From the office of Robert S. Grimshaw Jr MD FACP Internal Medicine 3535 Hill Blvd Yorktown Hts NY 914 962-3180 NEWS
Recognized Provider “With Distinction” by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/02
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Vertigo: How to Ditch the Dizzies
Irritation of the inner ear, called “benign positional (or paroxysmal) vertigo” - BPV - or labyrinthitis is one of the most common
emergencies we see. Nationally, this affects about 160,000 people annually.
It frequently follows an upper respiratory infection, though it can occur with no preceding illness. Often, there is no warning. Patients feel as if they’re spinning, or as if the room they’re in is spinning. And frequently they’re quite nauseated, enough to vomit. The cause of BPV is free-moving particles in the fluid (endolymph) in one of the 3 semicircular canals that make up the organ of balance, the inner ear or labyrinth.
Treatment can be with antihistamines such as Antivert (meclizine), a patch behind the ear (Transderm Scop) and physical maneuvers. Sometimes (very rarely) surgery is recommended.
We use Cawthorne exercises in the office and a series of movements called a modified Epley maneuver or “Canalith Repositioning Procedure”. The idea of both physical maneuvers is to move the loose particles from the posterior canal where they’re causing trouble back into the sump or utricle, where they don’t. A recent study at the Mayo clinic showed that ½ of patients will respond to the Epley maneuver alone; those treated with a sham procedure had a response of only 19%. It should be noted that usually 1/3 of patients have episodes of vertigo for more than 1 month after their first visit.
Patients can use a cervical collar and should sleep sitting up for the 1st 2 nights. They should not sleep on the symptomatic side for an additional five days and should avoid excess head turning for 1 week after the initial visit.
In another study, patients were taught how to do the Epley themselves, and did it 3 times daily until they got relief for 24 hours. There was a 64% response in a week.
Robert S. Grimshaw Jr MD FACP