You turn onto your side and for a few moments you feel the room spinning around your head. It is a frightening experience, even if it settles quickly. One possible cause of this pattern is benign positional vertigo, or BPPV. Webda, the health media of the Ministry of Health, also pointed in its piece "Vertigo when rolling over" to a short attack of spinning with a change in head position. But not every vertigo when lying down is this same diagnosis.[1]
What exactly does "vertigo" feel like?
In everyday speech, we sometimes use the same name for lightheadedness, nearly fainting, unsteadiness and the surroundings spinning. To begin a visit, instead of looking for the name of a disease, describe the experience: Does the environment spin, or does your head only feel light? Does it start with turning the head or with standing up? Does it last a few seconds or continue for hours? These questions are for better describing the symptom; their answers alone do not diagnose.
What happens in BPPV?
In the inner ear there are parts for the sense of movement and the position of the body. Very tiny calcium particles, if they move from their usual place and enter the balance canals, can create a different message during head movement; the result may be a false sense of spinning. The common term "ear stones" is used in this sense. It does not mean a large stone in the outer canal of the ear, and cleaning the ear does not solve this problem.[2]
What pattern can be consistent with this diagnosis?
A short attack of spinning with turning in bed, lying down or some head movements can suggest BPPV. In this condition, the attacks are usually short and may be accompanied by nausea. New hearing loss or a neurological symptom is not part of the usual pattern and cannot be set aside without evaluation. Even if one particular movement starts the attack, the diagnosis must come with a review of other causes.[1, 2]
Which signs need urgent evaluation?
If the vertigo accompanies double vision or loss of vision, weakness or numbness of the arms and legs, a speech disturbance or new hearing loss, get a medical evaluation immediately. A new severe headache, severe vomiting or a poor general condition is also not a reason to delay. Do not drive yourself to seek care. The shortness of the first attack or its resemblance to other people's experience does not make these warning signs unimportant.[3]
How does the doctor investigate the cause?
The history, the examination and observing the reaction of the eyes in positional tests can help with diagnosis. Tests such as the Dix–Hallpike or the supine head-roll test are raised. The AAO-HNS specialist guideline emphasizes that BPPV must be distinguished from other causes of vertigo. Not everyone needs imaging merely because of this symptom; additional symptoms affect the decision.[4]
What is a repositioning maneuver and why is it different from a pill?
In confirmed BPPV, some calculated movements of the head and body are used to move the particles. These methods are known by names such as the Epley maneuver. The choice of movement depends on the side and the type of involvement; it is better first to get the diagnosis and the suitable method from a trained person. A neck disease, limited movement or a risk of falling are also important in choosing the plan.[2, 4]
The AAO-HNS guideline does not consider routine use of vertigo-suppressing medicines the main treatment of BPPV. This does not mean you should suddenly stop your current medicine; talk to your doctor about the reason for taking it and the treatment plan. The reduction of a symptom and the resolution of the cause are not always the same thing.[4]
Until you seek care, let us take safety seriously
When the spinning starts, sit down or stay in a safe place. At night have enough light, get up from bed slowly, and avoid ladders or work at height when you are unsteady. The aim of these measures is to prevent falls. If you have severe or warning symptoms, do not delay seeking care in the hope of getting better with rest.[3]
What should we write down for the visit?
Write down the movement that starts the attack, its approximate duration, the first time it appeared, hearing or neurological symptoms and the medicines you take. If neck movement is limited or you have a history of injury, raise that too. This suggested list helps ensure nothing is missed in the session; one should not delay necessary care in order to complete it.
What should we do if it comes back after treatment?
Recurrence may occur and follow-up is important. If symptoms remain or their pattern has changed, a new evaluation is necessary; the earlier diagnosis is not permission to attribute all future attacks to the same cause.[4]
See other pieces in the articles section on ear, nose and throat health.
