Ears, Nose and Throat

Is Your World Spinning Round?

Health Trivia:

Did you know that almost 50% cases of dizziness are due to a condition called Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is one of the most common problems of the vestibular system, and, as Vestibular.org explains:

“The vestibular system includes the parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. If disease or injury damages these processing areas, vestibular disorders can result. Vestibular disorders can also result from or be worsened by genetic or environmental conditions, or occur for unknown reasons.”

Is Your World Spinning Round?

4 days ago I ended up stuck in bed because of vertigo (literally ‘spinning sensation’), severe dizziness and on one occasion, vomiting. It felt like I was inside a spinning wheel uncontrollably being tossed and turned. It was like a magnitude 7 earthquake! It was really terrible. These symptoms are due to my condition called “Benign Paroxysmal Positional Vertigo (BPPV)” It has been almost 4 years, since I last had such a severe attack that pinned me down on my bed.

I was diagnosed with BPPV way back in the early 2000. It started with recurrent ear itchiness and ringing of the ears that triggered symptoms of ear pain and later on moderate to severe dizziness. Then my ENT (Ears, Nose and Throat) doctor took my medical history where I learned that my condition was caused by several factors: one, was my love for swimming, which chronically exposed my ears to chlorine and bacteria from the pool, the doctor called it the “swimmer’s ear”, two, my habit of cleaning my ears everyday made the ear canal very dry which triggered the itchiness, and three, my history of allergy to sudden changes in weather was also one of the culprits. And, I guess now, my age is also catching up with me. Aha!

What Causes Inner Ear Problems?

This is how the Inner Ear looks like.

There are actually many types of vestibular conditions that can cause problems with balance, it can either be physiologic (problem with the structure and function) or pathological (disease process).

Conditions include “benign paroxysmal positional vertigo (BPPV), labyrinthitis or vestibular neuritis, Ménière’s disease, secondary endolymphatic hydrops, and perilymph fistula. Vestibular disorders also include superior canal dehiscence, acoustic neuroma, ototoxicity, enlarged vestibular aqueduct, and mal de débarquement. Other problems related to vestibular dysfunction include migraine associated vertigo and complications from autoimmune disorders and allergies.”

However, and as mentioned earlier, almost 50% of cases of dizziness are caused by BPPV. So, it pays to know your trigger factors and how you can minimize, if not avoid the symptoms.

What are the Symptoms of BPPV?

Vertigo is the distinct symptom of an inner ear problem, which is commonly mistaken for dizziness. It is characterized by a spinning sensation that does not stop even with the eyes closed and is worsened by sudden head movements. Dizziness on the other hand, is often described in many ways such as feelings of light-headedness, whirling movements or giddiness, faintness, blurred vision, mental confusion, headache and/or tingling sensations. Both symptoms of vertigo and dizziness may be present in BPPV, but the former cannot be eliminated.

Other accompanying symptoms of BPPV include unsteadiness of gait, loss of balance, ringing of the ears, abnormal eye movements, nausea, vomiting, and in rare occasions stomach upsets.

What Triggers the Symptoms of BPPV and How To Manage Them?

Like a Spinning Wheel

1. The most common trigger in most cases of a bad vertigo attack is the sudden movement of the head.

What to do:

  • Be conscious of your head movements and control the pace of your head turns.
  • Know which ear has a problem and recall positions that trigger the spinning sensation.
  • Move from side to side before settling down or getting up from bed.
  • Ask your doctor about repositioning head maneuver exercises or home-based exercise therapies that may be appropriate for you. These may help control your vertigo symptoms.

2. Another trigger is the lack of sleep as this weakens the ability of the inner ear to cope up and send signals to and from the brain whenever there are sudden head movements.

What to do:

  • Make sure to have enough sleep each night. It depends from one person to another, but for adults 6 hours of sleep is relatively good.
  • Get a job that will not require you to be in graveyard shifts, because night sleep has more rejuvenating effects than a long nap in the morning.
  • Take mental note of the sleeping hours that make you feel completely energized for the day. Then if work prevents you from getting enough sleep daily, make an inventory of your “sleep debt”.

An example would be:

Monday to Friday: only 5 hours of sleep per night = accumulated 5 hours of “sleep debt” for the week

Then make sure to pay off your “sleep debt” over the weekend, which means:

Saturday 6 hours + 2 and ½ hours = 8 and ½ hours
Sunday 6 hours + 2 and ½ hours = 8 and ½ hours

Note: This tip is from my ENT and also my cardiologist who taught me the damaging effects of “sleep debt” to the heart.

3. Another trigger is the unnecessary cleaning of the inner ears.

What to do:

  • Clean ONLY the outer ears if that is part of your everyday routine. You can use your cotton buds or your towel. Never attempt to use your cotton bud for the ear canal as this will only push the ear wax (that may contains dirt and bacteria) towards the inner ear. Doing this may give you more serious problems.

4. Another trigger is swimming.

What to do:

  • Avoid getting your inner ears wet, but if you are scheduled to swim, buy some ear plugs to cover them.
  • Make sure that the pool you are going to dip in is acceptably clean.
  • Do not even consider swimming if you have an allergy to chlorine or if you have an active ear irritation or infection, as these conditions may give you days of terrible vertigo attack.

What are Other Treatment Options for BPPV?

There are medications you can take that can help control the symptoms of dizziness, nausea, vomiting and headache. In some severe cases, surgery may be necessary to correct the inner ear problem.

Based on my personal experience, sleep therapy for 2 to 3 days can really do wonders. Immobilization of the head also for 2 to 3 days will also help the inner ear to regain its control of your balance.

Benign Paroxysmal Positional Vertigo (BPPV): http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
Vestibular Conditions: http://vestibular.org/understanding-vestibular-disorder
Vertigo Symptoms: http://www.mayoclinic.org/diseases-conditions/vertigo/basics/symptoms/con-20028216
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. (2008). Harrison’s principles of internal medicine (17th ed.). New York: McGraw-Hill Medical Publishing Division. ISBN 978-0-07-146633-2
Link: http://www.mhprofessional.com/product.php?isbn=007174889X

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