Emory Dizziness and Balance Center treats common forms of vertigo

By Martha McKenzie | Emory Medicine | Oct. 24, 2016

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For years, Marguerite Denny got a massage in her Decatur home every week. But one day when she sat up from the massage table, the room started to spin.

"It was like all the wood paneling in the den was rushing toward me and my head was swimming on the inside," says Denny.

For the next several weeks, any time Denny would lie down and get back up, her world would tilt and whirl for several seconds. Happily for Denny, her doctor was quickly able to diagnose her condition— benign paroxysmal positional vertigo, or BPPV—and refer her to the Emory Dizziness and Balance Center. After a few visits, she was free of the vertigo and remains free today.

BPPV is one of the most common causes of dizziness spells and vertigo. If diagnosed correctly, it can be treated quickly. Unfortunately, many patients end up seeing four or five doctors before they get a correct diagnosis.

"A lot of doctors don't know how to diagnose BPPV—they just call it vertigo and prescribe an antihistamine (Antivert) to relieve the symptoms," says Lisa Heusel-Gillig, a physical therapist at the Dizziness and Balance Center. "But that just decreases the symptoms of dizziness, it doesn't make it go away."

BPPV is caused by calcium carbonate crystals that have broken free and fallen into the fluid of the semicircular canals of the inner ear. When that happens, one ear is telling the brain one thing while the other ear is telling it something else, causing the spinning sensation. The feelings of vertigo are triggered by changes in the position of the head—getting up, lying down, and tilting the head back. The symptoms are usually brief, but some people also complain of poor balance and trouble walking for several hours after a vertigo episode. The condition sometimes clears up on its own.

The clinic uses a maneuver called Hallpike-Dix along with goggles that track eye movement to diagnose BPPV. From there it's a matter of manipulating the patient's position, rotating it in such a way that it moves the crystals out of the canals—somewhat akin to the puzzles where you tilt and rotate the game to get little balls to fall into the holes.

"If you know what you are doing, you can treat a person one time and the BPPV is gone," says Heusel-Gillig. She can also give the patient specific movements they can do at home once she knows exactly where the particles are.

BPPV is just one of the conditions treated at the Dizziness and Balance Center. Two other common causes of vertigo are migraines and vestibular hypofunction. The former primarily strikes women in the menopausal range and is often misdiagnosed. That's because the type of migraine that causes vertigo is not typically accompanied by a headache.

"When the hormones start changing, or when you are under a lot of stress, you can get these spells of vertigo," says Heusel-Gillig. "They may only last a few seconds, but they can really freak people out. And most of the people who have this type of migraine, myself included, had car sickness as a child."

Vestibular hypofunction results from damage to the nerve in the inner ear, often from a virus. Since the nerve does not grow back, patients will feel off-balance and dizzy until they get vestibular therapy. Within four to six weeks of therapy, however, patients typically recover almost fully.

The Emory Dizziness and Balance Center is in Executive Park and Emory Midtown and is staffed by Heusel-Gillig, neurologist Jaffar Khan, and a vestibular testing technician. Patients must receive a referral from a physician.