Mrs. V was a 64 year old homemaker who struggled with symptoms of vertigo and lightheadedness for 27 years. Her symptoms would come and go. She stated that she would experience sensations of severe spinning about 3-4 times a year for no reason. She was not on any medications and she was otherwise healthy. Her doctor informed her that she suffered from chronic vertigo for which there was no cure or treatment. As a result, Mrs. V developed depression and anxiety. She could not work and her doctor removed her license to drive. She lacked the skills to use the internet to research her condition. She did not know of anyone else with this condition and so she relied on her doctor’s advice that she would struggle with this condition forever.
Mrs. V booked in for a vestibular assessment with myself because I had treated one of her friends for an orthopedic condition and her friend had overheard me treating another client for dizziness while she was in the clinic. Mrs. V had one of her attacks a few days ago and was feeling very dizzy and lightheaded. From listening to Mrs. V’s story, it appeared that she was struggling with a condition called Benign Paroxysmal Positional Vertigo (BPPV). As part of any dizziness assessment, I completed a thorough history. Then I performed clinical screening tests to rule out other medical causes of dizziness that are less benign and require urgent medical intervention such as stroke or heart attack or dizziness that may be stemming from other reasons. Finally, to confirm whether a patient does indeed have BPPV, I performed a maneuver called the Dix Hallpike test and, if positive, it is highly likely that the sensation of spinning is indeed from BPPV.
In this instance, I was able to reproduce Mrs. V’s sensation of spinning with the Dix Hallpike test. Fortunately, there is a very effective treatment for BPPV called the Epley’s Repositioning Maneuver which I then proceeded to perform twice that day. After two Epley’s, I re-tested Mrs. V again with the Dix Hallpike test and her vertigo had resolved.
I followed up with Mrs. V one week later and she reported that she had had no further episodes of vertigo. The persistent lightheadedness and sense of imbalance that she had experienced for 27 years in between bouts of vertigo had also resolved. I repeated all of the tests that were done on initial assessment and she was normal. She felt both incredible joy and anger at the same time. I think you and I can understand the reasons for her reaction. I followed up with Mrs. V about one month after her last visit and she remained completely symptom free. She returned to her doctor and had her driver’s license reinstated. She was now free to pursue work outside her home. A 27 year condition was resolved in one treatment session.
Submitted by Albert Chan, PT
Our vestibular system is responsible for detecting angular acceleration and position of our head in relation to gravity. It has very complex connections to other parts of our brain, spinal and visual system that helps us maintain balance and equilibrium. The peripheral apparatus is housed in our inner ears and it has central connections to our midbrain. Dizziness is a very large umbrella term for any sensation of disequilibrium or imbalance including lightheadedness and vertigo. Benign Paroxysmal Positional Vertigo is but one condition among many that affects the vestibular system. The symptoms can be very severe and includes sensations of very fast spinning resulting in nausea and vomiting and in between bouts, some patients experience lingering sensations of lightheadedness and disequilibrium. Fortunately, if a person’s symptoms are primarily caused by BPPV, then there is a very simple treatment called the Epley’s Repositioning Maneuver that is effective up to 95% after one maneuver. Each maneuver takes about ten minutes to complete and within each treatment session, up to 3 maneuvers can be performed. This is one of the few “cures” we have in the field of medicine and it can be treated safely and effectively in a physiotherapy clinic.
The following conditions can be treated with Vestibular Therapy:
- Motion Sensitivity (motion sickness)
- Conditions resulting in dizziness, poor balance or risk for falls like Post Concussion Syndrome or post surgery or trauma.
- Vestibular Hypofunction
- Meniere’s Disease
If you are struggling with sensations of dizziness, you can either speak with your doctor or schedule an appointment here at the Kinsmen Sports Centre Physical Therapy Clinic for an assessment with Lauren Jenkins or Simon Cooke, physiotherapists with training in Vestibular Rehabilitation.