Fortunately, BPPV is easily treated, most frequently with the Epley maneuver to reposition the otoconia particles. The patient’s head is rotated in a particular sequence, redistributing the misplaced otoconia.
Explore this issue:October 2006
Check All Medications
If the diagnosis is not BPPV, it may not be vertigo. Many physicians recommend a look at the patient’s medication list.
One thing we alert our primary care physicians to is overly aggressive treatment of hypertension, Dr. Goebel said. Patients get controlled too tightly. Vessels in the elderly have lost some of their elasticity; they don’t respond as well to position changes. If they get out of a chair or bed too quickly, they don’t have enough blood pressure to maintain function and they feel dizzy.
Dr. Goebel noted that 120 over 80 is the magical, mythical number that everybody is shooting for; however, that might be fine in somebody who is 25 or 30, but for someone 75 or 80, if you control them down to 120 over 80, that might be too tight.
Dr. Goebel added that he also sees elderly patients who are taking dizziness medication such as meclizine or Valium, and it has actually made them worse. I end up suggesting to their primary care doctor that they go off the sedative medication.
Otolaryngologists should also check the patient’s medication list for such drugs as aminoglycosides, which are known to damage the inner ear, the cancer drug cisplatinum, and salicylates, which can cause hearing loss, tinnitus, and/or dizziness. Once ototoxicity occurs, the damage can be irreversible.
In cases of degeneration of the vestibular system, Dr. Goebel said most of the time, these patients don’t say they are vertiginous. They won’t ‘spin’ because they are losing the system so slowly over a matter of years.
A head thrust test is one method to look for a dynamic visual acuity problem. The patient keeps eyes on a target while rapidly moving the head. If the patient has lost the ability to read while the head is moving, it may be a damaged vestibular system. Another test puts the patient on a compliance surface such as a three-inch foam pad, so the patient can’t feel the ground and can’t use the touch system in his or her feet for balance. If the patient sways when closing his or her eyes, the cause could be degeneration of the vestibular system, Dr. Goebel said. Treatment in these cases is usually vestibular rehabilitation therapy with a physical therapist who teaches special exercises to help patients adjust to balance problems.