Benign Paroxysmal Positional Vertigo, or better BPPV, sounds crazy but it is what it says on the tin, it’s just that the language on the label could be Russian for all it mans to you or me. However, benign is a good word, it is one of those words you want to hear when anyone is talking about medical things about you, and I suspect we are all pretty familiar with it. Paroxysmal means that the condition occurs in attacks rather than as a steady problem. Positional means it’s all related to what you do with your body, in particular with your head. And vertigo is a nasty feeling of relative movement, usually spinning, between you and your surroundings and has recently been described to me as “I feel like I’m falling backwards and to the right”.
Now it may be benign but it can still be horrible with you, in some cases, stuck in bed because any movement causes you to throw up. In the later stages it leads to episodes of vertigo each lasting less than 60 seconds but all of this may settle after a couple of weeks. However, sometimes, it does not.
There is a beautiful test for it called the Dix-Hallpike test. And here it is in this cracker of a link:
I recently had a patient with undiagnosed, or more accurately un-treated vertigo. After a detailed history to rule out the other forms of vertigo I subjected her to this test and her reaction was a case-book response. I asked her to sit on the bench and rotate her head to the right. I then lowered her back towards the end of the bench where her head hung over the edge a bit. There was a second where nothing happened giving her enough time to say: “I feel OK” and then her eyes went crazy and she then went very quiet for about 20 seconds before saying “Ugg, that felt horrible”.
The problem was a post-traumatic one for her as she was involved in a nasty crash some time ago (2 years!). The condition is caused by ‘debris’ in the semicircular canals of the ears which move about in response to gravity and so stimulate the position detecting structures in your ears giving a false reading. This is a bit like motion sickness where your eyes are out of synch with your body.
The cure is a bit tricky. You can’t open these structures up and wash the debris out, at least not yet, and you can’t take drugs to dampen down your nervous system as you’ll spend most of your time flat on the floor. However, luckily, there are slight bulges at the ends of each of your canals that with some cunning manoeuvres you can get the debris to float (sink?) into and not stimulate your canals. The manoeuvre is the Epley manoeuvre. Now, this is a tricky manoeuvre and should be done by someone on you, so in this case by me, her chiropractor, not by you with a bit of paper in your hand. And I’d suggest that if you are about to do it on a patient then practise on a well friend first off a couple of times to get it right. Once you’ve got the hang of what you are doing then lay it on.
