A person with BPPV who was treated in Greece asked: “After the treatment maneuver I felt much better. However, I now feel,…off balance? Why? How long with this last? Should I keep trying the Epley treatment?”
This is a common question and has an interesting, if theoretical, answer. It seems that some people can tell when they have BPPV just by the way they feel, even if they don’t experience vertigo at that moment. They just feel off, like something isn’t right. It is almost as if they can feel the particles sitting in the posterior semi-circular canal. This feeling goes away after they get used to the particles being in the canal. These people still experience spinning vertigo when they lay down or move in such a way as to stimulate BPPV. Interestingly, when they undergo treatment for BPPV with the maneuver and the particles are suddenly gone they again feel odd. Some describe a sense of being off balance, or even lightheadedness. It seems as if they miss the particles after having become used to them. Again this feeling goes away after about 1-2 weeks and you return to normal. There is no need to continue repeating the treatment maneuver at this point unless you are still experiencing spinning vertigo.
This whole sequence of events can be prevented by rapidly undergoing treatment before your brain has had a chance to become accustomed to the presence of the particles in the ear canals.
As always it is important to consult your own physician about your specific symptoms, especially if they change or do not fit with your usual experience or expectations.
Someone recently asked about the treatment for the other 2 canals in the inner ear and if the Epley maneuver work for those types of BPPV.
The quick answer is no the Epley maneuver does not work for horizontal or superior canal BPPV but only for the more common posterior canal form of BPPV. The good news about that, however, is that those other two types are easier to treat.
First – superior canal BPPV is theoretical and may not actually exist in any significant clinical form. This is because BPPV is caused by the settling of lose “otoconia” in the inner ear. This can only happen in the lowest areas of the inner ear. For example – dust does not settle on the ceiling, rather it settles on the floor. The same is true of the inner ear. The particles settle, typically in the posterior canal because it is the lowest area and it is not tipped upside down by regular activity. By contrast – the superior canal is emptied every time you lie down and stand up. So, while it is possible to have crystals in that canal, it is not possible to have then “get stuck” there and cause BPPV.
The same is true, to some degree, with the horizontal canal. Whenever you roll over (like a log roll) the canal is emptied. So many times simply sleeping at night (when you may roll over) is curative for that condition. It is, however, more intense vertigo than posterior BPPV. It is worth noting that horizontal BPPV can sometimes be induced by the treatment maneuvers for posterior BPPV as the crystals may fall out of the posterior canal and temporarily fall into the horizontal canal.
Finally, posterior BPPV is the most common kind as the anatomy of the canals allows for collection of the crystals in the lowest part of the ear. In addition, neither rolling over nor lying down and getting up again will cause the crystals to empty out. The main treatment for this condition is the “particle repositioning maneuver” or Epley maneuver.
If you are having symptoms which don’t fit the norm make sure you discuss them with your own physician.
We recently were asked: “I think that I have Mal de Debarquement syndrome. I believe this because I tend to get it after train travel. In the past it took 6 weeks for it to go away. Now, it seems to be taking longer. Does the Epley maneuver work for this?”
Until recently very few people knew about Mal de Debarquement syndrome. This syndrome can occur after any type of travel. The best analogy is sea sickness. When you first step onto a boat you might feel sea sick due to the constant motion of the boat. After a few days you get used to it and the sensation goes away. However, the same can happen when you get off the boat. The land may feel like it is moving. Anyone who has used roller skates, skis or ice skates can attest to how strange it feels after a few hours of skating or skiing and then returning to your street shoes. The same is true after getting off a boat. It may take hours to weeks to get used to land. In some people this adjustment never happens and they feel sea sick on land forever. We call this Mal de Debarquement, or sickness after disembarking.
Mal de Debarquement and BPPV can be differentiated in a couple of ways.
1)BPPV is positional in onset meaning that it will not occur unless you move into a certain position.
2)BPPV is also short lived rather than continuous. Mal de Debarquement syndrome should be continuous.
3)Mal de Debarquement can occur, and perhaps be worse, when stationary. It is the sensation of motion where there is no actual motion. This is different than BPPV which is the sensation of spinning (either you spinning or the world spinning around you)
The Epley maneuver or devices which assist with the treatment maneuver only work with BPPV. That is not to say that you cannot have both, but we always suggest you see your own doctor and get a diagnosis of BPPV prior to using any treatment method.
We were recently asked, “Why does BPPV go away and come back?”. To understand the treatment and natural history of BPPV it helps to understand how it happens in the first place.
Lets imagine that the inner ear is akin to a tiny snow globe inside the head. In a healthy person the snow inside this globe is actually stuck down but with age the snow comes loose and begins to fly around when disturbed. Now lets imagine there is a house inside the snow globe. Inside the house are the very sensitive balance organs of the inner ear. There are, of course, windows in the house and sometimes flying snow comes in through those windows. When that happens you get BPPV.
Every time the snow globe is disturbed, by rolling over or looking up, the snow inside the house causes the balance organs to be confused and the sensation of vertigo results. The snow can fall out of the windows of the house as well but this only happens sometimes when you are in just the right position. The treatment maneuver for BPPV carefully guides these particles out. You can have your doctor do the maneuver or do it yourself with a BPPV treatment device
Without treatment BPPV often lasts 2 weeks until the particles inside the house (which is actually called the posterior semi-circular canal) fall out or somehow breakup. However, more snow can come in and usually does in about 60% of people.
BPPV can affect people of any age as everyone has the otoconia (ear crystals) which causes BPPV. These otoconia are a normal part of the balance system. Most children with BPPV have recently been in some kind of accident where there is a degree of head injury. It is not clear if the injury shakes these crystals loose or if blood gets into the canals and causes the crystals to come loose, or if the blood itself causes the symptoms. Most children with post traumatic BPPV seem to do well and accommodate quickly to the symptoms and respond well to treatment.
BPPV (Benign paroxysmal positional vertigo) in children can easily be confused with BPV of Childhood (Bengin paroxysmal vertigo) which is actually a migraine related phenomenon. It is unfortunate that the names are so close as they are not related disorders. The primary distinguishing difference is that BPPV can be brought on with position change and is due to otoconia whereas BPV is often associated with headache and not affected by position.
BPPV is most commonly seen in people over the age of 60 as they are most likely to have age related changes to their ears which causes the otoconia to come loose. While it is possible to see BPPV in children it is uncommon and often short lived. Careful attention should be paid to differentiate causes of vertigo in all patients.