Benign Positional Vertigo

It happened to me about 10 years ago. I lowered my head down to sleep after a normal day and WHAM!! I had the most violent and disturbing bout of dizziness I have ever had. My eyes rolled uncontrollably as the room spun around and around with a dizziness intense enough to make me vomit. Following this initial episode I continued to have bouts of dizziness whenever I would lie on my right side or move my head suddenly.

If this experience sounds familiar then you probably have a condition called Benign Positional Vertigo (BPV). It’s a condition that I see quite regularly in my practice. While it is usually distressing for those afflicted it is not serious and is quite easy to treat.

BPV is distinguished mainly by two points.

1. The dizziness associated with BPV is always related to movement of the head or change in body position.

2. BPV dizziness has a fatiguing quality to it. The dizziness is most intense immediately after movement and then fades away.

The inner ear contains structures that give us a sense of position in relation to gravity. These structures are the semicircular canals. There are three canals for each ear positioned perpendicular to one another. This gives us three dimensions of position sense. The canals are filled with fluid and are lined with sensitive hair cells that detect movements of particles suspended within the fluid. The movement is picked up by the hair cells as the particles flow past them. In this way movements of the head are detected and we become aware direction within space even when our eyes are closed.

It is theorized that the intense dizziness of BPV is caused when the particles stick together and form clumps. The clumps act like boulders within the semicircular canals and over stimulate the hair cells as they move past them. No one knows for certain what triggers the clump formation but it often correlates to recent colds or allergic reactions.

Epley’s maneuver is the treatment I recommend to my patients because it is simple to perform and usually clears the dizziness in a matter of days without the need for medication.

The first thing one must do is assess which ear affected. Usually the severe dizziness and eye rolling have a repeating rotational quality. I tell my patients to pay attention to which direction the room seems to spin when the dizziness comes. If it seems to spin to the right, then the right ear is the problem. Conversely, if the spinning is to the left, then it’s assumed the left ear is the one with the clumps. Once the problem side is detected a few simple movements done in the correct order is all that is required.

EPLEY’S MANEUVER

The steps outlined below will be for someone with right ear dizziness.

Step one. (Head Extension-Right Rotation) Lie down on your back and let your head hang off the edge of the bed so that it is tilted back with the head turned to the right so that the right ear is pointing to the floor.

Step two. (Head Extension-Left Rotation) Turn the head to the left from position one until the left ear is pointing to the floor. Remember the head should also still be extended back somewhat.

Step three. (Body Rotation Left) Rotate the entire body to the left until lying on left side with nose pointing to the ground.

Step four. (Sit Upright) In one continuous motion rise from position three until seated at edge of bed.

Perform this series of movements once or twice a day for a week.

That’s all there is to it.

Helpful Tips:

Typically the movements will induce dizziness at every step. Do not rush through the steps. Wait for the dizziness to subside completely at every step before moving on. It is important to not lie down immediately after doing this maneuver. I usually recommend doing this procedure early in the morning, maybe again at noon and then not again until the next day.

If done correctly it should only take three or four days until the symptoms subside.