Don’t ignore that spinning feeling: Your guide to vertigo diagnosis and treatment

Whenever Mr Ethan Lim (not his real name) experienced vertigo, he would do a bedside manoeuvre to ease the symptoms. However, a recent episode did not respond to this method.

Turning to his left while lying in bed triggered a spinning sensation that left him feeling uneasy.

He decided to visit the

Hearing Partners

clinic, which offers comprehensive hearing and vestibular (balance) diagnostic tests. The tests showed he had benign paroxysmal positional vertigo (BPPV), one of the most common causes of vertigo.

Unlike general dizziness, which is when one feels off-balance or groggy, vertigo is the sensation of spinning or swaying without actual movement. It may also come with symptoms such as ringing in the ears, headache, nausea, vomiting, involuntary eye movements, or changes in hearing.

Ms Jennifer Lee, senior clinical audiologist at Hearing Partners, explains: “BPPV occurs when the crystals in our inner ear get dislodged and affect the sensors responsible for detecting movements. The crystals may get dislodged from physical trauma to the head, inner ear infection, ear surgery or deterioration like ageing and vitamin D deficiency.”

According to studies, people over 60 are seven times more likely to have BPPV than those aged 18 to 39, says Ms Lee.

Fortunately, some cases of vertigo may resolve on their own, such as those caused by a viral infection. However, many cases require specific treatment to improve one’s quality of life, says Ms Lee. She explains that without treatment, vertigo can impact daily activities: “Many people with vertigo stop driving, exercising, or even going out alone for fear of falling.”

She adds: “Seeking care can also prevent complications and reduce fall risks – especially in older adults, who may have other issues that can cause imbalance, like weak muscles and poor eyesight.”

In addition, leaving any cause of vertigo untreated may also lead to persistent postural-perceptual dizziness or chronic vertigo, which is more debilitating and more challenging to treat, says Ms Lee.

“While vertigo itself isn’t life-threatening, it can be a symptom of more serious conditions like stroke or brain tumours, in rare cases.”

The good news is that simple cases of vertigo, such as BPPV that affects only one ear canal, are usually straightforward to diagnose and treat, she says.

“Complex cases might involve multiple causes or be related to central nervous system issues, making diagnosis and treatment more challenging,” says Ms Lee. “For instance, a patient with both BPPV and vestibular migraine would require a more cautious approach, as poorly managed migraines can heighten dizziness during manoeuvres, leading to discomfort and even vomiting. That is why Hearing Partners has brought in the latest diagnostic and treatment equipment to help its patients.”

A diagnostic and treatment tool for BPPV

Hearing Partners’ newest Camden Medical outlet features specialised equipment designed to accurately diagnose and treat BPPV. The equipment, resembling a chair, can rotate 360 degrees while keeping the patient securely seated, explains Ms Lee.

She explains that the patient wears goggles to record eye movements, helping the tester to identify very small eye movements to pinpoint the affected area accurately.

“As the equipment moves the patient into position, side-beating eye movements indicate lateral BPPV, while torsional upbeating eye movements indicate posterior BPPV,” she adds.

This refers to how the patient’s eyes move differently depending on which part of the inner ear is affected by BPPV when the patient is moved to a specific position.

Traditional bedside manoeuvres use manual methods and are less precise than this equipment. This was the reason why Mr Lim’s usual bedside manoeuvre did not work, notes Ms Lee. She adds that with traditional bedside manoeuvres, healthcare professionals cannot observe all eye movements during the process.

When it comes to treatment, Ms Lee says this equipment allows Hearing Partners to carry out what she calls “dynamic manoeuvres”.

“These manoeuvres can target specific semicircular canals more effectively. For instance, a ‘barbecue roll’ manoeuvre might be used for lateral BPPV, rotating the patient through a full 360 degrees.”

She adds that these “dynamic movements” are designed to return the dislodged crystals in the ear canal to their proper place, helping to reduce the patient’s dizziness and restore balance more efficiently than traditional methods.

“This makes it useful for patients with complex BPPV cases where multiple vestibular semicircular canals are affected.”

Ms Lee also says that with the use of this equipment, there could be significant improvement in patients who suffer from BPPV that do not respond to conventional treatments. “

One study

reported a 92.4 per cent success rate in treating refractory BPPV cases,” she notes.

Unlike manual treatment methods, the equipment is especially useful for patients who have neck conditions, the elderly or the physically disabled , as it can reduce discomfort and potential risks associated with manual bedside repositioning techniques, says Ms Lee.

“It allows us to safely position patients in different planes and angles to pinpoint and treat BPPV at its source,” she adds.

Ms Lee recalls that although Mr Lim was initially anxious about the treatment, he tolerated it well since he did not need to move on his own.

The equipment’s size and appearance were intimidating at first, but he felt secure with the harness and straps. The audiologist’s clear instructions and constant reassurance also helped ease his anxiety, especially when his vision was obscured by the goggles.

“This specialised equipment provided a precise and comfortable treatment for Mr Lim and he did not require a second treatment,” says Ms Lee.

However, while the chair can be used by most people, individuals with a known brain aneurysm or haemorrhage should avoid this treatment, notes Ms Lee. “Caution is also needed for pregnant women, as the straps and positioning may be uncomfortable. This is also the case for patients with heart conditions or high blood pressure, who should continue their necessary medications prior to the session.”

A typical session on the equipment lasts about 30 minutes for diagnosis, or 60 minutes if treatment is required. Ms Lee says 60 per cent of patients reported symptom relief after just one treatment, with an average of two sessions needed to fully resolve their BPPV.

Struggling with vertigo? Find out how this equipment and Hearing Partners can help – book a consultation today at

www.hearingpartners.com.sg

.