Hidden and benign paroxysmal positional vertigo accounts for 25% of vertigo in adults whose care pathway remains chaotic. Maneuvers performed by trained professionals can be effective.
“I felt my first dizziness in 2017, one morning when I got out of bed, it was as sudden as it was violent: not to get up! Recalls Jerome, 51. These were interspersed with regular dizzy spells and consultations with a vestibular physiotherapist, then in a department Ear, Nose and Throat at the University Hospital of Toulouse “, he says. “In my case, this positional dizziness is caused by crystals that are too embedded in the inner ear and therefore recurrent. I have become accustomed to resetting maneuvers and have learned to compensate in order to live the best possible daily life. But when a crisis occurs I feel that it is only 40% of my capabilities.
“Hi doctor? Why is he swaying?”: Dizziness, the second reason for consultation
A medical exam to rule out a stroke or a tumor
Dizziness or balance disorders is the second reason for consultation with a general practitioner, except for infectious diseases and after headaches. “In 25% of cases it is benign paroxysmal positional vertigo (BPPV). It can also be a vestibular migraine and finally Meniere’s disease,” says Professor Marie-Josée Esteve Fries, who directs the Department of Otolaryngology and Otolaryngology at the University Hospital Center in Toulouse.
“Purely mechanical and due to the displacement of the ear stones (crystals) in the ear; this vertigo occurs when you change position. It gives the impression that everything is spinning around you, and proves to be very disruptive on a daily basis,” describes a specialist. At the University Hospital of Toulouse, an average of 20 patients are consulted every day for the treatment of vertigo. They perform a vestibular assessment, possibly complemented by an MRI (magnetic resonance imaging) that makes it possible to visualize the structures of the inner ear. This evaluation, which is also offered in other ENT departments in hospitals and clinics, makes it possible to rule out the presence of central degenerative diseases, brain tumors or CVA (cerebrovascular accident) which can begin with sudden and isolated dizziness. “It allows you to stay vigilant about other inner ear ailments, which also cause vertigo.”
If post-traumatic positional vertigo can occur in the course of violent sports, head trauma, or due to vitamin D deficiency, in 1 in 2 cases, medication does not explain it.
For their treatment, liberation maneuvers, armchair manipulation or physical manipulation allowing only repositioning of the ear stones are effective. Generally, one to three maneuvers are sufficient, preferably at a time of crisis, but due to scheduling delays (between three and four months in hospital), vestibular physiotherapists take over in town.
“When a patient gives indications of positional vertigo, I perform very precise maneuvers using dedicated equipment to confirm the VPPB,” describes Dominique Gerboulet, vestibular physiotherapist in Toulouse and founding member of the National Federation of Vestibular Physiotherapists. “90% of these vertebrae are caused by crystals in the posterior canal, and the maneuver is to redirect them to their starting point, then observe the instructions to restrict movement for a few days. If the crystals are weak, this dizziness can recur. The purpose of the maneuver is to mark the distances between the repeats.” she points out.
Watch out for 3D
Another tip for people with vertigo and other people with motion sickness: Avoid 3D virtual reality experiences and overexposure to screens that can cause dizziness.