Ear crystals, or otoconia, are small calcium carbonate crystals that reside in the utricle, a part of the inner ear, says Dr. Michael Teixido, assistant professor at Thomas Jefferson University. Otoconia and the utricle maintain balance. If the utricle is compromised, the otoconia can dislodge and fall into the semicircular canal, another part of the inner ear. The result is dizziness and vertigo.
Benign paroxysmal positional vertigo (BPPV) is caused by otoconia dislodging from the utricle into the semicircular canal, says Dr. Teixido. With BPPV, moving the head into certain positions causes a bout of vertigo lasting five to 15 seconds. Vertigo is characterised by the feeling that you, your surroundings or both are spinning, says the Merck Manual. Vertigo is also accompanied by nystagmus, a rapid jerking eye movement; nausea; and imbalance.
Dislodged otoconia are normally absorbed by "dark cells" around the utricle, says Dr. Teixido. If too many otoconia become dislodged, they may fall into the semicircular canal, sending inaccurate signals about head position to the brain. More otoconia dislodge from the utricle as a result of ageing, injury, viruses, migraine or even high-impact exercise.
A doctor can diagnose BPPV with the Dix-Hallpike test, says Dr. Teixido. From a sitting position, the patient turns her head 45 degrees to one side and, with the doctor's help, lies down flat. This is repeated on the other side. The doctor watches each time for nystagmus. Usually one side induces more intense vertigo than the other.
BPPV usually goes away without treatment within six months. However, avoiding the positions that cause vertigo will prolong the recovery period. Motion sickness medications only mask symptoms. Office treatments performed by a health care professional and at-home exercises have been shown to be effective in treating BPPV. Surgery should only be considered if all other treatments have failed.
A doctor can perform two types of treatment, says Dr. Timothy Hain, professor of Neurology, Otolaryngology and Physiotherapy/Human Movement Science at Northwestern University Medical School. The Semont manoeuvre involves rapidly moving the patient from one side to the other. While this is 90 per cent effective after four sessions, the Semont manoeuvre isn't favoured in the United States because of its brisk movements. The Epley manoeuvre, or canalith repositioning procedure, involves moving the patient's head into four positions and holding each position for about 30 seconds. The recurrence rate of BPPV is about 30 per cent. A second treatment may be necessary. These manoeuvres should be done in a proper setting by a trained health care professional who can handle the patient's possible imbalance due to vertigo, as well as provide post-treatment instructions.
Brandt-Daroff exercises are a home treatment that is 95 per cent effective, says Dr. Hain. However, they must be done every day, three times a day, for up to two weeks, which may be unpleasant as the positions in the exercise often induce short bouts of vertigo. Ask your physician if Brandt-Daroff exercises are right for you.