My friend, whom I will call Sue, is in her late 70s. She recently turned over in bed onto her left side and got very dizzy. She felt like the room was spinning. This persisted for less than a minute, but when she slowly got out of bed, she also felt nauseous.
Over a span of four decades, this was the fourth time something like this happened to her. Sue instantly recognized the symptoms and knew they would recur multiple times a day until she got help.
Many years ago she saw an ear, nose and throat (ENT) doctor who performed a certain maneuver in his office that helped resolve her issue. However, that ENT doctor has since retired. When she tried to make an appointment to see a different ENT physician, she found out it would take two months and was instead put on a waiting list. Sue began to consider other options.
The complaint of dizziness has always triggered a whirlwind of diagnostic possibilities for me. When I started my medical career at Kaiser South San Francisco, I had a large number of Filipino patients. Frequently, dizziness was on their list of concerns. Not understanding what to make of it, I would thoroughly evaluate their complaints. It took me many months to realize that the complaint of dizziness in my Filipino patients actually meant that they felt woozy, light-headed or simply unwell.
Occasionally, there is a different presentation in a patient with dizziness: Someone, like Sue, who upon turning their head after waking up in bed, develops a terrible feeling of the room spinning. Typically, this sensation lasts less than one minute but then recurs throughout the day with certain head movements. Sometimes, it is associated with nausea and vomiting.
The name for this condition is benign paroxysmal positional vertigo (BPPV). For some patients, it is moderately annoying. For others, it is quite debilitating.
There are two main types of dizziness: One is a nonspecific feeling of lightheadedness. The other is vertigo.
The symptom of lightheadedness can be minor or very serious. Minor conditions might be due to getting up too quickly from a seated or lying position, hyperventilation, the effect of having one too many alcoholic drinks, a side effect of medication or a simple matter of sleep deprivation. If lightheadedness persists, it should always be checked out. I have seen serious cases of lightheadedness due to gastrointestinal bleeding or abnormal heart rhythms that patients were unaware of.
Vertigo, which is the other type of dizziness, is a sensation of spinning. It is a symptom, not a diagnosis. Anyone can experience vertigo by turning around rapidly many times.
From my experience, the most common cause of vertigo is BPPV. In a survey of 5,000 Germans, BPPV was shown to increase with age. It was seven times more common in those who are 60 and older, compared with those who are 18 to 39. It was also two to three times more common in women than in men. And for some reason, osteoporosis is associated with developing BPPV.
BPPV is attributed to the displacement of calcium carbonate crystals in the semicircular canal of the inner ear. Most cases of BPPV are idiopathic, or arising spontaneously without a known cause.
Known causes of BPPV include prior head trauma or whiplash injuries, an ear condition called Meniere’s disease, herpes zoster, prior ear surgery, migraine, stroke and sudden hearing loss. The median duration of BPPV is around two weeks. But if symptoms persist or if they are associated with other neurological symptoms, you should be evaluated to see if something else is going on.
I recall one patient in his late 60s who called me because he thought he’d had BPPV for two days. But when he mentioned that he had loss of balance, I saw him immediately. His neurological exam was abnormal, and an immediate brain scan unfortunately showed a small brain tumor in his cerebellum.
Treatment for BPPV usually involves particle repositioning maneuvers. The most successful one is called the Epley maneuver. In one study of nearly 1,000 patients, a single maneuver was effective in 85% of patients. If you are interested in doing the Epley maneuver at home, here is a helpful YouTube video:
Getting back to Sue: She thought about doing the Epley maneuver at home, but it seemed too complicated. Fortunately, one week after the onset of her symptoms, Sue was able to get an ENT appointment when another patient cancelled.
The ENT doctor identified the problem as arising from Sue’s left ear, so she performed the Epley maneuver three times, focusing on Sue’s left inner ear. The day after her ENT appointment, Sue turned over in bed and she no longer felt dizzy. Sue was also given a referral to see a physical therapist who specializes in treatment of inner ear disorders.
As Sue’s story illustrates, BPPV can be successfully treated most of the time. If you have doubts about what is causing your dizziness or if you have lingering BPPV, it’s important to see a doctor. Hopefully you can see one in a timely manner.