Why do we get dizzy?
Our balance depends on the brain combining information from the balance organ in the inner ear, the eyes, and the sensors in muscles and joints. A problem at any point in this system can cause dizziness. True spinning dizziness (vertigo) most often originates in the inner ear — and its single most common cause is BPPV, popularly known as "displaced crystals".
What is BPPV?
The part of the inner ear that senses gravity contains microscopic calcium crystals. If these crystals become dislodged and stray into the balance canals, head movements make the fluid in the canal move abnormally, producing brief but intense spinning attacks. BPPV stands for benign paroxysmal positional vertigo — the word "benign" emphasizes that the condition is not dangerous.
What are the symptoms like?
The typical complaint is intense spinning — usually lasting less than a minute — triggered by turning over in bed, lying down or sitting up, or moving the head up and down. Nausea may accompany it; hearing loss or ringing are not expected in BPPV. A short-lived sense of unsteadiness can remain between attacks.
Diagnosis and treatment
Diagnosis is made from the history and positional tests during the examination (such as the Dix-Hallpike test); observing the dizziness and the eye movements during these tests shows which canal is affected. Treatment is highly effective: repositioning maneuvers (the best known being the Epley maneuver), performed during the examination, carry the crystals back to where they belong, and most patients improve markedly within one or two sessions. Medication does not cure BPPV; it is used only briefly to ease accompanying nausea.
When is further investigation needed?
If dizziness is accompanied by hearing loss, ringing, severe headache, double vision, slurred speech, numbness or weakness of the face or limbs, or if the spinning lasts minutes to hours, causes other than BPPV must be investigated. Dizziness with these features requires prompt medical attention.
This article is for general information purposes only; please consult your physician for diagnosis and treatment.