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Dear Dr. Spector,

I experience dizziness when I first lie down and when I first get up at times. Could this have anything to do with ear, nose, and throat?

Sincerely,

Reid

Raleigh, North Carolina

Dear Reid,

Although dizziness can be from many, many different sources, the type that you describe seems very consistent with a variant that I see very frequently.

First, a little background. The balance system in your inner ear is a very complex setup that involves small crystals, called otoconia, that shift position in response to your head movements. In a condition called Benign Paroxysmal Positional Vertigo, these crystals can actually become dislodged, and float away in the surrounding fluid of the inner ear to places where they shouldn't be. It is believed by most experts that these wayward crystals irritate the fine sensors of the inner ear as they ebb and flow with further head movement and gravity. This problem causes the inner ear to report false impulses to the brain, that then interprets the information as radical movements of the head. This gives the affected person the very distressing feeling of violent movement, often to the level that would be experienced on a roller-coaster, even though their eyes are telling them that they are sitting still. These episodes are most apparent with certain types of head movements, like rolling over in bed, looking up into a closet, or reclining at the dentist or hairdresser.

If left untreated, the problem likely resolves in 3 to 6 weeks, but can persist for a year or longer in one-third of patients. Although this condition seems to be related to prior head trauma, viral infections, and increasing age, many patients I see do not have any predisposing factors.

A simple test performed in the office to elicit this response can accurately detect the problem, and even determine the ear that is causing the vertigo. Even better, another maneuver performed in the office, called a "canalith repositioning maneuver," can alleviate the problem immediately, up to 80% of the time. These maneuvers attempt to replace these crystals in their original position by moving the patient in specific ways to "guide" the crystal back home. Certain people will require more than one maneuver to alleviate the problem, and it can recur again in the future, at a rate of approximately 15% per year. That being said, I performed the maneuver on my mother last year, and it has not recurred to this day.

As usual, an in-office visit with a qualified ENT will be needed to determine if this is the problem you have, but chances are high.

Thank you for your question!

Jared E. Spector, MD

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