Last Monday I came over all funny. I was slightly disoriented and lost my sense of balance if I got up suddenly. I felt like one of those crayfish in a science experiment whose otoliths had been replaced by iron fillings and a slightly sadistic scientist was randomly waving a magnet to and fro, causing the poor creature to swim upside-down!! Perhaps I’d morphed into a giant crayfish?
But no, I was still me.
I decided to give it a couple of days and then go to see the Invertebrate Biologist, I mean GP, if I was still feeling odd. I live in England and we have a fantastic system of Socialised Medicine. I don’t have to pay a red cent if I need to go to the doctor!
My main symptom is a spinning sensation if I stand up suddenly, look up in the sky or when I get out of bed, especially at night when the lights are out and I don’t have any visual markers to orient myself. I also notice that I sometimes list to port (walked towards my left). I sometimes feel like I’m not sure where the ground is and am slightly nauseated. It isn’t entirely unpleasant and I’ve been in no danger of falling over, still I want to get it checked out.
By the time I rang to make an appointment at my health centre, I had to wait until Monday, today, to be seen. The doctor quickly diagnosed my condition: benign paroxysmal positional vertigo (BPPV), a disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance.
BPPV occurs as a result of otoconia, tiny crystals of calcium carbonate that are a normal part of the inner ear’s anatomy, detaching from the otolithic membrane in the utricle and collecting in one of the semicircular canals. When the head is still, gravity causes the otoconia to clump and settle (Figure 1). When the head moves, the otoconia shift. This stimulates the cupula to send false signals to the brain, producing vertigo and triggering nystagmus (involuntary eye movements).
To confirm his diagnosis, he performed the Dix-Hallpike test in which I sat upright and looked over each shoulder in turn, and was quickly lowered to a supine position. He was looking for me feeling vertigo and displaying nystagmus, or involuntary eye movement. Wow! I really had both of these symptoms when I looked to the right, which probably explains why I was listing to port. Problems on the one side of the brain can affect the opposite side of the body. I probably developed BPPV as a result of an inner ear infection from when I had that bad case of flu in the beginning of the year.
I was given a prescription for a medication to help with the nausea. Again, God bless the NHS! I pay a flat rate of £7.65/$11.50 for medication. Sometimes, adopting a “wait-and-see” approach is used for BPPV. Physicians often choose to monitor patients with BPPV before attempting treatment because it frequently resolves without intervention. If my symptoms don’t improve, I’ll go back in about a week for the Epley maneuver. This involves sequential movement of the head into four positions, with positional shifts spaced roughly 30 seconds apart. Which will move the displaced otoconia back into my utricle where they belong!
In the meantime, “I’m a crayfish…who dreamt she was a woman…and loved it. But now the dream is over…and the crayfish is awake.”