age, although it is increasingly common after the age of 50. Why it develops is not clear, although it can occur after a blow to the head.

Certain positions and movements such as rolling over in bed, sitting up, looking up, or bending forward, can set the otoconia in motion, pushing the inner ear fluid and bending the tiny hair-like sensors. When this happens, a false signal of movement is sent to the brain. The result is a sudden, short spinning sensation, usually lasting less than a minute. BPPV may also cause some nausea and possibly vomiting, lingering fatigue, queasiness, and a feeling of imbalance. Without treatment, bouts of vertigo due to BPPV may occur off and on unpredictably for weeks or even years.

To help relieve BPPV, your doctor may use a series of maneuvers that move particles from the posterior semicircular canal into the utricle. Each step is held for about 30 seconds. The steps include:

  1. Moving from a sitting to a reclining position. Head is extended over the end of the table at a 45-degree angle.

  2. Turning your head to the right.

  3. Rolling over onto your side. Head is slightly angled while looking down at the floor.

  4. Returning carefully to a sitting position.

  5. Tilting your chin down.


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