One more complication of getting older came to my attention this week. My husband had difficulty maintaining his balance when sitting and standing, so I (with a lot of help) whisked him off to the emergency room to find out what was wrong. After an X-ray, EKG, CT Scan, lots of blood tests, and an MRI, the diagnosis was BPPV, Benign Paroxysmal Positional Vertigo. I was very pleased with the first word in that diagnosis – benign. From my own experience with Paroxysmal Supraventricular Tachycardia, I already knew that paroxysmal just means it happens now and then, without being predictable. Vertigo I already understood. Positional refers to the fact that the vertigo was brought on by a change in the position of the head, in this case when my husband sat up quickly in bed. When he did that, crystals in his inner ear shifted position, bringing on the vertigo.
What are these crystals and how do they shift positions? Here is my high-school-biology-based explanation.
The inner ear contains three loop-shaped canals that contain fluid and sensors that monitor the rotation of the head. There are also other structures that monitor the up and down, right and left, and back and forth motion of the head related to gravity. These latter structures have crystals that make you sensitive to gravity. The crystals sometimes get knocked out of position which results in your inner ear being unable to determine your position relative to gravity, making you feel dizzy or light-headed or out-of-balance.
The treatment was a little unusual. We are so used to some drug being prescribed for any physical problem, but the attending physician explained that drugs have no place in treating a structural or mechanical problem. The shifting of crystals in my husband’s inner ear was probably the result of the deterioration of the inner ear structures. That is the usual cause in an older person. The same diagnosis in a younger person may be the result of damage as a result of a blow to the head. The treatment involved controlled (from the therapist’s viewpoint, but not so much from my husband’s viewpoint) rapid head movements intended to dislodge the crystals from the problematic position into a less problematic location. This was followed by keeping the head in as stationary a position as possible for several hours to minimize the risk of the crystals moving again. Since the crystals are more likely to move while lying down, my husband had to remain in bed with his head raised at least 45% above his body. Since it is possible the condition may reoccur, he will have a few more vestibular treatments to ensure the crystals are not roaming around his ear canals.
The symptoms of BPPV can be disturbing, even though the condition is not considered serious:
- A sense that you or your surroundings are spinning or moving (vertigo)
- A loss of balance
- Blurred vision associated with the sensation of vertigo
Those latter two symptoms can bring on dehydration which has its own set of complications, some of which can be serious. Should you or someone you care about report these symptoms, do not wait. Go to the nearest urgent care facility before the symptoms become more serious.