Ora Larson at home in Saint
Paul, Minn. She suffered a common form of vertigo and found relief
through a technique called the Epley maneuver.
Credit
Alex Potter for The New York Times
The first time it happened, in 2011, Bob Amberger thought he might be having a stroke.
A
retired real estate agent and contractor in Modesto, Calif., he awoke
one morning, started to climb out of bed, and felt the room whirling
around him. “It was the most disconcerting experience imaginable,” said
Mr. Amberger, 71.
If he kept still, the sensation abated, “but as soon as I moved, it was a wild merry-go-round.”
Frightened, he called 911 and spent a day and a night at the hospital, undergoing thousands of dollars in tests —
CT scan,
M.R.I.,
ultrasound,
blood work — that found nothing alarming. But whenever a nurse or
doctor asked him to sit up in bed, he had to reach for the rails.
Two
weeks later, still feeling as though he had a hangover, he saw his
primary care doctor, who finally explained that Mr. Amberger had the
most common kind of
vertigo. Reassuringly, there was an easy fix.
So many of the ailments that plague older adults can be managed but not cured.
Benign paroxysmal positional vertigo is a different story.
Although
it can be terrifying and tormenting, a trained physical therapist,
audiologist or otolaryngologist can usually dispatch its symptoms on the
spot with a simple repositioning maneuver. When the vertigo comes back
months or years later, as it tends to do, it can be vanquished again.
Often, patients can perform the maneuver themselves at home.
“When
you tell patients that all you have to do is move your head in a few
different directions, they think you’re crazy,” said Dr. John Oghalai,
an otolaryngologist at Stanford University.
But
when they find their vertigo gone with a nonpharmacological,
nonsurgical treatment lasting 10 or 20 minutes, “they love it,” he said.
B.P.P.V., as it’s known, occurs when the tiny
calcium
carbonate crystals of your inner ear loosen and migrate into one of the
semicircular canals, where their presence signals the brain that you’re
moving when you’re not.
The
resultant spinning sensation usually lasts only a minute or so, but
changes in head position can bring it on multiple times a day — when you
bend down to empty the dishwasher, lean back in a dentist’s chair, or
merely roll over in bed. B.P.P.V. can also follow a
head injury. The whirling sometimes become intense enough to cause
nausea and vomiting.
This
kind of vertigo occurs more frequently in older adults, apparently
because the protein coating that holds the crystals in place weakens
with age. “Like an old Post-it note, after 60 or 70 years the stickiness
wears off,” said Dr. Carol Foster, an otolaryngologist who directs the
Balance Laboratory at the University of Colorado Hospital.
Mercifully, the
dizziness
often resolves on its own within a few days or a couple of weeks. That
also makes it difficult to calculate how many people suffer from
vertigo, since some never seek treatment or get a correct diagnosis if
they do.
When
Dr. Oghalai and his colleagues evaluated 100 patients who came to a
geriatrics clinic at Baylor University over two weeks, none of whom had
previously reported dizziness, they
found that 9 percent had undiagnosed B.P.P.V. Balance experts think it is even more widespread.
Though
the vertigo itself isn’t dangerous, the Baylor study found that
patients who had it were more likely to fall, which can cause serious
injuries, and were less able to handle daily activities like bathing and
dressing. They were also more likely to have received a depression
diagnosis.
If
the vertigo persists, “it can be very debilitating,” said Dr. Susan
Herdman, professor emerita of rehabilitation medicine at Emory
University. Some patients come in feeling so unsteady that they are
holding onto walls and furniture, or even using a wheelchair.
On
average, patients with this disorder have already visited five other
physicians before they arrive at Emory’s Dizziness and Balance Center,
Dr. Herdman said.
Along
the way, they may have undergone lots of expensive, unnecessary tests.
They may also have been taking prescription anti-nausea drugs for
months, or even years, which may slow the perceived spiraling but don’t
stop the vertigo.
What
does stop it, an estimated 90 percent of the time, is canalith
repositioning, also known as the Epley maneuver, after the Oregon ear
surgeon
who devised it in 1980.
“This is a simple mechanical disorder,” said Dr. Foster, who has
performed the maneuver thousands of times. “You can fix it in minutes.”
The
therapist first confirms the benign paroxysmal positional vertigo
(there are many other kinds) by turning your head from one side to
another while looking for a characteristic eye movement called
nystagmus.
The
Epley maneuver also involves turning your head in several positions
while you’re sitting, then lying on your side. The process is quick,
generally taking less than five minutes. (You can see the steps
online.)
Gravity
allows the inner ear crystals that have shifted to float back into
place. Practitioners sometimes must repeat the maneuver or use related
ones. The treatment can bring on vertigo in itself, and patients
sometimes report feeling a bit off-balance for a day or two afterward.
Usually, however, they’re
startled to find that the spinning has stopped.
“It
was amazing,” said Ora Larson, 76, who lives in St. Paul, Minn. She had
taken anti-nausea drugs for years after her first bout of B.P.P.V in
the 1970s.
A
decade later, Mrs. Larson was experiencing vertigo again and happened
to read a newspaper article about the Epley maneuver. She drove 65 miles
to a hospital that offered it. “I was willing to try anything,” she
said.
She
had immediate relief then, and continues to head for a clinic when the
vertigo threatens to reappear. “It’s so noninvasive and so easy,” she
said. “You don’t even have to put on a gown.”
Dr. Foster
has developed an additional maneuver for home use, called t
he half-somersault that is done kneeling on the floor. Mr. Amberger found it online and reports that “it works stunningly well.”
Dr.
Foster’s initial trial with 68 patients using it at home showed that
the half somersault was as effective as a self-administered Epley, but
it’s still so new that studies replicating her results haven’t been
published.
The
Epley itself has only been widely practiced for about 20 years. Some
medical professionals clearly don’t know about it — or even recognize
B.P.P.V. Frustrated specialists believe that tens of thousands of older
adults endure its miseries without learning that there’s a safe,
accepted, low-cost way to make the world stop twirling around them.
“Sometimes,
health care providers say, ‘You’re just getting older,’” said Courtney
Hall, a researcher and physical therapist at James H. Quillen V.A.
Medical Center in Mountain Home, Tenn. “But feeling dizzy isn’t a normal
part of aging.”