When my cousin Ellie got up one morning, she felt like the room was spinning all around her. She was nauseous and felt she had no balance. Panic-stricken, she made an appointment with her doctor. Her diagnosis: benign paroxysmal positional vertigo (BPPV). Dizziness is one of the most common reasons for people to visit their doctor, according to the Mayo Clinic. Vertigo is a frequent cause of dizziness and BPPV is the major type of vertigo.
What is vertigo?
Vertigo is the feeling that the surroundings are moving or the room is spinning around you. It is a temporary disturbance of the balance structures in the inner ear caused by BPPV, migraine, inflammation of the inner ear, excessive fluid in the inner ear (Meniere’s disease), or a noncancerous growth on the vestibular nerve (acoustic neuroma). Women are twice as likely to suffer from BPPV, the most common type of vertigo, as men. BPPV can cause nausea and vomiting and last for minutes, hours, or intermittently for weeks. After treatment, BPPV may still recur, as Ellie found out.
Causes of BPPV
The inner ear controls balance by communicating via nerve impulses with the brain. BPPV is caused by bone-like calcium crystals breaking off and floating in the inner ear, causing the nerves to send confusing messages to the brain. In people under the age of 50, BPPV is often caused by some type of head trauma, such as banging the head on a hard surface. It is not known what causes BPPV in older people. The incidence of BPPV increases significantly in people, especially women, over 60 years in age.
Link to osteoporosis
A study, published in the journal Neurology in 2009, found that people with osteoporosis were three times more likely to have vertigo or BPPV than people without osteoporosis. Twenty-five percent of women with vertigo had osteoporosis and another 47 percent of women with vertigo had osteopenia (low bone density), while only nine percent of the study subjects without vertigo had osteoporosis and 33 percent had osteopenia. Although osteoporosis overall was lower in men, men with vertigo had a higher incidence of osteoporosis. The researchers suggest that the link between BPPV and osteoporosis may indicate a problem with calcium metabolism.
Ellie was successfully treated in her doctor’s office by a physical manipulation, called the Epley Maneuver. The Epley Maneuver consists of a sequence of precise head movements to relocate the calcium particles in the ear. Although the Epley Maneuver can be done at home, it works best with an assistant. Recently, a new exercise, the Half Somersault Maneuver, was developed. The Half Somersault Maneuver is also a home exercise and does not need an assistant. It is very effective and there is less chance of moving calcium crystals into the wrong parts of the ear, which can make vertigo worse.
With any kind of dizziness, or if you suspect you have BPPV, visit your doctor to make sure your symptoms are not related to stroke, cardiovascular factors, or other abnormalities.
Sources
http://www.mayoclinic.com/health/dizziness/DS00435
Jeong, S.H. et al. Osteoporosis in idiopathic benign positional vertigo. Neurology (2009) 72: 1069
http://www.sciencedaily.com/releases/2009/03/090323161107.htm
http://content.karger.com/produktedb/produkte.asp?doi=337947
