In adults aged 65 or older, dizziness is one of the most common reasons individuals visit their physician or become hospitalized. In the clinic, we may ask you to describe your dizziness to determine where the source of the problem is. The two most common answers are either light-headedness, where you feel like you may faint, or you may describe the dizziness as a room-spinning sensation that causes nausea and sweating, and you may have to sit down and close your eyes to help make it disappear.
Depending on your answer, there are different diagnosis and different treatments for each. The light-headedness may be a result of a blood pressure problem, a blood sugar problem, dehydration, etc. You may even experience the light-headedness in conjunction with the room-spinning sensation. We often consider your current medications or lack thereof and your water intake for this problem, or we refer back to the physician for further evaluations and tests.
If your answer for the description of dizziness was the room-spinning sensation, it may be what is called Benign Paroxysmal Positional Vertigo (BPPV), and is the most common form seen and treated in the physical therapy clinic. This is a result of a problem in the inner ear.
There is an inner ear system on each side of your head. It is a very small system that makes a very big difference on your balance. This system is made up of 3 semicircular canals, positioned at angles away from planes of motion. They are filled with fluid and are lined with very fine hairs. When you move your head, this fluid pushes the hairs sends signals to your brain to tell you where your head is at in space when considering rotational movement of the head. The three canals converge at a common location that diverges into two chambers, known as the utricle and the saccule. The utricle and saccule house many tiny calcium carbonate “rocks” called otoliths. The weight of these otoliths help move the hair follicles and tell your brain movement in the vertical and horizontal motions.
Occasionally, an otolith may fall out of the utricle/saccule and into one of the semicircular canals, where it does not belong. This may be a spontaneous action, or it could happen from a hard knock on the head from an external force. This otolith, or rock, may be stuck or rolling loosely in the canal, but it gives your brain incorrect signals of your head moving when it isn’t. You may not experience this sensation until you turn your head a certain direction. It is common to hear from patients that the sensation happens from rolling over in bed or turning their head quickly. Though the room-spinning dizziness feels like it lasts an eternity, it only lasts less than 1 minute.
The good news is, this is easily treated. Physical therapy will take you through a series of specific positions, called the Epley maneuver, that are performed to roll the rocks through the canal and back into the utricle/saccule. The positions will likely induce your symptoms, but the end-goal for treatment is for your symptoms to be resolved completely. It may take multiple sessions, but generally takes very few.
To watch a video of the Epley Maneuver, click here.