Vertigo can put your life off balance

By BOB MASSEY

Feeling Fit Correspondent

You haven't had a drop of alcohol, yet the world starts to spin.

It happens from reaching up or stooping down for an object in the kitchen, or even from just rolling over in bed. All it takes is a move of your head.

That's what it's like having benign paroxysmal positional vertigo (BPPV for short), which is considered the most common cause of vertigo -- that sense of dizziness, light-headedness or loss of balance. At least 20 percent of patients who complain of vertigo are diagnosed with BPPV.

But that figure is probably low -- since BPPV is often misdiagnosed. This is because a patient may have other balance-related disorders at the same time.

If you've experienced a sudden episode of BPPV, you're first thought -- right after "Whoa!" -- has probably been, "What on Earth is going on?" The answer? In a word, otoconia.

Balancing act

The cause of BPPV has to do with the complex, maze-like network -- called the vestibular system -- in the inner ear that regulates balance. This system does not work alone, but coordinates with other areas such as vision and the skeletal system. Combined, they give us a sense of our body's position, if it's at rest or in motion. The vestibular system also allows us to focus on objects when we change position, by being aware of mechanical forces such as gravity.

Things get mighty complicated in there for such a small area of the body. But here's the thumbnail explanation.

Several areas of the inner ear contain sensory hair cells. On top of those are otoconia, which are tiny granules of calcium carbonate. Gravity pulls on the otoconia when you tilt your head, and they in turn move the sensory hairs. By this process, the brain is alerted to the head's position.

With BPPV, otoconia tumble into one of the other sensory areas, creating a conflicting signal to the brain about the position of the head. The sense of being off-balance may occur in any position -- standing, sitting or lying down. Additional motion-related symptoms, such as nausea or vomiting, may also occur.

While the condition is rarely serious, it does pose a risk.

Assuming the position

The symptoms of BPPV usually last less than a minute. If you're walking or standing when a particularly intense episode occurs, it increases your chances of falling. And that can be serious. Also, if frequent vomiting accompanies the condition, you have to be careful to not become dehydrated.

It would be helpful to say physicians know the cause of BPPV -- but half the time, they can't find one. A head injury could do it -- but that's the most common cause in people under 50. For the rest, BPPV usually comes with something as simple and unavoidable as age. Although the condition can occur at any stage of life, those over 60 are most likely to be affected.

Fortunately, there are tests available that measure abnormal eye movement, as well as other standard diagnostic tests, that can help a physician identify the condition and eliminate the likelihood of other causes (such as a brain tumor).

Treatment is usually performed in a physician's office, and consists of "Canalith repositioning" -- a series of movements designed to coax the otoconia back into place. Some doctors may also recommend maneuvers you can perform at home.

However, even after successful therapy, BPPV may return -- and there is no known cure. There's no doubt living with BPPV creates some challenges, but it can often be managed so that it doesn't interfere significantly with your quality of life.