Every now and then, medicine throws up a cure that is so quick and so simple that patients find it difficult to accept. This has happened with one of the most common forms of vertigo. Men who have spent years enduring this frustrating condition can have it vanquished in a 10-minute consultation in which no drugs, machinery or invasive procedures are used. All it takes is a painless manipulation of the head.
Some men are dumbfounded when they hear of the method. They think it’s a crackpot idea.
Vertigo is an illusion of movement. Although stationary, a sufferer feels either that he is moving or that objects about him are moving. This sensation is quite distinct from mere dizziness, unsteadiness or giddiness. About 5 per cent of men and women visiting general practitioners complain of vertigo, describing an unpleasant feeling of imbalance and spinning, often accompanied by nausea and vomiting.
Its origins can be difficult to determine because more than 80 disorders are reported to have vertigo as a possible symptom. Vertigo takes different forms, with the most common being known as benign paroxysmal positional vertigo, or BPPV. This form is triggered by a change in the position of the head. It can happen when a man rolls over in bed, when he turns around in the car to reverse or when he puts his head back to reach a high shelf.
As he does this, he is overcome with a brief but intense sensation of whirling and disorientation. This can recur throughout the day and cause considerable distress. In some men it may go on for years. In others it may resolve itself spontaneously in weeks.
It usually occurs on one side only, and each bout lasts no more than 30 seconds. Men who suffer vertigo over a prolonged period sometimes develop stiffness as a defence against movement.
BPPV is more prevalent in older people and usually happens for no apparent reason. It results from degeneration in the inner ear and can also follow trauma or an infection.
Fortunately, about 95 per cent of those with BPPV can be cured quickly.
It has been known for some time that BPPV arises because of a problem in one of the three semicircular canals of the inner ear. Back in the early eighties, there was a great reluctance to do invasive surgery on the inner ear. The rule was that the inner ear should never be violated for fear of causing deafness.
However, after experimenting on animals and discovering it was possible to drill into and plug the problematic semicircular canal without affecting hearing, doctors tried it on two men who were already deaf and were willing to have the operation. They were both cured.
The first man was in his mid-60s and had suffered so much from his vertigo that he was prepared to risk hearing loss and have the operation. He had lived with BPPV for almost 3 years and found it intolerable.
The procedure was a success and his hearing was preserved. Since then, this operation has been used around the world, with excellent results. But the original doctors hardly use it anymore! Rather, they use a simple head manipulation because it is quicker, cheaper, less invasive and, usually, just as effective.
There used to be a popular theory that a deposit in the canal caused BPPV. Later there was a theory that it was caused by small particles in the fluid in the canal. These canals are lined with fine hairs, and it was believed the particles stimulated the hairs, causing a tremendous sensation of movement when the person was quite still.
One surgeon opened up one of these canals and actually extracted the particles, providing proof for the particle theory. He showed that if you could get the particles out of the canal, you could cure the BPPV.
All one needed to do was to move them. By manoeuvring the head, it is possible to mechanically steer the particles out of the semicircular canals and into another part of the inner ear where they will do no harm. This requires some skill and knowledge about the anatomy of the inner ear.
The 5 per cent of people who don’t respond to this manoeuvre could be candidates for the surgery or one of the other methods for treating BPPV, such as drugs and habituation exercises that attempt to train the brain to cope with vertigo on a daily basis.
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