Vertigo, the false sensation of spinning or tilting when the body remains still, can cause nausea and vomiting and imbalance that results in falls. Vertigo can arise from several different factors affecting the inner ear, the nerve that connects it to the balance-sensing area of the brain, or the brain itself. Benign paroxysmal positional vertigo--short episodes of vertigo after certain head movements--is the most common type of vertigo.
Provocative Maneuvers
Benign paroxysmal positional vertigo occurs because misplaced ear crystals called canaliths tickle hair cells of the semi-circular canal of the inner ear, triggering a false sensation of movement. With BPPV, symptoms disappear over time because the body exhausts its ability to respond to the stimuli that elicit an episode. Provocative maneuvers that move the head to intentionally bring on an episode of vertigo in a safe environment--such as while in bed after waking up--exhaust the system and minimize symptoms later in the day, according to the Merck Manual.
Canalith Repositioning for BPPV
An easy and effective treatment for BPPV, canalith repositioning uses a series of choreographed head movements to move canaliths back out of the semi-circular canal. Several different sequences of movements, including the Epley and Semont maneuvers, rotate the head sideways and back, using gravity to move the crystals. Performed under a doctor’s supervision, these maneuvers succeed in about 80 percent of patients with BPPV, according to Dizziness-and-Balance.com. To prevent the canaliths from falling back into the semi-circular canal, the patient should sleep propped up on the evening following the maneuvers and avoid tilting the head for several days.
Other
All patients with vertigo can benefit from medications that control the associated nausea. Patients with forms of vertigo other than BPPV need treatments tailored to the specific cause of their vertigo. According to the Merck Manual, patients with Meniere’s disease, labyrinthitis (inflammation of the labyrinth of the inner ear) or vestibular neuronitis (inflammation of the nerve of the inner ear) can take medications that suppress activity of the vestibular nerve, such as diazepam or antihistamine and anticholinergic drugs. For cases of vertigo induced by medications treating some other condition, stopping or switching drugs could be the solution. Some underlying conditions, such as migraine and low blood pressure among others, can cause vertigo. In those cases, treating the underlying condition usually resolves vertigo as well.
Surgery
Left completely untreated, BPPV usually resolves after a few months as body reabsorbs the errant crystals. If time and treatments fail to resolve BPPV, or if a different inner ear problem is to blame, a surgery called posterior canal plugging might be an option. In this procedure, the surgeon places a barrier in the posterior canal of the eat to prevent the semi-circular canals from responding to head movements. Dizziness-and-Balance.com says that this procedure is about 85 to 90 percent effective, with a 3 percent risk of hearing loss in the affected ear.
