Inner Ear 'Rock Slides' Lead To Vertigo

Eye movements are recorded, reviewed, analyzed and saved on the computer.

Experts who treat dizziness estimate that about 20 percent of all dizziness is due to loose crystals — or ear rocks — in the inner ear.

The condition, known as benign paroxysmal positional vertigo, or BPPV, is usually treated with a series of simple head movements aimed at putting dislodged ear rocks back where they came from so they can be cleared away by the immune system. BPPV can be triggered by a head injury or a virus. The condition is more common in older adults.

Tiny 'Ear Rocks' Keep Us Balanced

Within the inner ear, there's a little pouch called the utricle that contains about 1,000 little pebbles made of calcium carbonate.

The tiny rocks serve an important purpose: They stimulate nerve cells when we move our heads — and send signals to our brain that guide our sense of up and down.

"The trouble is that sometimes the little rocks fall off," explains Dr. Timothy Hain, a dizziness expert at Northwestern University. When the rocks fall into one of the inner ear canals, the brain gets confused. As the rocks roll around in the canal, the brain senses that the head is moving a lot more than it actually is. The result: vertigo.

With Age Comes Dizziness

Head injuries and viruses can trigger the "rock slide" seen in BPPV. But several studies also document that the condition is more prevalent among adults over age 50.

The dizziness usually comes on suddenly. For Adele Freed, 83, of Frankfort, Ill., the sensation was similar to being tipsy from alcohol.

"I remember everything was spinning," she recalls. "And when I tried to get out of bed, the walls were moving. I just didn't have any balance."

Freed's family medical doctor gave her a prescription of Meclizine to treat the dizziness. When she didn't improve, she went to Hain, who's known at Northwestern University as the dizziness doc. He diagnosed her with BPPV.

The condition is not uncommon. About 1 in every 5 patients referred to him has this condition. And some researchers estimate that about 50 percent of all dizziness in older people is due to BPPV.

"This is really a success story in medicine," says Hain. "We've figured out the cause of this condition — and we've figured out how to treat it."

Freed was relieved to learn that the dizziness could be relieved by a series of simple movements that take about 15 minutes. A physical therapist guided her through the maneuver. Hain also gives patients exercises to do at home. The goal is to dislodge the rocks from the canal, and get them back where they belong.

"I was amazed that the whole secret to what I had was to get those crystals back in place," says Freed.

The Treatment

The main strategy used to move the rocks out of the canal is called the Epley maneuver. It was first introduced in the late 1980s, and has since been adopted by many ear specialists, neurologists, physical therapists and audiologists.

At the Washington Hospital Center, in Washington, D.C., audiologist Saul Strieb demonstrated the process. It begins with the patient moving quickly from an upright, seated position to lying flat on his or her back. The patient holds the supine position, and then turns the head. This position is held for about one minute, then the patient rolls onto his or her side. The sequence is often repeated.

"It's not successful all the time," says Strieb. "Sometimes it takes repeat visits."

Several randomized clinical trials have demonstrated that the Epley maneuver is a safe and effective treatment. Some studies document an 80 percent success rate. However, there is no solid evidence that the maneuver provides a long-term resolution of symptoms. Recurrence rates may approach 50 percent, depending on the age of the patient.

For those who seek no treatment at all, the condition usually improves on its own within a few months.

In severe cases, where the symptoms linger, physicians can perform a surgery to plug the ear canal.

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It's MORNING EDITION from NPR News. I'm Renee Montagne.

And in Your Health today we hear about dizziness and balance. We have a look at physical exercises that can improve balance problems that can crop up as we age.

First, NPR's Allison Aubrey reports on a common type of vertigo that's easy to treat once it gets diagnosed.

ALLISON AUBREY: If you'd spent any time on playgrounds, you might recall that kids seem to get a real kick out of swinging and spinning.

Unidentified Child: This is fun.

AUBREY: Whether it's the excitement around this carousel spinner or flying high on a swing, for children, there's a novelty to that feeling of dizziness, but not so for many older adults. Eighty-three-year-old Adele Freed says about a month ago she sat up in bed one morning and had the distinct sensation that she was drunk.

Ms. ADELE FREED (Experienced dizziness): I remember everything was spinning. And when I tried to get out of bed, the walls were moving. And I just didn't have any balance. It was a frightening experience for me.

AUBREY: And did it come on all at once?

Ms. FREED: Yes.

AUBREY: When Freed went to see her internist, he put her on the dizziness medicine, Meclizine. But when she didn't get any better, she made an appointment to see Timothy Hain, a physician at Northwestern University who's known there as the dizziness doc. Hain diagnosed her with a type of vertigo called benign paroxysmal positional vertigo, or BPPV for short. He says about one in five patients referred for dizziness have this condition. And he told Freed he could help her.

Dr. TIMOTHY HAIN (Northwestern University): Yes, this is really a success story in medicine, and where we figured out the cause of this condition and we figured out how to treat it.

AUBREY: Hain explains the cause is really pretty fascinating. Within the inner ear, there's a little pouch called the utricle that contains - and here's where it gets kind of funky - about 1,000 tiny little pebbles, actually crystals of calcium carbonate.

And it turns out these rocks are key to our sense of balance. When everything's working properly, the little pebbles in both our ears stay securely attached. And they help send signals to our brain, guiding our sense of movement. The trouble comes when the rocks fall off and roll into one of the inner ear canals.

Dr. HAIN: And if they fall into it, then they - they're at the lowest part of the inner ear and they just sort of stay there.

AUBREY: And then every time you reorient your head - say, going from a sitting position to lying down or just bending over to reach for something - the rocks roll around in this sensitive canal and make you dizzy. Adele Freed says when Dr. Hain explained to her that rolling pebbles were the cause of her vertigo she was surprised.

Ms. FREED: I had never heard of it before.

AUBREY: Hain told her the cause could be anything from aging to a head injury or a virus. But Freed says she was very relieved when he explained that his physical therapist could likely correct the problem with a series of simple head movements that can be done in a few minutes.

Ms. FREED: I was amazed that the whole secret to what I had was to get those crystals back in place.

AUBREY: The treatment Doctor Dizzy uses is now widespread. Here in D.C. at the Washington Hospital Center, an audiologist named Saul Strieb demonstrated the maneuver with one of his patients.

Mr. SAUL STRIEB (Audiologist, Washington Hospital Center): What I want you to do is keep your eyes open and tell me if you feel dizzy.

AUBREY: On Strieb's table is patient Geeta Tiwari. She's sitting up wearing a pair of infrared goggles that pick up her eye movements and project them onto a computer screen so Strieb can monitor them.

Mr. STRIEB: How do you feel?

Ms. GEETA TIWARI (Patient): Good.

AUBREY: Strieb then tells her to quickly lie down on her back.

Mr. STRIEB: We're looking at her eye movement. So if we saw some rotary eye movements, for example, that would suggest a problem with loose otoconia.

AUBREY: Otoconia being the fancy name for those ear rocks.

He then guides her through three move movements, turning her head to the side, rolling onto her left and then sitting up.

(Soundbite of noise)

So remember the silly, dizzy kids on the playground? Their eyes spin just like Strieb's vertigo patients. But everything is fine when they get off the ride, because nothing in their inner ears is out of place. For adults with loose ear rocks, Strieb's job is to try to get those pebbles back in place. He says a sequence of head movements usually works.

Mr. STRIEB: It's not 100 percent successful all the time. I mean, sometimes it just takes repeat visits.

AUBREY: Patient Adele Freed says it took two visits with her physical therapist to relieve the dizziness. She says on a scale of one to 10…

Ms. FREED: If (unintelligible) 10, I'd say it's a one or a half a one. It's night and day.

AUBREY: Dizzy Doc Tim Hain says for most patients, even those who opt for no treatment at all, the rocks may eventually clear out on their own. And over the course of several months, the dizziness diminishes.

Allison Aubrey, NPR News. Transcript provided by NPR, Copyright NPR.

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