BPPV

A 42 year old woman named Sue wakes up one morning with a sickening feeling of severe dizziness and nausea.  She tries to get up, but can barely walk, because she feels so unsteady.  A feeling of fear and helplessness also fills her as she sees the world around her spinning whenever she moves.  Her husband calls 911 and she is taken to the hospital.  There she is given intravenous medications and a CT scan of her head is performed along with a bunch of other tests.  Multiple doctors examine her during her two day stay.  By the time she is discharged from the hospital she is still dizzy, but can move around slowly.  She is told that her brain was fine, her heart was fine and that she “probably had vertigo” and is sent home with a prescription for medication and told to follow up with her primary physician.

The following week she sees her primary physician who recommends that she see an ear, nose, throat physician (ENT).  By the time she can see the ENT it is another two weeks later and she is still having daily dizziness.  The medication that was prescribed does nothing to help.  The ENT performs a bunch of tests for her inner ear which causes severe dizziness again, however all of the testing is normal.  She is then referred to a neurologist.  The neurologist also can’t find anything wrong with her and tells her to see a psychiatrist.  “WHAT!?!” she thinks to herself, “I’m not crazy, I’m truly dizzy and wobbly!” she thinks to herself as she still has dizziness every day and holds on to objects as she walks for stability.  She can’t go into large busy stores, lie flat or use the computer much, because all these activities make her symptoms worse.  HOW CAN THERE BE NOTHING WRONG!?!

The answer is that there was something wrong and there continued to be something wrong.  She is an example of someone who had benign paroxysmal positional vertigo (BPPV) which resolved on its own, but subsequently developed chronic subjective dizziness (CSD).  For most people the feeling of spinning uncontrollably, nausea, and being unbalanced are horrible feelings  Anytime there is a problem with the systems of your brain and inner ear (the vestibular system) that control your equilibrium you can have those symptoms and feel those terrible feelings.  When this happens your body finds ways to adapt to help you feel more stable.  This can include changing the way the brain uses balance signals from the body such as relying more on vision for balance.  You may also associate certain activities with the horrible feeling of the dizziness.  Once the disease that caused the dizziness in the first place clears up then the balance pathways in the brain should return to their normal state and the dizziness should go away.  Sometimes, however, they don’t and you are left with persistent dizziness for months or years even though all of the brain scans, blood work, heart tests, and inner ear tests are normal.  That is the CSD.  This condition is more likely to happen in people who are more prone to anxiety, but it could happen to anyone.  In people with a certain degree of depression or anxiety it can even happen without an inner ear disease.

Unfortunately, many healthcare providers including ENT’s, neurologists, and physical therapists aren’t aware of this phenomenon.  The good news is that there are physicians, physical therapists, and other healthcare professionals  with interest and training in this area that can help you overcome this dizziness.  Once a proper examination is done and it is determined that this is the cause of the dizziness, then the right treatment can begin.  The treatment may consist of specialized vestibular rehabilitation therapy (VRT), a temporary course of psychiatric medications, psychotherapy or a combination of these treatments.  The treatments work to help the brain and mind restore normal interactions between the parts of the brain that deal with balance and fear.  The result is no more dizziness and improved balance allowing you to feel normal doing the things you need to do in life.

If you have been having trouble getting a diagnosis for your dizziness when all of the testing you had was normal or think you have CSD, make an appointment at NPBTC.  We have a neurologist, psychiatrist, and a physical therapist with special interest in this area who will work together with each other and you to help you overcome your dizziness.

Special thanks to Jeffery P. Staab, MD and Michael J. Ruckenstein, MD, for their research and publications on CSD.  Please see their works for more information.