The Many Causes of Dizziness

When I have a patient that wants to know what to do about their dizziness, the first thing I want them to do is describe how it feels without saying “dizzy”. Dizzy is a blanket description that can mean anything from lightheaded to room spinning dizziness. It may sound callus, but I always hope for room spinning dizziness.

There is a good reason for that...room spinning dizziness that occurs with head turning and lasts for about a minute, is most likely BPPV. That is benign paroxysmal positional vertigo. If you’ve heard of the “crystals in the ear”, that is BPPV. The reason I hope for this type of dizziness is that it is incredibly easy and effective to treat. The best part is that it usually takes 1 visit, sometimes 2. 

There are videos on YouTube describing how to treat this, but I highly recommend you don’t attempt it on your own because you may get lucky and fix it, but you also can get unlucky and create a second problem. Let’s have a look why:

This is the inner ear. There are 3 semicircular canals on both sides of your head. Inside the canals is fluid, and at the base of the canal, there is something called a cupula. On the cupula are otoconia (the crystals) that anchor hair cells. When you turn your head to one side, the fluid pushes the hair cells to one direction (and the opposite direction on the other side). This connects to a nerve and gives the brain information. When the crystals are out of place, it throws off the whole mechanism. The treatment aims to roll the head in a manner that gets them back to the cupula where they are reabsorbed. Now, the problem is that the canals have a common area (the utricle). If you attempt this treatment by yourself, you run the risk of placing the crystals into another canal. Now you have two problems and the dizziness will intensify. 

Now, what if it’s not this type of dizziness? Well, that will probably require a thorough evaluation. It can be Meniere’s disease, labrynthitis, vestibular neuritis, a perilymphatic fistula, an acoustic neuroma, or VOR hypofunction. That’s a lot of jargon, and it’s not an exhaustive list, but the last one, VOR hypofunction, is worth some description as it’s usually a repercussion of BPPV. When someone has been dealing with BPPV, they don’t want to turn their head out of fear that it’ll provoke the dizziness. This lack of movement will sometimes lead to VOR hypofunction. 

VOR stands for the vestibulo-ocular reflex. Your ability to maintain your gaze on an object while turning your head is due to this reflex. If you’re not turning your head and using the reflex, it can become “miscalibrated”. Luckily, there is an easy exercise that can retrain the reflex. Now I’d make sure to get evaluated first to make sure it isn’t something more serious. I also wouldn’t do this if you still have unresolved BPPV. Once cleared, here is how you can start to retrain the reflex: 

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