By Dr Harold Gunatillake, FRCS.

I am sure that some percentage of readers of this article would have had one or more attacks of vertigo (spinning) at some stage in their lives. It is on record that 40% of Americans do suffer from benign paroxysmal positional vertigo (BPPV). These attacks involve brief episodes of intense dizziness when you change the position of your head. Your surroundings appear to be moving either vertically or horizontally. This invariably occurs whilst turning your neck in bed, and rarely whilst standing completely still, walking or in the sitting position. Some people feel that they are actually spinning. The effect may be slight and only just noticeable, or it may be so severe that you fall to the ground. The condition is more common among the older people, mostly men than in women. Everyday activities like turning in bed, looking up or bending forward, especially if performed quickly, will trigger vertigo, often nausea and occasionally vomiting. BPPV can come in bouts lasting several days to many months. It may resolve for no apparent reason only to return again at some time in the future. The condition does not respond to medication like Serc, Stugeron, and stemetil, though they may give relief from nausea and general malaise. These medications themselves can have side effects, and driving a car or working on machinery is harmful.

Vertigo is more severe than dizziness, which is often experienced as a feeling of light- headedness when you stand up.

Mild vertigo is very common and symptoms are not serious. It is not a disease. However, recurrent or persistent vertigo could be caused by an underlying condition. You should see your GP to rule out a more serious cause and to get treatment.

This problem results from a problem with the nerves and structures of balance mechanism in your inner ear (vestibular labrynth). It occurs when calcium carbonate particles normally contained in a sac called utricle gets loose and fall into the wrong part of the three canals of the inner ear, producing an episode of dizziness. As these crystals move about inside the inner ear, they distort the information generated by this system to the brain. The result is a disruptive dizzy sensation of short duration.

These three canals positioned in different directions, are called Semicircular canals because of its shape. They communicate with the vestibule, which is a part of the vestibular labrynth.

Fortunately there is a simple way to treat this condition by self to relieve the symptoms, such as spinning and dizziness.

The crystals, which cause the distorted information, are relocated within the system to a section (utricle) where they do not move and therefore no longer cause the disturbance for a while. The manoeuvre is called the canalith repositioning procedure. The doctor, or the physiotherapist, in the office, demonstrates this. This procedure consists of several simple head manoeuvres. As mentioned the goal is to move particles from the fluid filled semicircular chambers of your inner ear into tiny bag-like structure (utricle) where these particles don't cause trouble or will be reabsorbed by fluids of your body. Each manoeuvre is held for about 30 seconds.

Canalith repositioning procedure

(Courtesy- Mayo Foundation for Medical Eduction and Research)

Step 1

First, you move from a sitting to a reclining position. Your doctor will help extend your head over the edge of the table at a 45-degree angle.

Step 2

Next, with your head still extended over the edge of the table, your doctor will prompt you to turn your head to the right about 90 degrees.

Step 3

Next you roll onto your side. Your head should be slightly angled while you look down at the floor.

Sttep 4

Finally, you return carefully to a sitting position and then tilt your head down.

After the procedure, you must keep your head upright for 48 hours, even as you sleep.

This allows time for the particles floating in your vestibular labrynth to settle into your utricle or be reabsorbed by your body fluids.

You may need to wear a neck collar to prevent tilting your head. It may be necessary to repeat the procedure several times.

These manoeuvres may bring about sensation of vertigo, and discomfort, but should not cause pain.

The next 48 hours is crucial. Keep the head upright most of the time. Continue to be cautious and try not to perform the activities, which cause the vertigo. When reclining, keep the trouble ear on top. (When you turn your head during above manoeuvres you will notice that the vertigo triggers only when moving to the side of the trouble ear.)

Use several pillows. Do not lie flat. Move slowly and not into positions which normally cause vertigo. Again, this is necessary for two days; this allows gravity to pull the particles away from the problem area.

The following self-help techniques may relieve or prevent the symptoms of vertigo:

• Sleep with your head slightly elevated on two or more pillows.
• In the morning, get up slowly and sit on the edge of the bed for a minute before standing.
• Avoid bending down to pick up items.
• Avoid extending your neck, for example, while reaching up to a high shelf.
• Move your head gently and slowly when at the dentist, hairdresser, or during activities where your head is lying flat (horizontal) or the neck is extended.

Diet

Avoid foods containing high sugar or salt content. Foods with complex carbohydrates with lower glycaemic index, such as legumes and whole grains are better choices.

Drink adequate amounts of fluid daily. Avoid foods and beverages with caffeine. Limit your alcohol consumption.

Avoid aspirin and non-steroid anti-inflammatory drugs such as brufen, voltaren. Avoid nicotine

When you suffer from BPPV you must see your doctor first. He will do certain investigations to rule out other conditions that cause vertigo. Correct assessment and diagnosis are most important. The treatment is not difficult but it should be demonstrated and taught by a trained medical professional, as it must be done properly in order to be effective.

The author has not discussed the other causes of vertigo.

Ref: Brochure on BPPV prepared by Kathee De Lapp, St Vincents Hospital, Sydney

www.nim.nih.gov/medlineplus , 25 May 2006

Diagrams provided by the author.