On Aug 16th, 2014 I awoke feeling a little bit off. At first I wasn’t sure what was going on but I felt a little sick to my stomach and slightly dizzy. I turned to my left and sat up and my world started to turn, slowly at first. I lay back down immediately fearing I would fall and it all got a lot worse. The room spun quickly and I had trouble seeing. Just as I was starting to feel like I needed to throw up the sensation began to lessen and eventually passed leaving me nauseous.
At that moment, unlike most people who suffer with this condition, I knew exactly what was going on. As it happens, I am an ENT surgeon (Otolaryngologist) and specialize in the treatment of dizziness. Several years ago I actually invented the DizzyFIX device as well as the only iphone app that treats a disease. The device is home treatment for a common cause of dizziness called Benign Positional Paroxysmal Vertigo or BPPV. The iphone app takes doctors through the maneuver so they can effectively treat their patients. In a stroke of irony, which was not lost on me, I awoke to find that I had BPPV…again.
About 2 years ago I had my first episode of BPPV. I experienced the classic findings of short lived episodes of positional dizziness. Despite my knowledge of this condition it actually took me several minutes to confirm that I had BPPV. I was only 37 at the time and BPPV is typically a disease of people over 60. There are a few other reasons to have BPPV such as head trauma, inner ear infections or Meniere’s disease. I had had none of these conditions.
BPPV is typically diagnosed with an Epley maneuver whereby the tester looks in the eyes of the patient and moves their head into a position which brings on the dizziness. It is all but impossible to definitively diagnose the condition on yourself without a video camera. In this case I had my wife nearby. It is essential to identify nystagmus (rhythmic beating of the eyes) to diagnose BPPV. In the case of BPPV the nystagmus causes your eyes to twist and beat towards the affected ear. I asked my wife to look in my eyes while I lay down on my right side trying to bring on the symptoms for the purpose of diagnosis. At the time she was worried I might be having a “conversion disorder” where my work was crossing over into my personal life and being made real by my mind. Basically she thought I was imagining it. Unfortunately for me when I lay down there was little to see in my eyes, but I certainly felt dizzy. The nystagmus associated with BPPV actually fatigues, meaning that repeated stimulation results in less and less dramatic nystagmus each time. Additionally subjective dizziness is a common problem for people with sub-clinical BPPV. The patient may feel the symptoms but their doctor can’t see the nystagmus in their eyes.
Nevertheless, I performed the maneuver to treat BPPV, called the Epley maneuver, on myself. This is actually the maneuver that the DizzyFIX helps people perform at home. The maneuver works by moving loose crystals from one part of the inner ear to another. In the ear there are two balance systems, the semi-circular canals and the otolithic membranes. The first tells you about rotation by using fluid in a canal like a stationary ice cube in a glass of water which you are turning. The second tells you about gravity by using crystals (called otoliths) attached to tiny hair cells which bend in the direction of gravity. If the crystals come loose they can float around like snow in a snow globe. They can land in the canal system and make you think you are turning when in fact you are not. Every time you shake the snow globe you felt a spinning sensation. This is what is it like to have BPPV.
Despite the fact that I had treated hundreds of patients with BPPV it is quite another thing to experience it first-hand. What surprised me most was the immediate change in my lifestyle. Within minutes I felt disabled – seriously disabled. I had trouble getting out of bed. I felt nauseous on the way to the bathroom. I could barely pick up my towel off the floor for fear of spinning dizziness. I had trouble looking up and washing my hair as it made me spin. I was asking myself how was I going to drive to work, how could I work, how could I look after the kids. Despite knowing the diagnosis and immediately performing the maneuver I still felt nauseous. This feeling lasted a solid two hours. After this left I had a persistent off balance feeling that lasted about 10 days. This post procedural sensation is actually quite common but not well documented. There is little that can be done for it except try and re-acclimatize to normal. Certainly sitting still and avoiding motion has been shown to slow recovery from dizziness.
So here I was 2 years later with what appeared to be another episode of BPPV. About 60% of people with the condition have a form which recurs after variable periods. This time I wanted to be sure that my wife saw the nystagmus in my eyes. I called her over prior to lying down. Told her exactly what to look for and considered getting a camera. To be honest the dizziness was so bad that all I wanted to do was get it over with as quickly as possible. I lay down as quickly as possible on my right side to maximize the nystagmus. I felt horribly dizzy and couldn’t see straight. I knew I was having mystagmus. I held my eyes wide open so my wife could see them and by her gasps I knew she saw torsional nystagmus in them. At least I had one believer. I performed the maneuver on myself again and this time I am sure that I actually could hear the crystals moving in my ear. I felt particularly dizzy again when I rolled up onto my left shoulder and looked towards the floor. I felt a wave of dizziness but also a sense of relief as I knew the maneuver was a success. Following treatment I again experienced nausea lasting several house and an off balance phase lasting days to weeks. In each case I lost a full day of work. I can’t imagine how awful it must be for people who can’t even get a diagnosis for weeks or months.
Despite the obvious negatives of suffering from BPPV I have gained from this experience a very personal insight into the lives of dizzy patients. BPPV is a the most common cause of dizziness related to the inner ear and paradoxically is it often treated with ineffective medical therapy. My hope for all patients is that they can identify their own condition quickly and achieve results which limit their suffering and minimize the disability associated with dizziness.