DEAR DOCTOR K:
I suffer from benign paroxysmal positional vertigo. I’ve heard that something called the Epley maneuver may help. Could you explain what this is?
Vertigo is the sensation that either your body or your environment is moving, usually spinning. Vertigo can be a symptom of many different illnesses and disorders. The type of vertigo you have — benign paroxysmal positional vertigo (BPPV) — is the most common form. As you’ve probably experienced, simply changing the position of your head can cause a sudden spinning sensation.
Inside the ear are three tiny canals that help us recognize the position of our body in space and maintain balance. Inside the canals is fluid and tiny hairs attached to nerve endings. The way the fluid washes against the hairs changes when your body is in different positions. When the fluid moves the hairs, nerve signals are sent to the brain. Those signals get translated in a way that lets you know what position your body is in.
BPPV occurs when tiny calcium crystals form in the inner ear and become dislodged. They bang around the canals and touch the sensitive nerve endings inside. The brain starts to get conflicting signals. You experience this as a sensation of your body moving around in the world (or the world spinning around your body).
If you have BPPV, simply looking up or rolling over in bed can dislodge crystals and cause brief bouts of extreme dizziness. Vertigo can feel like the room is spinning or as though you are spinning in the room. It can be just a sense of imbalance. It also can cause nausea, vomiting and ringing in the ears.
One treatment for BPPV is the Epley maneuver. In this maneuver, a doctor or physical therapist moves your head and body through a series of positions. You can also learn to do it yourself. You begin by lying on an examination table. The therapist gently moves your head to the left and right, then has you roll over and sit up.
Each position moves the loose crystals through the ear canal, repositioning them to relieve symptoms. Your symptoms may improve in as little as 10 minutes. Your doctor also may provide specific exercises for you to continue at home.
Here is an illustration that shows how the therapist will move your head and body (and how you can do it yourself). The picture also shows how the crystals will be repositioned during each step to relieve your vertigo.
For more persistent vertigo, your doctor may recommend something called balance rehabilitation. The types of exercises prescribed will depend upon what movements provoke your symptoms.
The Epley maneuver, and several similar exercises, have given relief to many people with BPPV. Before these maneuvers were discovered, the vertigo would ultimately go away on its own, but it could take weeks. These maneuvers speed the improvement — from weeks to minutes. Unfortunately, attacks of vertigo do often return, but the maneuvers help drive them away.