Dizziness, or vertigo, is a fairly common problem affecting 80 percent of people age 65 and older.
Vertigo is a sensation of whirling, loss of balance or lightheadedness often associated with looking down from a great height, standing up too quickly or rotating and tilting the head in certain directions. It may be caused by disease affecting the inner ear, problems in the cervical spine or poor blood flow through the vertebral and carotid arteries that supply blood to the brain.
Conditions causing these symptoms involve the inner ear and include vestibular neurontitis, Meniere’s disease and benign paroxysmal positional vertigo (BPPV).
Vestibular neurontitis is an inflammation of the vestibular nerve believed to be caused by a virus. Meniere’s disease is an inner ear disorder that causes episodes of dizziness (often with nausea and vomiting), hearing loss, tinnitus, and pressure or fullness in the involved ear. Over time, hearing loss progresses and the degree of loss can become severe to profound. Vestibular neurontitis and Meniere’s disease, which require medical treatment, are more uncommon.
BPPV, a common cause of dizziness
The most common cause of dizziness is benign paroxysmal positional vertigo, which, fortunately, is easily diagnosed and treated without medications. Fifty percent of the time dizziness in older people is caused by BPPV, and therefore will be the focus of this article.
Now, let’s break down the somewhat complicated terms of BPPV to be easily understood:
Benign — it is not life-threatening
Paroxysmal — it comes in sudden, brief spells
Positional — it gets triggered by certain head positions or movements, especially turning over in bed or looking up and turning the head such as looking up at a bookshelf.
Vertigo — a false sense of whirling or spinning and loss of balance.
BPPV is a mechanical problem in the inner ear. It occurs when some of the calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle (a fluid filled cavity in the inner ear) become dislodged and migrate into one or more of the three fluid-filled semicircular canals, where they are not supposed to be. When enough of these particles accumulates in one of the canals, they interfere with the normal fluid movement that these canals use to sense head motion, causing the inner ear to send false signals to the brain. Thus the term “rocks in the head.”
BPPV is triggered by certain changes in head position, such as tipping the head up or down. It’s rarely serious unless it increases the risk of falling. People can experience dizziness, a spinning sensation (vertigo), lightheadedness, unsteadiness, loss of balance and quite often nausea, sometimes very severe.
Treatment for BPPV involves a series of head movements that shift particles in the ears and can be performed by any physician familiar and experienced in the procedure. The process is completely painless and takes only a few minutes. As the patient progresses through the procedure, he or she may experience some dizziness and nausea which quickly dissipates. In fact, more than two or three treatments are rarely required to alleviate the dizziness and nausea. In many cases, symptoms that were persisting for months are often relieved in days.
The most severe case I ever encountered was a middle-aged female who presented with neck pain. While taking her history, she never mentioned she was suffering with dizziness and nausea. However, as I began to check the range of motion in her neck, she experienced these very symptoms. After running the simple diagnostic check, it was obvious she was suffering from BBPV. Fortunately, after two treatments her symptoms completely disappeared.
BBPV is very common among middle-aged and elderly patients, is easily diagnosed and responds quickly to appropriate treatment without drugs. Should you experience these problems, ask your doctor if you might have BBPV.