New head maneuvers treat vertigo By Tom Majeski Knight-Rider New Service ST. Paul, Minn.- You bend over to tie your shoelaces, roll over or sit up in bed and it hits you like a tornado, leaving your head spinning like a top. Doctors call the disorder "benign paroxysmal positional vertigo." But victims describe it as severe dizziness, the kind that causes nausea. If it occurs often enough, it can make it nearly impossible for its victims to function. Now, doctors at the Mayo Clinic in Rochester, Minn. are using a new technique that they say cures the disorder in 90 percent of its victims. Rather than drugs or surgery, the treatment, called canalith repositioning procedure, involves a series of five simple head maneuvers that can be performed in about 15 minutes. While dizziness is not life threatening, it is a serious health problem, especially among older people. More than 90 million Americans have experienced a bout of dizziness at one time or another, and it is the third most frequent reason people see their doctors. For people 75 and older, it is the most frequent reason for doctor visits. Frustrating ailment The ailment challenges doctors and frustrates patients because there are many causes and few effective treatments. Last month, for instance, a woman from London came to the Mayo Clinic for help. For the past three years, she had battled bouts of dizziness so severe that they prevented her from lying down and sleeping, said Robert Brey, director of the clinic's Vestibular Dysfunction Laboratory. The woman told Brey that she had visited doctors throughout Europe, but all said her problem was psychological. In frustration, she came to Mayo, where Brey and his colleagues, using relatively simple tests, diagnosed benign paroxysmal positional vertigo. After putting her through the head maneuvering technique and the observing her to ensure the treatment worked, doctors sent her home three days later, apparently cured. "She's very, very happy," Brey said. 160,000 new cases yearly Between 8 and 25 percent of people who suffer bouts of dizziness have paroxysmal positional vertigo, Brey said. It occurs most often in adults 50 years and older and causes about 160,000 new cases of dizziness annually in the United States. The problem begins when tiny particles break off from the walls of a small compartment in the inner ear called the utricle. Doctors believe this flaking can be part of the natural aging process or it can be caused by a blow to the head. After time, the particles float into the adjacent fluid-filled semicircular canals, which help produce a sense of balance, and gather to form tiny clumps, Brey said. When a victim lies down or gets up, the clumps slide back and forth in the canals, acting like little plungers that push and pull the fluid. This rushing motion bends the tiny hair cells that help regulate balance, triggering the dizzy sensation. Back in 1980, a physician in Portland, Ore., developed a head maneuver that moves the floating particles back into the utricle, but the technique didn't catch on until a doctor in France developed a similar procedure and published his findings in 1990, Brey said. 90 percent cure rate Since then, the doctors at the Mayo Clinic have used the technique with 470 patients, curing about 90 percent of them, he said. Although the five-step head maneuvers sounds simple, "this is not a do-it-yourself technique." Brey said. "There are a couple of hundred causes of dizziness, so patients should get a diagnosis first," because benign paroxysmal positional vertigo is the only type of dizziness that can be treated with canalith repositioning procedure. In some parts of the country, physical therapists are being taught the maneuver. It is also being taught in the Mayo Medical School, Brey Said. Patients who have the disorder produce jerky eye movements that not only confirm the diagnosis, but also pinpoint which ear is involves, Brey said. Doctors who "understand what's going on" can be taught how to maneuver the particle back into the utricle, Brey said, adding that once the particles float back into the utricle they are eventually trapped by the chambers sticky walls. To ensure that the particles don't escape before being trapped, patients who have undergone the maneuver must keep their heads upright for 48hours, and then restrict their head movements and refrain from sleeping on the effected side for a week. If the process doesn't completely relieve the dizziness, the maneuver can be repeated, he said.