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“Help! The Room is Spinning!”

By Karen Elbert, PT, DPT, OCS

You’re feeling dizzy. Do quick movements of your head or bending over increase your dizziness? How about looking up? Does turning over or getting in and out of bed cause things to spin more?

According to a standardized test known as the Dizziness Handicap Inventory, answering yes to some or all of these questions is a useful predictor for diagnosing a vestibular disorder known as Benign Paroxysmal Positional Vertigo, or BPPV.4 This type of vertigo is easily tested and diagnosed and also can be very easily treated. 

The vestibular system, or inner ear, aids in detecting movement, equilibrium and spatial awareness. The utricle and saccule are two small organs within this system that hold tiny crystals and hair cells which aid in sensing gravity and linear movement of the head.7 We also have semicircular canals filled with fluid which aid in detecting rotational movement.2 Occasionally, the crystals get loose and fall into the canals causing an increase in sensitivity to movement and a spinning sensation with movement of the head or body position changes. 

BPPV happens idiopathically in about 50-70 percent of the reported cases.6 However, it can also occur as a result of injury such as following a fall, car accident or other head trauma. This type of spinning dizziness can be very debilitating, affect your daily life and also put you at a higher risk of falling.1 Research states that around 20 percent of dizziness reported to practitioners is BPPV.3,5 However, it can often be overlooked or misdiagnosed if the correct tests and treatments are not performed.3

If diagnosed quickly and correctly, BPPV symptoms can typically be diminished in one to two visits without expensive testing or medications. There are simple tests and treatments that vary, depending on where the crystals are located within the canals. The treatments involve moving your body in specific positions in order to mechanically move the crystals back to their proper location.6 These tests and treatments should always be performed by a trained professional, such as a physical therapist or physician with specialized training in vestibular rehabilitation. If you are having these symptoms, please make sure to specifically ask if your practitioner is trained in vestibular rehabilitation and treatment. 

There are many other causes of dizziness and vestibular dysfunction that may require further testing or treatment. These include, but are not limited to, labyrinthitis, vestibular neuritis, a perilymphatic fistula, Meniere’s Disease, Mal de Debarque, an acoustic neuroma, or a vestibular hypofunction secondary to other conditions. Dizziness can also be caused by reasons outside the vestibular system, so it is important to consult with a qualified professional when symptoms occur. 

Karen Elbert is a doctor of physical therapy and co-owner of Dynamic Physical Therapy in Palm Desert and can be reached at (760) 501-6655. She is also a member of Desert Doctors. For more information, visit www.DesertDoctors.org.

References:
1) Agarwal, Y., et al. Disorders of balance and vestibular function in US adults: date from the National Health and Nutritional Examination Survey, 2001-2004. Arch Intern Med, 2009. 169(10): p 938-44; 2) Hayes, K. (2021, February 22). Semicircular Canals of the Ear. Very Well Health. https://www.verywellhealth.com/semicircular-canals-anatomy-of-the-ear-1191868; 3) https://dizziness-and-balance.com/disorders/bppv/bppv.html; 4) Jacobson, GP, Newman CW: The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116:424-427; 5) Neuhauser, H. K. and T. Lempert (2009). Vertigo: epidemiologic aspects. Semin Neurol 29(5): 473-481.; 6) Parnes, L.S, et al. (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 169(7): 681-693.; 7) https://www.sciencelearn.org.nz/resources/476-carbonates-in-and-on-the-ear

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