Physical Exam Can Sort Out - And Treat - Common Type of Vertigo

Professor of Clinical Medicine Dr. Eric Strong teaching the physical exam to colleagues

Some older patients with dizziness undergo thousands of dollars of tests that often turn up nothing. Others are told it’s just a part of aging. But with the most common kind of vertigo, there’s actually an easy fix. “You don’t even have to put on a gown,” says one patient in a New York Times article from 2016.

Diagnosis and treatment of benign paroxysmal positional vertigo (BPPV), as highlighted by the vignettes in the New York Times piece, is both simple and effective. And it highlights something important: for all the technology available to us, the physical exam is still extremely effective.

According to the article, BPPV “occurs when the tiny calcium carbonate crystals of your inner ear loosen and migrate into one of the semicircular canals, where their presence signals the brain that you’re moving when you’re not." Trained providers can diagnose and treat the symptoms of BPPV simply by repositioning the patient’s head. BPPV is confirmed by presence of nystagmus, a characteristic eye movement when the patient turns his/her head side to side.

The symptoms of BPPV can be treated by a 5-minute procedure called the Epley maneuver. Otolaryngologist John Oghalai tells the NYT, “When you tell patients that all you have to do is move your head in a few different directions, they think you’re crazy.” But “they love it” when they “find their vertigo gone with a simple test and a non-pharmacological treatment. Leaving it untreated can lead to falls that cause serious injury,” says the NYT.

Yet another reason that we here at Stanford 25 emphasize the bedside: you never know what you might discover.

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