After Alex Donaldson fell backwards from a chair and hit her head with force – what she describes as a ‘good bash’ – doctors feared she had injured her neck, but she had a different concern.
For almost instantly Alex, 45, a GP and mother-of-two from Hertfordshire, was affected by such severe dizziness it made everyday life almost impossible.
‘For the first few weeks I struggled so badly with it that I couldn’t drive,’ says Alex.
‘If I kept my head still I would be OK, as the dizziness only hit when I moved. I told my doctor but they put it down to concussion and said it was temporary – I was told to simply rest.
‘But it didn’t go away. I couldn’t work because I looked anxious – if a GP looks nervous it worries the patient.’
Several weeks after the fall in October last year, Alex was referred to a specialist in balance disorders, who diagnosed benign paroxysmal positional vertigo (BPPV) – one of the most common types of vertigo, which can cause the sensation of dizziness or spinning.
BPPV is so common that according to the Meniere’s Society, a charity that offers support to people affected by dizziness or balance disorders, an estimated 50 per cent of us experience it at some point in our lives.
The condition occurs when crystals (formed of calcium carbonate) that sit in our inner ear became loose, usually due to a trauma such as a fall, although it can also happen as part of the ageing process.
Alex Donaldson says her dizziness meant she ‘couldn’t work because I looked anxious – if a GP looks nervous it worries the patient’
BPPV is so common that according to the Meniere’s Society, a charity that offers support to people affected by dizziness or balance disorders, an estimated 50 per cent of us experience it at some point in our lives
These microscopic crystals ordinarily sit in a bed of jelly in the inner ear, but if dislodged they can fall into one of the semi-circular canals in the ear (which form the vestibular labyrinth which helps inform the brain how you are moving).
These canals contain fluid and fine hairs which respond to the movement of our head, and nearby nerves then send messages to the brain to maintain our sense of balance.
The presence of the crystals can lead to confused messages being sent to the brain that someone is moving, even when they are perfectly still, prompting a disturbing sense of dizziness.
It is called paroxysmal, because the sensation of dizziness generally comes in short, intense bursts of up to a minute.
Although Alex’s BPPV was the result of a serious trauma, Dr Diego Kaski, a neurologist at the National Hospital of Neurology and Neurosurgery in London, who specialises in balance disorders says it can follow even a relatively mild bang to the head.
‘I’ve seen people get BPPV both after falling off a roof or even just falling backwards without serious injury,’ he tells the Daily Mail.
‘The crystals don’t dislodge very easily, but you don’t have to be concussed for it to happen.
‘It is more common in older people because the jelly the crystals sit in degenerates with age, making it easier for the crystals to become dislodged.
Adele Buckley says she experienced such severe spells of dizziness she fell over and needed eight stitches in her eyebrow
‘And although it is called “benign” you can fall as a result of the dizziness it causes, and falls can be fatal.’
BPPV is diagnosed using a specialist manoeuvre, known as the Dix-Hallpike manoeuvre, during which a medical practitioner rapidly moves your head from side to side to determine the location of the misplaced crystals.
It was after being put through this test by Dr Kaski, that Alex was diagnosed.
She recalls: ‘The movements were very quick and involved simply moving my head to see which side the problem was – we didn’t discover until much later on that, because my injury was so explosive, both ears were affected.’
Not everyone who develops BPPV will require treatment as it can resolve spontaneously – either as the crystals fall out of the semicircular canal or because they break down or dissolve.
But some will need treatment which takes the form of different manoeuvres, the aim of which is to nudge the displaced crystals back out into the ear canal.
Dr Kaski began treatment on Alex using the Semont manoeuvre. This involved Alex sitting on the edge of a bed and then lying down with her head to one side, and then switching to the opposite side.
‘Dr Kaski did the Semont twice,’ says Alex. ‘I felt terribly dizzy throughout, and even though it took just a few minutes, I felt totally exhausted afterwards.
‘The next day you have to take it slow and let the brain learn to trust what it is seeing – the trouble is, having suffered such debilitating dizziness, your eyes don’t trust what they are seeing.
‘You are left with a real fear of the sensation returning, of feeling once again that you are on a rollercoaster.’
Alex did the movements at home twice a week for a month – but her dizziness persisted, so Dr Kaski recommended she try a different technique known as the Epley manoeuvre.
It involves a practitioner repeatedly turning the head and body from left to right to try and dislodge the crystals – using slower movements than the Semont.
It’s the ‘only real treatment for BPPV if the Semont manoeuvre doesn’t work’, says Dr Kaski. ‘We try the Semont first because it is easier to perform in a busy clinic, and it can work for some patients.
‘We have millions of these crystals sitting in this jelly in our inner ear, but after the manoeuvre, the dislodged crystals don’t actually go back into the jelly – they get absorbed into the lymphatic system and eventually leave the body.’
Three months after the initial treatment, at Dr Kaski’s recommendation, Alex underwent the Epley manoeuvre and was clear of symptoms after two sessions.
Alex recalls: ‘The first time it worked partially, and then 48 hours after the second manoeuvre, it disappeared completely.’
Yet she is one of the lucky ones – as Dr Kaski says many of those affected continue to suffer without the help they need as ‘there is a lack of awareness of BPPV itself, alongside a huge lack of awareness of the simple, effective treatment because it isn’t routinely taught in undergraduate medicine’.
As a result many continue to suffer with BPPV, which Dr Kaski says is ‘very scary and disabling – patients are often on sick leave, unable to function at work, at home or socially’.
This was the experience of Adele Buckley, 63, from Southwold, Suffolk, who lived with unexplained extreme dizziness for a year without a diagnosis.
‘I thought I had a brain tumour at first,’ confesses the hospitality worker and mother-of-two.
‘I couldn’t walk down the stairs without holding on. And if I turned my head too fast, I got horribly dizzy.
‘Everything was moving around me, and my fear of falling was intense. I fell over once and had eight stitches to my eyebrow.
‘Until you’ve experienced a period of acute dizziness and poor balance, it is hard to appreciate just how debilitating it can be. It impacts every aspect of your life.’
She saw five different specialists, was sent for brain and body scans and received several mistaken diagnoses, including an inner-ear infection, before a sixth specialist diagnosed BPPV almost a year after her symptoms began.
The most likely cause, the consultant said, was that Adele had blown her nose too hard repeatedly over an extended period when she had a heavy cold, and the strain of it had dislodged her inner-ear crystals.
Adele underwent the Epley manoeuvre, just once, and at the end of it the dizziness had gone.
‘I was violently sick afterwards’ she says. ‘And then I felt fine.’
However, her experience in 2005 was so frightening that she says ever since she ‘is careful about blowing my nose too hard’.
Dr Kaski, who has never heard of over-enthusiastic nose-blowing triggering BPPV, says: ‘More GPs need to understand that, of all the neurological problems there are, this [BPPV] is one you can fix, often, in just 45 seconds,’ says Dr Kaski.
‘Dizziness is often referred to ENT (ear, nose and throat) departments but this [BPPV] is such a treatable problem that arguably all doctors should be aware of it.
‘Physiotherapists need to be part of the medical treatment for BPPV too, because the Epley manoeuvre is a form of physiotherapy and falls within their clinical skills.’
Some BPPV patients need repeat treatments, which can be done at home, although it’s not something that patients can do themselves, says Dr Kaski, as ‘it can be difficult for patients to get themselves into the correct position due to the symptoms it generates’.
‘It is far less likely to be successful than those done by someone else, and there is a potential risk of moving the crystals into another canal, which can complicate treatment afterwards.’