Dizzy at the Dentist?

When you think of going to the dentist, does the fear of having a vertigo episode also come to mind?

Does this sound like you: “Don’t lay me down all the way otherwise the room will spin” or “When you sit me back up, do it slowly”. If it does, you might be suffering from BPPV.

What is Benign Paroxysmal Positional Vertigo (BPPV)

• Benign: not malignant
• Paroxysmal: occurs suddenly
• Positional: relating to head position
• Vertigo: spinning sensation or seeing objects jump of moving around you

BPPV caused by misplaced otoconia, calcium carbonate crystal-like structures, in the inner ear.  Otoconia, which are normally found in the utricle of you inner ear, breaks away from the gel membrane and moves into one or more of the semicircular canals.  When you move your head in certain positions, the symptom of vertigo occurs (nausea and imbalance can also occur).  Most commonly these symptoms present when a person is laying down, sitting up, or rolling in bed.

What Causes BPPV

The most common cause of BPPV in people under the age of 50 is a head injury.  There is also an association with migraine, Meniere’s disease, virus, and ototoxicity increasing the chance of an occurrence of BPPV. Minor strokes of the anterior vestibular artery may also be a cause.  In half of all cases, the cause is unknown.  In older people, the most common cause is degeneration of the vestibular system of the inner ear.  BPPV becomes much more common with advancing age.  50% of all cases of dizziness in people over 65 years old are due to BPPV.

Determining the Treatment Approach

With infrared goggles to monitor eye movement, our trained vestibular physical therapists place the patient into certain head positions to determine which canal or canals are affected. Overall, the posterior canal is the most commonly occurring canal for BPPV.

 There are two types of BPPV:

1. Canalithiasis:

• Otoconia is free floating in the canal.
• Symptoms and eye movements fatigues typically within 30 seconds.

2.  Cupulolithiaisis

• Otoconia is adhered to cupula
• Non fatiguing symptoms and eye movements (longer than 1 minute)

The treatment for BPPV will depend on which canal is involved, and which type of BPPV is found.  Many people find relieve after a few treatment sessions.

Will BPPV Come Back

BPPV is a condition that needs to be managed.  The recurrence rate of BPPV after these maneuvers is about 25-33% at one year, and 50% within 5 years.  Without specific interventions, 75% of patients have spontaneous resolution of symptoms in approximately one month.  However, in 25% of patients, the symptoms can continue for years. Therefore, it is worthwhile having the treatment as it is highly successful and can prevent prolonged symptom duration.

If you are experiencing dizziness or balance difficulties, our specialized physical therapists and physical therapist assistants may be able to help. Contact one of our clinics to find out more, 952-345-3000.