• The Room is Spinning!

    by Dr. Niki Varveris, PT, DPT, MSPT, MBA, CKTP
    on May 22nd, 2018

I woke up and couldn't get myself out of bed because the entire room was spinning around me or maybe I was spinning around the room! It felt as if my eyes were twirling all over the place. What was that all about? Vertigo, a medical term describing a symptom of perceiving (falsely) the movement (whirling, spinning, or rotating) of the environment is real! Although the cause of this debilitating condition is sometimes difficult to delineate, benign paroxysmal positional vertigo (BPPV) is the leading cause of vertigo in the adult population. I'm sure anyone who has experienced vertigo would agree that there is nothing "BENIGN" about it. But what exactly happens to cause such a debilitating event? And why does it only seem to happen with certain head movements?

BPPV occurs when loose otoconia or crystals as we all call them, find their way into an area of the inner ear (the semicircular canals) where they shouldn't be. The sensation of spinning is dependent on the involvement of one of the three semicircular canals (horizontal, anterior or posterior). As the head moves, the "crystals" move within the semicircular canals, stimulating the nerve hair cells and causing false information to be sent to the brain which in turn create a sense of dizziness and movement. As long as the "crystals" remain in the semicircular canal, head movements will produce vertigo. Some people learn not to move their head in a certain way to avoid reproducing their vertigo. But there is a treatment which improves the condition so that you don't have to move around like a robot! And NO, just doing the Epley's Maneuver you saw on youtube may not be the right answer.

The treatment performed mostly by Physical Therapists specializing in vestibular rehab is called Canalith Repositioning Procedure (CRP). CRP, when performed according to proper identification of the involved canal and location of the crystals (inside the canal called canalithiasis or hung on the cupula called cupulolithiasis) can be 80% effective in the management of BPPV. Epley's maneuver and the Semont-Liberatory maneuver are the two main Canalith Repositioning Procedures. Which CRP to choose is entirely dependent on which semicircular canal, which ear and what location the crystals have migrated to. Most people are not aware of which ear is the source of the problem, let alone which canal and at which location. This may explain the poor success rate of self-treatments! 

Physical therapists specializing in vestibular rehab are experts at performing quick, non-invasive exams to determine the source of your vertigo. With proper identification of the involved canal, appropriate canalith repositioning procedures can resolve the problem in as little as one visit. So the next time you wake up and feel as if the room is spinning (despite not having had any alcoholic beverages) you might want to contact your healthcare provider and get rid of the problem sooner rather than later.

Author Dr. Niki Varveris, PT, DPT, MSPT, MBA, CKTP

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