Vanguard Neurologist

From NPR.org:

Experts who treat dizziness estimate that about 20 percent of all dizziness is due to loose crystals — or ear rocks — in the inner ear.

The condition, known as benign paroxysmal positional vertigo, or BPPV, is usually treated with a series of simple head movements aimed at putting dislodged ear rocks back where they came from so they can be cleared away by the immune system. BPPV can be triggered by a head injury or a virus. The condition is more common in older adults.

Tiny ‘Ear Rocks’ Keep Us Balanced

Within the inner ear, there’s a little pouch called the utricle that contains about 1,000 little pebbles made of calcium carbonate.

The tiny rocks serve an important purpose: They stimulate nerve cells when we move our heads — and send signals to our brain that guide our sense of up and down.

“The trouble is that sometimes the little rocks fall off,” explains Dr. Timothy Hain, a dizziness expert at Northwestern University. When the rocks fall into one of the inner ear canals, the brain gets confused. As the rocks roll around in the canal, the brain senses that the head is moving a lot more than it actually is. The result: vertigo.

With Age Comes Dizziness

Head injuries and viruses can trigger the “rock slide” seen in BPPV. But several studies also document that the condition is more prevalent among adults over age 50.

The dizziness usually comes on suddenly. For Adele Freed, 83, of Frankfort, Ill., the sensation was similar to being tipsy from alcohol.

“I remember everything was spinning,” she recalls. “And when I tried to get out of bed, the walls were moving. I just didn’t have any balance.”

Freed’s family medical doctor gave her a prescription of Meclizine to treat the dizziness. When she didn’t improve, she went to Hain, who’s known at Northwestern University as the dizziness doc. He diagnosed her with BPPV.

The condition is not uncommon. About 1 in every 5 patients referred to him has this condition. And some researchers estimate that about 50 percent of all dizziness in older people is due to BPPV.

“This is really a success story in medicine,” says Hain. “We’ve figured out the cause of this condition — and we’ve figured out how to treat it.”

Freed was relieved to learn that the dizziness could be relieved by a series of simple movements that take about 15 minutes. A physical therapist guided her through the maneuver. Hain also gives patients exercises to do at home. The goal is to dislodge the rocks from the canal, and get them back where they belong.

“I was amazed that the whole secret to what I had was to get those crystals back in place,” says Freed.

The Treatment

The main strategy used to move the rocks out of the canal is called the Epley maneuver. It was first introduced in the late 1980s, and has since been adopted by many ear specialists, neurologists, physical therapists and audiologists.

At the Washington Hospital Center, in Washington, D.C., audiologist Saul Strieb demonstrated the process. It begins with the patient moving quickly from an upright, seated position to lying flat on his or her back. The patient holds the supine position, and then turns the head. This position is held for about one minute, then the patient rolls onto his or her side. The sequence is often repeated.

“It’s not successful all the time,” says Strieb. “Sometimes it takes repeat visits.”

Several randomized clinical trials have demonstrated that the Epley maneuver is a safe and effective treatment. Some studies document an 80 percent success rate. However, there is no solid evidence that the maneuver provides a long-term resolution of symptoms. Recurrence rates may approach 50 percent, depending on the age of the patient.

For those who seek no treatment at all, the condition usually improves on its own within a few months.

In severe cases, where the symptoms linger, physicians can perform a surgery to plug the ear canal.

From ScienceDaily.com:
People who have osteoporosis are more likely to also have vertigo, according to a study published in the March 24, 2009, print issue of Neurology®, the medical journal of the American Academy of Neurology.

The study involved 209 people with benign positional vertigo with no known cause such as head trauma or ear surgery. Vertigo is an inner ear disorder that is a common cause of dizziness. The disorder is believed to be caused by loose calcium carbonate crystals that move in the sensing tubes of the inner ear.

The people with vertigo were compared to 202 people with no history of dizziness. People with osteoporosis, or low bone density, were three times more likely to have vertigo, and people with osteopenia, which is the stage before osteoporosis, were twice as likely to have vertigo as people who had normal bone density.

In women, 25 percent of those with vertigo had osteoporosis, compared to nine percent of those who did not have vertigo, and 47 percent of those with vertigo had osteopenia, compared to 33 percent of those without vertigo. For men, 12 percent of those with vertigo had osteoporosis, compared to six percent of those without vertigo, and 40 percent of those with vertigo had osteopenia, compared to 27 percent of those without vertigo.

“These findings suggest a problem with calcium metabolism in people with vertigo,” said study author Ji Soo Kim, MD, PhD, of Seoul National University College of Medicine in Korea. “Women most often have their first case of vertigo in their 50s, when they are also having a drop in bone mass due to loss of estrogen. Estrogen is one of the main hormones that influence calcium and bone metabolism.”

Kim said researchers haven’t determined the role of estrogen in vertigo. Kim noted that the link between osteoporosis and vertigo was also found in men, so other factors must also play a role.