Vestibular testing

sometimes needs to be performed over time.  If a person is not in the midst of a spell when having their vestibular system checked, the result of the test may not always be accurate.  The key to receiving an accurate picture of how well the inner ear is truly working is to test how well it functions on "good" and "bad" days.

Lateral canal cupulolithiasis with vibration

I recently had a client who had ageotropic nystagmus in the head right position that did not fatigue at 3 minutes.  It did abate with fixation, but returned when the fixation light was turned off.  After about 20 seconds of vibration, the ageotropic nystagmus abated.  Upon rolling to her left side she had geotropic nystagmus.  Following 2 360 degree rolls, she no longer had nystagmus in either of the positions.  We finished with one more 270 roll.

What does dizzy mean?

According to the clients I have seen, there are at least 114 ways to describe the sensation.  One of the keys to getting help when an individual is dizzy is for them to be able to describe the different sensations they feel when they are dizzy.  Learning the "dizzy language" helps battle the problem.

"He'll snap your head back and forth"

WAIT!!!  STOP!!!!  No I won't.  A client recently told me she was told I would do this to her to help get rid of her dizziness.  I guess it was part of the motivational talk she received to build up the courage to come and see me for vestibular rehabilitation.

It's funny how we describe experiences.  In my opinion, this language does not represent the type of therapy I do.  Perhaps it is just a matter of semantics.  I don't "snap" heads.  In fact, 99% of the things I do are very gentle.  I think a better way to say it is "he'll turn your head gently in proper directions at the right time."

A hypofunction and hyperfunction all in one ear

does not seem to be all that uncommon.  It becomes more of a challenge when the underlying cause is not in remission.

"I was worried it was all in my head!"

I hear my clients say that usually at least once a week.  So many people who suffer from problems causing spinning are frustrated because the believe others think they are "crazy".  Once we point out that these individuals do have nystagmus and that we can see when their dizziness begins and ends, they are so relieved.  They appreciate being told that their problem is real.  Of course, they appreciate even more having the problem taken away.  So, yes, the problem really is in their head...but it's in their inner ear which is located in their head!

Amplitude and frequency of nystagmus

seems to be directly related to the severity of the vestibular problem.  The higher the frequency and amplitude of nystagmus, the more dizzy my clients seem to be.  Following repeated repositioning attempts, I recently observed severe nystagmus improve to, what seemed to be, 1/10th then 1/20th of a turn of torsion.  This was asymptomatic, however, I still believe it represented the problem still being present (at a much lesser degree).  Sometimes, it seems like the eyes are "loading."   Nystagmus does not occur, but the slow phase seems to begin.

Vestibular rehabilitation specialists

can help determine the presence or absence of an inner ear problem and help others manage the problem. 

The Neck

has a very high number of sensors compared to other parts of our bodies.  These sensors tell us how fast we are moving our heads and whether our necks are bent forward, sideways or backward.  Many of them are located between the base of the skull and the first two cervical vertebrae.  These sensors are even more important when the inner ear stops working properly.

Why did my dizziness come back?

It is so frustrating when someone's dizziness is corrected for a few days/weeks only to have it return.  So why does it come back?  I think there are a few reasons.  First, we have to define it.  What is it?  What is the cause of it?  If "it" is BPPV, then some would argue the reason it comes back is because it is a virus and viruses tend to return, if it's caused by Migraine then every Migraine may increase the likelihood of it coming back.  If it is caused by a lack of blood flow and the cause of the lack of blood flow is not corrected, it could come back.  If it is caused by hormonal changes, with monthly changes in hormones...it could come back.  If it was because of a head injury and the inner ear is still traumatized, putting the rocks back may only last a short period of time until they fall out again.  I often think of this issue as several tornadoes going through a town.  You can't clean up the town until the tornadoes are gone.  Actually, you can clean up the town, but you will just keep cleaning what you previously cleaned if the tornadoes do not quit coming.  

So, when we put the rocks back, if the cause of the BPPV is not stabilized, the problem will continue to recur.  At that point, doing repositioning maneuvers is helpful in the short term to help manage each recurrence.

"My dizziness came back and I tried Brandt Daroff exercises

but I am not getting better.  What should I do now?"   To answer this question, one has to understand why they are dizzy.  If they had BPPV before and it has come back, then I would not choose the Brandt-Daroff exercise as my first option to correct the problem.  We now believe that Brandt-Daroff exercises can cause multi-canal BPPV.   I believe the key is to determine where the calcium crystals are loose and then do the most appropriate canalith repositioning maneuver.  This will likely require a health care provider trained in vestibular rehabilitation.

Naming your own nystagmus

would be close to impossible and I do not recommend trying if you have not been trained in evaluating nystagmus.  You cannot see your own nystagmus because when nystagmus is present, you feel spinning.   One way you could see your own nystagmus is to have someone take a video of your eyes while you are having a spell.   If you took the video to your health care provider they may be able to better determine why you are dizzy.    Sometimes, a health care provider trained in vestibular rehab can know which direction your eyes are beating based upon the direction in which you feel spinning. 

Which Canalith Repositioning Maneuver is done depends

upon the canal the otoconia are in.  The way we determine where the rocks are loose is by watching the eyes when performing a variety of tests.  We have been trained to identify and name the nystagmus that occurs.  Depending upon the direction of the nystagmus and how long the nystagmus lasts will guide us in determining the most appropriate repositioning maneuver to perform.