An Easy Fix for
J
oe Bayer said it best when he described lying down for bed as being on a “merry-go-round.” “You’re sitting perfectly still, but everything around you looks as if it is spinning out of control,” Joe says. Joe was suffering from BPPV, otherwise known as benign paroxysmal positional vertigo, a vestibular disorder that is the most common cause of vertigo. With this condition, one feels a false sense of spinning. This usually occurs when someone moves their head, such as when they look up, tilt their head, lie down, or roll over in bed. Someone with BPPV may also experience symptoms like vomiting, loss of balance, and nausea. Though not life-threatening, BPPV can be frightening due to its paroxysmal, or sudden, onset.
An Inner Ear Issue
In the inner ear, complex mechanisms of canals, nerves, crystals, tiny hair cells and fluids serve as part of the body’s balance system. BPPV occurs when those crystals become dislodged and find their way into one or more of the three semicircular canals in the ear — this interferes with the normal fluid movement that these canals use to sense head motion, which then results in confusing signals to the brain. The dislodging of the crystals can sometimes be associated with a head injury, migraine, inner ear infection or disease, diabetes, or osteoporosis. However, Boone Therapy Physical Therapist Rachel Beanland says the vast majority of the cases she sees happen for no apparent reason. “Most times patients simply lie down for bed or stand up from lying down and notice the room is spinning,” Rachel says.
Diagnosing and Treating BPPV
In 2020, Joe came to Boone Therapy after the spinning sensation became unbearable at night. “Joe had nystagmus, which confirmed he had BPPV,” Rachel says. Nystagmus is a rapid, involuntary movement of the eyes. A medical professional can watch for nystagmus with tests like the Dix-Hallpike, which involves holding the patient’s head and having them lie back on a table quickly, with their head tilted to one side and slightly lower than the shoulders. The Dix-Hallpike allows gravity to move the dislodged crystals and trigger vertigo. If the condition is confirmed, a physical therapist can reposition the crystals or otoconia in the inner ear with a simple procedure known as the Epley maneuver, or canalith repositioning. “The maneuver moves the crystals out of the canals so they stop causing symptoms,” Rachel says. The Epley maneuver is a series of rapid changes in the position of the head. It’s similar to the Dix-Hallpike test — the Epley maneuver follows the final position of the Dix-Hallpike test – but involves an additional rolling of the body to one side while the patient’s head is held in position. The maneuver is repeated three to four times. If a patient doesn’t get full relief from the Epley maneuver, Rachel says other maneuvers can work depending on the canal the crystal is in.
20
BOONE HEALTH
Summer 2021
