Easy Fixes for Vertigo

Geoff Blackburn had no idea what was happening to him. To the retired 64-year-old in Ladysmith, B.C., basic activities-lying down to sleep, getting up, bending down to tie his shoe or moving his head rapidly-caused the room to spin for about five seconds. The dizziness be­came more frequent, but a neurologist found nothing seriously wrong with Blackburn and sent him to a therapist specializing in balance disorders.

After a few tests, therapist Lorelei Lew told him he had “benign paroxysmal positional vertigo,” or BPPV, dizziness that makes you feel that the room is spinning, or that you are spinning. Although the treatment doesn’t always quell symptoms permanently, it usually is simple: With Blackburn lying down, the therapist tilted his head to one side and moved it in a series of motions. “It was magic,” says Blackburn. The vertigo went away and hasn’t returned.

Balance, controlled in part by the vestibular system, depends on the inner ears, which have three semicircular canals to detect the rotation of the head. In addition, receptors containing calcium-carbonate crystals help the body detect gravity and changes in motion such as stopping and starting. Sometimes the crystals can become dislodged and can enter one of the semicircular canals, playing havoc with one’s sense of balance and causing BPPV. The disorder is usually the result of aging, trauma to the head or an infection of some kind.
An episode of BPPV is triggered by a particular motion and usually lasts ten to 15 seconds. Episodes also cause nystagmus-involuntary movement or jitteriness of the eyes-which is key to the diagnosis of BPPV.

Dr. Lorne Parnes, a professor in the Department of Otolaryngology at the University of Western Ontario, says repositioning man­oeuvres are highly successful with BPPV. “With one manoeuvre, you can correct the condition 80 percent of the time; with three treatments, you alleviate it in 95 percent of patients.”

But for some BPPV sufferers, as well as for those with other non-life-threatening balance disorders, diagnosis and treatment-or both-may not be so straightforward or low-tech. While BPPV is the most common cause of balance disorder, with an estimated 300,000 new cases diagnosed in Canada each year, dizziness in one form or another affects approximately 50 percent of adult Canadians at some time in their lives. But there is good news for these thousands of sufferers: Treatment options-old, new and still being researched-are available.

But for 48-year-old Randal Roberts of Edmonton, no amount of repositioning man­oeuvres seemed to help; his BPPV attacks were recurring. The episodes started 20 years ago, following a bad car accident. They were brief, but for a half day afterwards, Roberts would feel disoriented and woozy. “I had to read something two or three times to understand what I was reading,” he says.

It’s for people like Roberts that Dr. Matthew Bromwich, who practises pediatric otolaryngology at the Children’s Hospital of Eastern Ontario, invented the DizzyFix-a curved tube containing a small green ball floating in oil, attached to a baseball cap. Wearing the cap, the BPPV patient goes through a sequence of movements that send the ball along a specific path in the tube-and also guide the crystal debris out of the semicircular canals. “Within two or three minutes,” says Roberts, “I feel a lot better.” He uses the DizzyFix about once every six months, when he feels light-headed and knows a dizzy spell is coming. At about $140, the device “works for 85 percent of people with BPPV,” says Bromwich.

Another common cause of dizziness, arising from infections and the use of certain antibiotics, is damage to the inner ear, which can cause it to send confusing signals to the brain. Paul Godlewski, a Toronto physiotherapist, says treating this kind of damage is more complicated than fixing BPPV. “Instead of one or two sessions,” he says, “you need two to three months of treatment.” For these people, physiotherapists prescribe balance exercises to teach the brain how to make sense of the signals it is getting.

Seven years ago, Elizabeth Fera, a 53-year-old resident of Sault Ste. Marie, suffered permanent damage to her inner ears-the side effect of an antibiotic. She had to give up her job as a florist and couldn’t walk in the dark or go up stairs without holding on to a railing. And if she got on a plane, she couldn’t even walk to the bathroom. “Everything was spinning and dizzy and twirling,” she says.

Fera tried physio and walking with a cane, without success. Then, two years ago, she heard about a new device, the BrainPort, which seemed to help some people for whom everything else had failed.

The BrainPort-which hangs around the neck-uses feedback from an attached mouthpiece placed on the tongue to give the user information about the position of his or her head and body in order to help the user learn how to correct balance problems. “In effect, you are adding a new balance sensor to substitute for the damaged vestibular system,” says Toronto physiotherapist Kathleen Shortt of LifeMark Physiotherapy, who has been working with this device since 2006.

Fera “trains” with the BrainPort by standing still, eyes closed, for 20 minutes, twice a day. That’s enough to keep her sense of balance working for the day, even when the mouthpiece is not in place-a carry-over effect.

The BrainPort, which costs about US$10,000, gave Fera back her life. She no longer uses a cane or suffers from vertigo. “It’s great,” she says. “I can canoe, kayak and take my dog for walks.”

Roné Boyko, an otherwise healthy 38-year-old woman who likes to jog and swim, had her first attack of vertigo in the summer of 2003. “I woke up one morning and couldn’t see straight,” the Winnipeg mother of two and vice-princi­pal of a French elementary school remembers. “I felt the floor was going to fall out from underneath me.”

The bouts grew more frequent, until they were happening weekly. She also had tinnitus-a ringing in the ears-as well as a feeling of fullness in the ears. Her family doctor and an ear, nose and throat specialist urged her to try a diet low in salt, caffeine and alcohol. But the attacks continued.

Finally, in 2007 Boyko was sent to see Dr. Brian Blakley, chair of the Department of Otolaryngology at the University of Manitoba. An electronystagmography (ENG) test showed that the response in one of Boyko’s ears was reduced by 75 percent, compared with her good ear. This helped Blakley make the diagnosis: Ménière’s disease, in which an oversupply of endolymph, a fluid in the inner ear, causes vertigo. Blakley prescribed various medications, which Boyko found to be mostly ineffective. “I begged Dr. Blakley to fix me. I was crying in his office.”

Sixty percent of people with Ménière’s are helped by lifestyle modifications and medication. But for those who aren’t, surgery is an option.

Blakley suggested a shunt to drain off the excess endolymph. Since this procedure, which Boyko had in February 2008, she has had only four attacks of vertigo. They were mild and are becoming less and less frequent. “It was a blessing,” says Boyko.
Today there is more hope than ever for sufferers of vertigo, and Boyko firmly believes that you shouldn’t give up.
“Make the medical profession hear you,” she advises. “Stand up for yourself.”

For more info on balance and dizziness disorders, visit the Vestibular Disorders Association  and the Balance And Dizziness Disorders Society.

For more info on DizzyFix, visit the DizzyFix website.

For more info on the BrainPort, visit their website.