BPPV (Benign Paroxysmal Positional Vertigo) is the most common type of inner ear problem, comprising approximately 25% of all inner ear problems. It is caused when crystals in the ear that are supposed to sit on top of the nerve fibers in a jelly like matrix, become loose and start floating in the semi-circular canals of the ear. When this happens, the person can experience a spinning sensation (vertigo) that lasts for seconds and is triggered by changes in head or body position. For instance, it happens when getting in/out of bed, bending over, or tipping your head back.
In answer to the question, “Can people have BPPV in both ears?” the answer is YES. About 40% of people can have it in both ears at the same time. The good news is that if the condition does not go away on its own, it can be treated with maneuvers to guide the crystals back into the part of the ear where they belong.
If you think you have BPPV, I encourage you to find a qualified doctor or physical therapist, who can test to see if BPPV is your problem, and if it is in one ear or both ears. The proper testing leads to the proper treatment, and to the proper cure…
Painting entitled, A Serious Question, by Sergey Solomko
This is a condition that causes dizziness when a person changes position, for example when getting out of bed in the morning, or when standing up from a chair.
I test for this condition with my physical therapy patients in Sarasota, Florida who complain of dizziness when changing positions, because not all dizziness is caused by inner ear problems! The symptoms of orthostatic hypotension are similar in some ways to an inner ear condition called Benign Paroxysmal Positional Vertigo that can also cause dizziness with positional changes, however, the treatments for these two problems are very different.
What happens with orthostatic hypotension?
Orthostatic hypotension is not an inner ear problem. It is caused by dropping blood pressure. When the person sits up, or stands up, the blood drops from their head, and until the body readjusts, the person feels lightheaded and dizzy. If the body doesn’t adjust fast enough, the person could pass out.
What are some factors that could cause orthostatic hypotension?
Low sodium in the body
Poor vascular circulation in the legs
Over medication with cardiac meds meant to control high blood pressure
How is it tested?
The person’s blood pressure is taken first when lying on their back in bed.
Then the blood pressure is taken when they first sit up at the edge of the bed.
Then the blood pressure is taken when they first stand up.
If the blood pressure drops more than 20 mm Hg from one position to the next, then the test is positive.
What can be done to correct orthostatic hypotension?
• A physician should review your medications, especially if you are taking cardiac medications, as they may need to be held or adjusted.
• Sometimes this condition is caused by dehydration, so drinking water is very important!
• Sometimes patients are deficient in sodium, and their body is not retaining the fluids it needs to have good fluid volume.
• Sometimes the vascular vessels in the legs loose their elasticity, and wearing compression stockings can help prevent this shift of blood to the legs when changing positions.
Speak to your physician if you suspect orthostatic hypotension could be causing your dizziness. This is a problem that can usually be corrected.
Painting: Getting Up, by Berthe Morisot 1886
VOR stands for the Vestibular Ocular Reflex. This is basically the coordination that one has between head and eye movements. The way it works is this: when a person is moving their head, the ears send information to the brain to tell the brain how the head is moving. The brain then uses this information to coordinate the eye movements so that the person can stabilize their gaze on an object even though their head is in motion. We do this all the time! For instance, if I am talking to someone, and nodding my head yes or no, then I am using my VOR.
When a person has a weakness in one ear following an inner ear infection, for example, the brain that was used to getting the same amount of information from each ear, realizes that the information from the two ears is no longer balanced. The affected side is not sending the same amount of information as the healthy ear anymore. Initially, this can cause dizziness, nausea, and imbalance. To avoid these symptoms, patients will often avoid head motions. While this may seem logical at first, to continue avoiding head motions only makes the problem worse. You see, the brain needs to learn the difference that now exists between the two ears, and the only way the brain can do this is by experiencing the movement! The brain won’t learn how to recalibrate itself if the person continues to avoid moving their head. By doing the VOR exercise, we force the brain to pay attention to the inner ear information when the head is moving, because the brain must in order to coordinate the eye motions and allow the person to keep their eyes fixed on the target without the target looking blurry, double, or as if it is jumping around…
Initially, this exercise may cause dizziness, or increase the person’s baseline dizziness. The patient should first do this exercise at a slow speed, and for a short duration (30 seconds). That way if the exercise causes dizziness, the dizziness should dissipate in a few minutes after stopping the exercise. With practice, the exercise will no longer cause dizziness or nausea. Once this happens, then we work on increasing the duration of the exercise little by little until eventually they can do it for 2 minutes and feel fine afterwards. At that point, we work on increasing the speed of the head motion, so that the brain learns how to process faster and faster head motions, and not feel dizzy. After that, we move on to other variations. You see, there is a progression to the exercise, and a vestibular specialist will be able to teach you how to do the exercise correctly, and guide you in your journey toward recovery.
Man with His Head Full of Clouds- Painting by Salvador Dali, 1936
This is the title of a radio interview I did on July 1st, 2014 with Heidi Godman on her radio program Health Check on WSRQ Sarasota Talk Radio. She interviewed me, and also my husband Dr. Jack Wazen who is an MD, to discuss answers and treatment advice on balance and dizziness problems. During the podcast, I shared with Heidi how physical therapy can treat these problems, and Dr. Jack Wazen talked about the medical side of diagnosing and treating specific balance or dizziness problems. Conditions we discussed included Meniere’s Disease, BPPV, labyrinthitis, and tumors.
Cilck here to go to the Sarasota Talk Radio WSRQ website, where you can find Heidi Godman’s Health Check program, which was recorded on July 1, 2014. I hope you enjoy listening to the program as much as I enjoyed making it.