Dizzy?! You May Have Positional Vertigo

Recent studies have showed that 80% of of individuals 65 years and older have reported having experienced dizziness. One study estimates that as many as 35% of adults aged 40 years and older in the USA (approximately 69 million Americans) have experienced a form of vestibular dysfunction. This can negatively impact their quality of life as well as put them at risk for falls. Vertigo is the 9th most common complaint to general practitioners and accounts for 20% of diagnoses made by doctors specializing in vestibular disorders (ENT, Audiologists). Vestibular dysfunction can be produced by a variety of different causes: dislodging of particles in the inner ear, inflammation of the inner ear and/or nerves, overproduction of fluid, acoustic neuromas (benign tumors of the inner ear), viral and bacterial infections.

When discussing matters involving the vestibular system often times the words vertigo and dizziness are used interchangeably. In fact, these two symptoms are different and differentiation between them can assist with diagnosis and treatment. Vertigo is a sensation of spinning, this may be an illusion of yourself spinning or the world around you. Dizziness is a sensation of being lightheaded, floating, or rocking.

The most common cause of vertigo is Benign paroxysmal positional vertigo (also known as BPPV). Approximately 50% of the elderly population who complain of dizziness are suffering from BPPV. This particular type of vertigo comes on for no apparent reason but can sometimes be the result of a trauma or whiplash injury. Degenerative changes within the ear or trauma cause particles (commonly referred to as crystals) to dislodge from their appropriate position in the inner ear. Once they’ve become dislodged they are free floating within the fluid of the inner ear. Movement of the head upward, downward, and side to side causes these particles to float from their normal resting area, the saccule, to the semicircular canals. The semicircular canals are lined with hair cells that process the movement of the fluid and tell your brain where your head is located in relation to the rest of your body (for example, your head is now looking downward approximately 45 degrees to read this article). When the particles are within the semicircular canals they brush against the hair cells and cause the brain to misinterpret the information. Typically only one of the inner ears is affected thus, the sensation of vertigo occurs when one ear is reading the hair cells properly and the other is not (because of the particles being misplaced).

BPPV is characterized by a sudden onset of severe symptoms that typically last less than 60 seconds. Symptoms are produced with movement of the head and positional changes. This condition will make it hard to bend forward, turn to look over your shoulder, roll over in bed, look up and down, and go from lying to sitting. As mentioned previously, typically only one of the inner ears is effected so it’s not unusual that these individuals may be able to perform movement in one direction with minimal symptoms while the other direction causes severe symptoms. Symptoms may include but aren’t limited to: vertigo (spinning), dizziness (lightheadedness), nausea/vomiting, fatigue, difficulty concentrating, difficulty walking and imbalance. This disorder can be differentiated from others of the inner because it is intermittent (comes and goes) in nature and is brought on by very specific movements.

In a recent research study performed in Europe, data collected suggests that 86% of individuals with BPPV will seek out medical consultation (general practitioner or specialist), experience interruption of their daily activities, and/or have to take time off from work. Out of that large population, only 8% receive effective treatment for their condition. This low percentage is due to a lack of education on the treatment options for vertigo. A majority of the general public is unaware of the benefits of utilizing vestibular rehabilitation (physical therapy) for treatment of most vestibular dysfunctions. BPPV is the most easily treated vestibular diagnosis because it is mechanical in nature. The golden standard of treatment for this diagnosis is the Epley Maneuver which is 70-90% effective in re-positioning the particles and eliminating BPPV. This maneuver can be performed by trained professionals: physical therapists, vestibular and balance specialist, and Doctors specializing in ENT. The prognosis for this condition is good, and usually requires 4-6 rehab sessions over a 3-4 week period (these numbers can vary).

Please notify your physician if you have any of the following red flags associated with vertigo and dizziness: ringing in the ears, sudden and severe headache (thunderclap headache), blurred vision, difficulty or fluctuating hearing, and slurred speech. These may be signs of a more severe condition and more diagnostic testing may be required prior to starting vestibular rehab.

For more information on other vestibular disorders, the Vestibular Disorders Association’s website is a useful tool (www.vestibular.org).

If you or someone you know is suffering from vertigo, dizziness, or a balance impairment please get in touch with your general practitioner and see if a referral to vestibular rehab (physical therapy) is appropriate for you.

Article written by Dr. Kaitlyn Hamel at Seacoast Spine & Sports Injuries Clinic in Portsmouth, Hampton, and Alton NH. Email with any questions regarding this article and topic: drhamel@seacoastsportsinjuries.com.