Questions from our readers

After I treat my BPPV with maneuvers, I still feel “woozy” for days/weeks afterward.  No acute vertigo, but light-headedness, and a general “brain fog” malaise which typically greets me each morning but resolves later in the day.  For weeks or months, until I feel really good then “bam”, another BBPV episode that restarts the process.

Is this at all typical?  Drives me nuts!!

The purpose for maneuvers in BPPV is to resolve ALL the vertigo.  It’s not acceptable to continue to have dizziness.  There are two possibilities: 

1) You may still have some particles in the canals of the inner ear, so you still have BPPV

2) You have another dizziness disorder

Most of the time, having some dizziness after you’ve treated BPPV means  that you still have particles in the ear.  The sticky crystals that cause the dizziness (otoconia) come in different size clumps.  Often there will be several clumps that need to be removed.  The amount of dizziness you feel increases as the number of particles increases, so spells are longer and more severe when there are many clumps and larger clumps. 

As you do maneuvers, you gradually rotate clumps out of the canals, but it takes on average four maneuvers to remove most of the crystals.  The dizziness gradually declines as the number of particles decreases, but you’ll still have some dizziness when there are only a few left. So how do you know when all have been removed?  The best way to tell is that all your dizziness is completely gone.  A way to test this is to turn your head toward the “bad” (affected) ear, and then toss your head back and up over your shoulder.  If there’s a slight dizziness when you do that, you still have particles in your ear canals and need more maneuvers. 

Many people with continued dizziness after maneuvers have BPPV in the opposite, untreated ear.  Doing a few maneuvers for the other ear can help resolve this.  Particles can also get stuck in the ear and refuse to exit, so applying a vibrator (the handle of an electric toothbrush works well) can help move those particles.  See my book on the homepage for troubleshooting stuck particles.  Physical therapists and physicians can be consulted for additional maneuvers if you can’t resolve the problem.

Some of the people I see for BPPV actually have another cause of their dizziness.  If maneuvers don’t resolve the dizziness, you should see a physician for evaluation.  Brain fog in the morning and lightheadedness are often found in people with sleep apnea (abnormal snoring).  They can have very short spells of vertigo that happen during the day, so it can sometimes be mistaken for the short spells of BPPV.  Maneuvers don’t help that condition–it often requires a breathing machine.

See you next year for more vertigo posts!

Published by Vertigone

I translate the medical world of dizziness for non-medical people

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