Vertigo – Crystals in the inner ears (BPPV)?

Feeling the room spinning when you roll in bed? Having intense dizziness when you get up from lying down? Heavy spinning with turning your head? This symptom is called Vertigo. You might have heard this term thrown around by people around you or healthcare professionals.

There are multiple causes of Vertigo. We are going to focus on one very common cause of it: Benign Paroxysmal Positional Vertigo, or BPPV. If you experience BPPV, chances are, you seek /will be seeking help from a medical doctor. Your doctor will explain to you that you have loose crystals in your inner ear, and that is causing dizziness. You might be prescribed medication to help with the symptoms, and/or physiotherapy with a physiotherapist that can treat vertigo.

Crystals in my ear(s)?!

That sounds A LOT worse than it actually is! Our ears are naturally lined with crystals! The inner ear plays a HUGE role in telling the brain about what our body is doing, and help us stay balanced. This part of the inner ear is formed by 3 loops (Green – picture 1) connected to a reservoir (Blue – Picture 1).

Picture 1 – Semicircular Canals of the Inner Ear

Naturally occurring crystals (otolith) line the inside of each of the canals (Picture 2). When we move our heads, the fluid contained in these loops move and brush against these crystals. They send signals to the brain, and help the body determine which way it is moving. This information tells our brain where we are in space.

Picture 2- Crystals lining the semicircular canals

Once in a while, sometimes with no apparently reason, one or multiple of these crystals dislodges from the lining and gets trapped in the canal and moves around with the fluid inside. The signals sent to the brain then gets scrambled up, thus creating the sensation of vertigo.

Do I have BPPV?

Although are many causes to Vertigo, BPPV is by far the most common! Symptoms of BPPV are quite distinct and is often easily diagnosed in clinic. Here are some questions you can ask yourself to help determine if your vertigo is caused by BPPV:

  • Did you recently hit your head or was in a car accident?
    • You might have a concussion. If you experience dizziness and vertigo after hitting your head, you should visit your doctor.
  • Is your vertigo mostly associated with movement?
    • Vertigo from BPPV should only be present when you are changing position or moving your head (i.e. turning in bed, lying down, sitting up, etc.)
    • If you have a consistent mild dizziness/vertigo at all times, it probably is not BPPV.
  • Do you have pain in your ears? Does your neck hurt?
    • Typically, BPPV should not be associated with pain.
  • How long does the vertigo last for?
    • Vertigo from BPPV is usually defined by moderate to intense spinning sensation lasting less than 1 minute each time. If it lasts longer than that, it is probably not BPPV.
  • Do your eyeballs twitch when you experience Vertigo?
    • Ask a friend or family member to take a look at your eyes when you are experiencing intense vertigo. If they see your eyes twitching (nystagmus), it is most likely vertigo (although certain other conditions can also cause nystagmus, BPPV is the most common one).

Other common causes of vertigo may include, but not limited to:

  • Concussion
  • Meniere’s Disease
  • Cervicogenic (neck) dizziness
  • Labyrinthitis
  • Vertebrobasilar Insufficiency (lack of blood supply to brain)
  • Migraine-Associated Vertigo
  • etc.

Flushing out the Dislodged Crystals

Alright, I have BPPV, what can I do about it? Physiotherapy is extremely helpful in treatment of vertigo from BPPV. Typically in clinic, it only takes 1 to 3 sessions to completely get rid of Vertigo from BPPV. We will assess you to make sure that BPPV is the cause of your vertigo. If BPPV is your diagnosis, we will take you through a few gentle movements, and use gravity to guide the crystals out of the canals into the reservoir, where it will be reabsorbed by the body. The relief should be immediate.

Before booking your appointment, just make sure to confirm with your physiotherapist that they treat vertigo!

Self promotion =)

If you have vertigo, come see me and Kristine at our physiotherapy clinic in Barrhaven! We both are trained in treatment of vertigo and BPPV.

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About the Author

Lily Zhang

Lily Zhang is a registered physiotherapist with training specializing in the McKenzie Method.  She graduated from McGill University and is currently working in Barrhaven (Ottawa, ON). She has over 10 years of professional training/clinical experience in orthopedic physiotherapy.  You can Follow Her Blog @PhysioVive Facebook Page.

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