Today we are going to answer a frequently asked question that I hear from a lot of people, which is “What is the most common vestibular disorder?”
The answer is BPPV: Benign Paroxysmal Positional Vertigo.
For people over 75 years old, the number one complaint to their doctors is dizziness. About 45-50% of the time dizziness has an inner ear component, or a vestibular component.
The most common vestibular cause of vertigo or dizziness is BPPV – that stands for Benign Paroxysmal Positional Vertigo.
“Benign” means that it is not related to any disease or pathology. In fact, it is just a little crystal [or crystals] rolling around inside the ear out of place.
“Paroxysmal” means that the symptoms come and go; they are not constant.
“Positional” means that it varies based on the position of your head.
“Vertigo” is any false sense of motion; spinning, tilting, or moving through space when you’re actually standing still, or a false perception of otherwise normal motion. So, that’s Benign Paroxysmal Positional Vertigo!
Benign Paroxysmal Positional Vertigo is actually just a crystal [or crystals] that’s out of place in the inner ear. This little crystal is supposed to be in the inner ear. It helps us with our balance, but when it gets out of place it floats down into a [semi-]circular canal where it’s not supposed to be, [and] we get this false sense of vertigo.
For people with this condition [BPPV], 30-40% of the time it resolves on its own. That leaves about 60-70% of people who have BPPV that will continue to suffer with it for the rest of their life until somebody identifies it and treats it for them.
Symptoms of having BPPV can include dizziness and vertigo in certain positions, balance problems, walking problems, and fear of falling.
There is also a cognitive component where people say that they feel foggy in their brain – they have mental disorganization, difficulty with cognitive stamina, concentration, difficulty making decisions, and problems with executive functions.
High level thinking processes are affected.
These cognitive symptoms can go away immediately in some cases when the vertigo is cleared.
If this condition is properly assessed and treated by a skilled provider, it resolves in one treatment 85-90% of the time.
Now you can see why I feel this urgency to bring this information to you; so that if you are someone who is suffering with dizziness, vertigo, imbalance, or unexplained repeated falls, you know that you don’t have to live like that!
The average person with BPPV sees between four and five different physicians and spends an average of $2,000 before they arrive at a diagnosis. That doesn’t even include treatment!
A lot of times people with BPPV undergo unnecessary diagnostic testing and take long-term medications that they might not even necessarily need if they were to see an appropriate provider that could fix their condition.
Who gets BPPV? Who might experience this?
I find [BPPV] a lot in my older patients who are having unexplained repeated falls just due to normal aging. The little membrane that the crystal is supposed to be on ages, and those crystals come off more easily with the aging process.
It can just be related to normal aging, spontaneously occurring and peaking in the fifties and sixties of life. People in their fifties and sixties have the highest rate of this condition, and of them, women have it about 6.8 to 1 times more than men; so about 7 woman for every 1 man gets this condition in middle age.
I would say peri-menopausal women get BPPV very often. Also, anybody over 65 years old may benefit from being screened for this condition due to normal aging.
Other people who might have BPPV include athletes who have concussion injuries, people who have been in car accidents or hit their head, people that have been the victim of any kind of abuse or domestic violence where they’ve had a head injury, and especially veterans coming back from Iraq that have experienced roadside bomb blast injuries because that energy of the blast can shake loose the crystal in their inner ear.
If you or anyone you know are suffering with unexplained dizziness, vertigo, imbalance, or unexplained repeated falls, I recommend for you to seek out a Vestibular Specialist through the Vestibular Disorders Association website, Vestibular.org. You can find somebody just like me in your area who can evaluate your inner ear and hopefully resolve, if not at least reduce your symptoms.
I also do patient and family advocacy phone consultations with people across the country to help you at least get a plan together of which healthcare providers to seek in your area and what to say to advocate for yourself.
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
I think I have finally connected the dots with assistance of this update