BPPV – Vertigo with Iyad Saloum

Mark: Hi it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby. Today we're talking about something that I think is, I don't know how common it is. It seems to be fairly common cuz we've talked about it a few times where the world spins all around you. What is going on with this Iyad?

Iyad: Yeah, so it's a condition called BPPV, where most of the time we get people coming in and complaining that whenever they either lie down or they turn their head to certain direction, they experience an illusion of the world spinning around them. Like the room spinning around them. I had one recently describe it as I feel like my head is spinning inside itself. 

And what tends to happen with that is inside our inner ears, we have an organ called the vestibular organ that kind of functions like an accelerometer that would be in your watch. It measures certain things and your head uses it, your brain uses it to figure out what's happening with your head, so it can kinda code for different movements of your head.

And some of these things in our ear will be gravity sensitive, and some of these things will just be rotation sensitive. So not so much sensitive to gravity. However, the things that are gravity sensitive, there's little crystals there that could get dislodged in one of those canals that usually are better at telling us about turning. And when one of those crystals can get one, or a group of those crystals can get kinda blocked in there.

And all of a sudden I get a different illusion of movement when I turn my head because I have my regular movement happening and then this crystal trickles a little further down and then I get a next kinda second bout of movement. But my brain only feels that on one side. So what happens is this kind of mismatch between left and right can cause us to feel like the world is spinning.

And it tends to be really terrifying for a lot of people when they get it because they feel like, oh my God, what's happening? Why am I spinning so much? And it just cause it tends to come out of the blue usually. Luckily it tends to be, and as for its name, benign, that's what the B stands for. It tends to not cause any serious harm beyond, you know, feeling like the world's spinning around you. And it's quite treatable, which is the good news. 

Mark: So let's talk about causes. Why would this happen? 

Iyad: The million dollar question. We don't know specifically why these things happen. They can happen spontaneously with a lot of people. In some cases we see head trauma being associated with it, but it's not really a clear definition.

So like, let's say if you were to experience any kind of impact to the head, you're not guaranteed to have it. However, we do tend to see it sometimes, like let's say there's a higher likelihood of it happening after an impact to the head. The other thing is, it tends to affect people who are a bit older, but we don't know if age could be a risk factor.

But it seems to be linked more to people who are a bit older in age. But that being said, I've treated people who are in their twenties with this, and I've also treated people in their nineties who have this. So honestly it's one of those things that the main way we distinguish it is by the pattern and the time that you stay, like in spinning, let's say. 

So the pattern tends to be associated with a head movement or any kind of change in position of the head. So people will tell you, oh, I was lying down, then I feel it for a bit. And it tends to last a short period of time. So like a couple of minutes would be as high as you would think. Most people tends to be about 30 seconds to a minute and then it settles down and they kinda tend to stop and try to brace themselves to prevent more movement. 

As far as, I guess on the biggest impact it would have is on your ability to do most things in life. You know, driving becomes a little interesting and walking up and down stairs where you have to move your head. So it tends to scare people a lot. 

And the whole reason I wanted to talk about this is, we've had a few cases in the clinic where, people go see their physicians get diagnosed adequately with the condition, and they get advised. Tends to be phone consults for the most part, to try something called the Epley Maneuver, which is the treatment that you would do, you could do it at home, it would affect about 70% of types of BPPV so it won't really capture all of them. 

And then a few of them say, they come in and see us, like Hey, I tried this thing for about a week and it hasn't really gone away. It feels horrible when I'm doing it, but it doesn't seem to kind of cause any resolution. And really the whole idea of this here is because you have three different canals and the Epley Maneuver can only really address two of those. And sometimes they do it to the wrong side.

Mark: So how do you assess that when someone comes in and they've been to see their doctor and they're still having this world spinning phenomena. 

Iyad: So we, it's a great question. We do have a very simple exam. We wanna make sure, obviously if they hadn't seen their physician, we try to make sure that there's nothing else going on. So we would want to rule out the serious, nasty stuff. And you know, again, we, once we do that, we kind of move into an assessment. We'd wanna look at a few things. If it's spinning, it tends to be related to the vestibular organ. However, if some people just say, your eyes feel dizzy or loopy, or I feel like I'm rocking on a boat, that might not necessarily be the inner ear.

So we would wanna figure out what's causing that dizziness. But if we're, let's say, diving into the inner ear part, we have certain positions and tests that we could place people in. And based on that, we could stimulate, let's say an episode of Vertigo and then based on the direction of their eye movement, and that's something called nystagmus, where your eye starts to respond as if you're actually moving, when you're stationary. We can figure out which, let's say canal is affected and we can treat it adequately. 

Mark: And what is the typical course of treatment? 

Iyad: So usually we would do something called Canalith Repositioning Maneuver, which is a fancy work for saying is we try to move those crystals that are kind of free floating in those canals, back to, we think it goes back to where they came from. But we maybe just think of it as just try to clear them out of that canal.

And what happens then is you restore the normal function of those things cause you don't have this thing that's just kind of jostling in there and maybe giving you a false perception of a movement. And Epley Maneuver is considered one of those, but again, the Epley Maneuver doesn't fix everything because it only addresses the two canals of the three. And then sometimes we have a few other things that we might do. 

The other thing that kind of tends to happen is that the Epley Maneuver only works on a certain type of BPPV. So that's where we are able to, based on the direction of the eye movement and let's say the speed at which they get the symptoms. If you lay them down and within barely any time, they start to get these different movements.

And it might indicate that they have a different type of this BPPV and we have different maneuvers that we could use to help restore that normality. And then some people will experience a small bit of kind of that residual, let's say, feeling off. And what we do with that is we give them certain exercises to help kind of habituate to that and get more comfortable with it.

So for the most part tends to be very treatable. And it's actually like one of the easier ones to deal with as a dizziness. I guess if you wanted to have something, probably would be that. But yeah, nobody wants to get dizzy at the end of the day, but that's tends to be very treatable and the treatment is quite successful.

Mark: If your world is spinning on you, the people that go see are Insync Physio in North Burnaby. You can reach them on their website, insyncphysio.com. Or you can give them a call at the clinic to book your appointment (604) 298-4878. You want physios who are trained specifically in how to treat this. This isn't just any physiotherapist. These are experts in how this works. Thanks Iyad. 

Iyad: Thanks, Mark.