BPPV maneuvers got rid of my wife’s room spinning vertigo, but immediately after she now has vague non positional dizziness while standing and walking. From what I read, it could be something called residual dizziness caused by the brain changing how it interpreted signals from the affected ear. Supposedly some exercises with head and eye movements – VOR exercises – will help speed up the process of the brain turning back to normal ear signal processing. Is this right?
If you have BPPV and do the half somersault to clear the crystals, there are three possible outcomes: 1) You still have some spinning feelings when lying down; 2) The spinning is gone but you still feel a bit off or unsteady; 3) You are returned to normal with no dizziness or imbalance. If the latter, this is great. You’re done with BPPV. If you still have spinning, you still have BPPV and need to repeat the maneuvers until it resolves. But what do you do if, like the person above, the spinning is gone but you’re still unsteady?
Residual dizziness after BPPV means that you still have crystals in your ear, just not enough to cause spinning. In order for crystals to make the room appear to spin, you have to have enough of them to span the semicircular canal, acting as a piston. They also have to be in a clump large enough to form a plunger-like mass. If you do a few maneuvers and the spinning stops, but you’re still not right, this usually means that you have crystals that still need to be moved out, but not as many as before. If the clump doesn’t totally span the canal, it may still be enough to give you very mild spinning feelings inside your head without actually making the room spin.
This can also happen if the clump of crystals broke up so that is more like a sludge along the edges of the canal, rather than a solid clump. You will feel dizziness mildly when making quick up or down head movements and it can throw your balance off a bit. The treatment is to do another set of half somersaults the next day and see if you can clear the last few particles.
Another cause of residual dizziness is having crystals in another canal. Most crystals are in the posterior canal, which is vertical and makes you dizzy when you lie down, arise quickly or tip your head up or down. This type responds to the half somersault. However, it’s not uncommon to have crystals in other canals when you have BPPV or after maneuvers. Clearing one canal won’t completely resolve the vertigo if this happens. If the particles are in the horizontal canal, the dizziness is brought on by turning the head from side to side, whether upright or in bed. This requires another maneuver, the Gufoni maneuver, to clear. The anterior canal, another vertical canal, can cause chronic dizziness when upright. The treatment is to do the deep head hanging maneuver (Hain-Yacovino maneuver). These maneuvers are illustrated in our book, Overcoming Positional Vertigo and in our videos on this website.
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