Many people experience dizziness but don’t know what to do about it. Dizziness may be a symptom of a more serious health issue and should be discussed with your healthcare provider. Quite often, however, dizziness in older people is caused by positional vertigo, and there are simple and effective treatments to reduce or eliminate this “off-balance” feeling.
Three sources in the body contribute to balance: vision, muscles and joints, and the inner ear’s vestibular system. Positional vertigo is just one disorder that can affect the vestibular system, but it’s also the easiest to treat. Symptoms often resolve after just one treatment.
Positional vertigo causes dizziness when tiny calcium crystals collect in one of the semicircular canals in the inner ear. These canals are responsible for telling the brain a person’s position. The crystals develop when structures in the ear called otoliths have degenerated or have been damaged by head injury or infection.
The most common symptom of vertigo is dizziness; other symptoms may include light-headedness, imbalance and nausea. Activities that bring on this feeling typically include a change in head position, such as rolling over in bed or reaching up to a high shelf. If positional vertigo is suspected, physical therapists use the Dix-Hallpike test to confirm. The patient’s head is turned to a 45-degree angle and then the patient is told to lie down quickly and position his head at 30 degrees below horizontal. Therapists look for nystagmus, a reflexive, involuntary eye movement characteristic of positional vertigo.
A video-monitoring tool can also be used to aid in diagnosis. The tool includes a set of goggles that magnify the patient’s eyes and a video monitor the therapist watches to check the intensity and direction of eye movement. The direction of eye movement tells the therapist which semicircular canal needs to be treated.
A common treatment for positional vertigo is the Epley manuever, a series of head positions that enables a therapist to move crystals to another part of the inner ear where they can be reabsorbed by the body. After just one treatment, many people no longer experience vertigo. To help minimize the chance of recurrence, a follow-up appointment is scheduled to make sure the Dix-Hallpike test is also negative.