Michelle Pastula, Physician Assistant – Hellertown, PA
Dizziness, along with chest pain and fatigue, is one of the top reasons for a visit to urgent care. Often times, unnecessary testing such as electrocardiograms, blood work, and glucometry are ordered to determine a diagnosis. The need for these tests can be eliminated with a thorough patient history and a test called the Dix-Hallpike Maneuver. This test can diagnose a common cause of dizziness called Benign Paroxysmal Position Vertigo (BPPV).
What is Benign Paroxysmal Position Vertigo (BPPV)?
BPPV affects a component of the inner ear that, in conjunction with feedback from our eyes and body, tells the brain how to maintain balance. The inner ear is made up of three canals and two organs. These organs, called otolith organs – derived from the Latin words for ‘ears’ and ‘stone’ – contain tiny crystals that help the body sense acceleration. When these tiny crystals fall out of place and into one of the canals, fluid movement in the canal is disrupted. As a result, when you move your head, the spinning sensation known as vertigo occurs.
BPPV is the most common cause of vertigo. As the name suggests, this vertigo is:
- Benign: not life threatening
- Paroxysmal: comes and goes, usually lasting one minute or less
- Positional: occurring with movement of the head – for example, turning over in or getting up from bed.
The severity of BPPV can vary from nuisance to debilitating, resulting in time out of work and impaired activities of daily living. If left untreated, the symptoms can recur for weeks or months.
Patients may perceive and describe vertigo using a variety of symptoms, including:
- The classic spinning sensation
- Disequilibrium
- Lightheadedness
- Feeling faint.
Diagnosis and Treatment
Due to the varying descriptions, patients may end up receiving a full work-up to exclude other causes of dizziness, which is where the Dix-Hallpike Maneuver comes in. If this test is positive, there is no further workup needed for a diagnosis of BPPV.
Traditionally prescribed medicines are not highly effective for the brief episodes associated with BPPV, unless the episodes are extremely frequent. Instead, a re-positioning maneuver called the Epley Maneuver, which uses gravity to move the crystals out of the canal and back into place is preferred. This maneuver is easy to do and can be taught to the patient to perform at home.
Often times, patients leave urgent care after a myriad of unnecessary tests, finding that their symptoms have improved only slightly (if at all) and they continue to suffer at home. Through awareness and use of the Dix-Halllpike and Epley Maneuvers to treat BPPV, patients will see a quick and cost-effective relief of symptoms.
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