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The I'm 'Just' Dizzy Podcast
The I'm 'Just' Dizzy Podcast
Bridgett Wallace, PT, DPT

How can we feel balanced in a world that never stands still? The I’m 'Just' Dizzy Podcast is your ultimate resource for conquering dizziness and living a balanced life – physically, spiritually, and emotionally. The title is a reminder that no one is “just dizzy.” You, your loved ones, a co-worker, a neighbor – someone in your life has most likely experienced disabling dizziness or who limits their daily activities due to fear of falling. This podcast gives you access to experts in the field and real-life tools to bring tangible changes in a safe community. Let’s work together to raise awareness and understanding for overcoming and conquering the challenges while living with dizziness and balance problems.

In this episode of the I’m Just Dizzy podcast, we’re focusing on Benign Paroxysmal Positional Vertigo (BPPV), a prevalent inner ear disorder many have encountered. BPPV occurs when tiny calcium carbonate crystals, or otoconia, dislodge from their normal location in the inner ear, causing brief spells of vertigo with specific head movements. Despite the unsettling sensation, it’s the most common cause of vertigo and can significantly impact daily life, sleep, and work. Interestingly, the risk of experiencing BPPV increases with age and may recur, with over 50% of individuals seeing a return of symptoms within three years.

Factors elevating the risk of BPPV include low vitamin D levels, older age, osteoporosis, hormonal changes, diabetes, head trauma, migraines, and inner ear fluid imbalances. Often, the exact cause remains unknown, emphasizing the importance of early detection and treatment to enhance life quality and reduce fall risks.

The episode encourages listeners to use a handout provided for a visual understanding of BPPV. It highlights two primary indicators of BPPV: the brief duration of vertigo episodes, typically lasting less than 60 seconds, and its recurrence, underlining the transient yet impactful nature of the condition.

We also explore a key symptom of BPPV—the vertigo triggered by specific head movements such as rolling over in bed or tilting the head back. This condition, while often presenting as a spinning sensation for many, may manifest differently in individuals over 65, appearing more as a sense of unsteadiness rather than true spinning. This subtler presentation can complicate diagnosis in older adults, with an estimated 10% of those aged 65 or older possibly having undiagnosed BPPV.

Diagnosing BPPV involves specific tests targeting each of the semicircular canals, utilizing eye movement direction during these tests to pinpoint which canal is affected by the dislodged ear crystals. The direction of this nystagmus helps healthcare providers determine the exact location of the dislodgment, facilitating targeted and effective treatment. In cases of BPPV, these crystals detach from the utricle, leading to symptoms by either adhering to the cupula within the canals or moving freely within them.

In recent years, a new form of Benign Paroxysmal Positional Vertigo (BPPV), known as Type 2 BPPV or short arm canalithiasis, has been identified, characterized by positional dizziness without nystagmus. This discovery underscores the importance of familiarizing oneself with the inner workings of BPPV to understand why specific treatments are crucial. Treatment for BPPV varies depending on the type, with over 20 maneuvers designed to reposition dislodged ear crystals. The Epley maneuver is most commonly used for posterior canal BPPV, while the barbecue roll is preferred for horizontal canal cases. Anterior canal BPPV, though rare, is typically treated with variations of the Yacovino maneuver.

Treatment success can often be achieved in one to four visits, but complexity increases with atypical presentations or multiple canal involvement. Post-treatment precautions, like avoiding certain head positions, have been traditionally recommended, although recent research questions their necessity. Nonetheless, maintaining these precautions might still benefit some patients.

The downloadable handout is of immense help to follow along with this podcast to aid in the complex terminiology and provide a visual representation.

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Handouts