Vol. 4: Vertigo: I have crystals in my ear??
A couple of years ago as I was waking up one morning I rolled over and felt an intense spinning. I thought “OMG, do I have BPPV?” As a clinician, it’s always bizarre when you have learned a lot about something and then it dawns on you that you have it. I did a self-Dix Hallpike (diagnostic tool) and treated myself using the Epley maneuver. It’s not ideal to treat yourself because there is a reflex in your eye that a trained clinician can observe which helps to determine the course of treatment. However, my self-treatment worked and I immediately felt better! So… What is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is the most common disorder of the inner ear which creates a false sensation of spinning or dizziness. It occurs in 70-80% of concussions and is often overlooked by many providers. In many people there is no specific event that causes BPPV to occur (as described above) but there are some things that may bring on an attack:
Mild to severe head trauma
Keeping the head in the same position for a long time, such as in the dentist chair, at the beauty salon or during strict bed rest
Bike riding on rough trails
High intensity aerobics
Other inner ear disease (ischemic, inflammatory, infectious)
The good news is that with a vestibular trained physical therapist BPPV can be effectively treated!
There are two types of balance organs in the inner ear: semicircular canals and otolith organs. The otolith organs contain tiny crystals of calcium carbonate called otoconia. The otoconia are constantly being shed, dissolved, and replaced by new ones. If too many crystals fall off at one time and you look up or lie down before they dissolve they can fall into one of the semicircular canals. When you rise, they don’t fall out, but rather they fall in and become trapped in the canal. Upon lying down the crystals fall to the lowest part of the canal, which causes the fluid to flow within the semicircular canal. This stimulates the balance nerve (eighth cranial nerve) and causes an intense spinning (vertigo) that lasts a few seconds until the crystals fall to the lowest point. When rising the crystals fall in the other direction which again triggers dizziness. This will continue until the crystals in the canal dissolve or are moved out of the canal with special maneuvers.
The vestibular system monitors the motion and position of the head in space by detecting angular and linear acceleration. There are 3 semicircular canals –posterior, anterior, and horizontal- in the inner ear (on each side) which detect angular acceleration. Stimulation of the semicircular canals most commonly causes “nystagmus” which is a repeated and rhythmic oscillation of the eyes. Determining the direction of the nystagmus is critical to determining which ear is affected and in which canal informing the appropriate treatment maneuver. Although the majority of cases occur in the posterior canal (as in my case), the other canals should not be ignored. Along with determining the appropriate ear and canal, there are two more pieces of the diagnosis: is it cupulolithiases or canalithiasis? Canalithiasis describes free-floating particles within a semicircular canal. Cupulolithiasis describes particles adherent to the cupula of a semicircular canal.
Determining the specific type of BPPV is crucial to determining the appropriate treatment technique and effectively resolving your dizziness. If you think you have BPPV either from a concussion or spontaneously, come on in to Happy Brain Physical Therapy for quick treatment to get you back to life.
Call 203 822 2098 or email us at annie@happybrainpt.com with questions.
or book an appointment online https://happybrainpt.embodiaapp.com/
