Vertigo:  One Cause and Treatment
By Paula Lawrence, PT

The feeling of dizziness, sometimes known as vertigo, can be a challenging problem that greatly impacts a person’s activity level and way of life.  The causes of vertigo are many, from inner ear infections to tumors of the brain.  One common cause of dizziness, or vertigo, is called Benign Paroxysmal Positional Vertigo (BPPV).

BPPV symptoms include dizziness, lightheadedness, loss of balance, and nausea.  Symptoms of this malady are almost always related to a change of position of the head in space.  Often, people will report an onset of dizziness with getting out of bed or rolling over in bed.  Looking upward and tipping the head back also are problematic motions, thus BPPV has been nicknamed “top shelf vertigo.” 

This type of vertigo is thought to be caused by debris which has collected deep inside the inner ear.  This debris has a formal name of otoconia, but is often referred to as “ear rocks.”
The otoconia are actually small crystals of calcium carbonate which are normally a part of the utricle of the inner ear.  If the utricle becomes damaged by head injury, infection, or other disorder of the inner ear, or if the utricle degenerates because of advanced age, the resultant particles can become dislodged and cause symptoms of BPPV.

BPPV becomes increasingly common with advancing age, due to degeneration of the vestibular system of the inner ear.  People under age 50 most often experience BPPV after a head injury.  This diagnosis is made 50% of the time when no known reason can be identified.  Physicians diagnose this condition based on history, physical examination, and the results of vestibular and auditory tests.  “Jumping of the eyes,” or nystagmus, is a characteristic sign of BPPV, especially after changing the position of the head.  Sometimes, an MRI scan of the brain may be done if a brain tumor or stroke is suspected.

 Treatment for BPPV may include motion sickness medications to address the nausea symptoms.  The problems are often known to be intermittent, and in some cases the symptoms will dissipate within six months.  Another treatment alternative includes various kinds of physical maneuvers and exercises that are designed to remove the debris from the back of the semicircular canal in the ear. 

Physical Therapists trained in these maneuvers can both test and treat BPPV with non-invasive positioning techniques.  Goals of these physical therapy measures are to decrease the severity of symptoms, improve a person’s balance and mobility, and increase safety during ambulation and activities of daily living.