There is a new technology available to Colorado Springs for vestibular rehabilitation or the treatment of vertigo. It is called GyroStim. If you are suffering from vertigo or dizziness one type of vertigo can be related to the movement of crystals in our inner ear. This is called Benign Paroxysmal Positional Vertigo or BPPV. This type of dizziness feels like the room is spinning. You feel ‘ok’ but the world is moving around you. BPPV vertigo is common with head movements, getting up and down from lying and with looking down activities. People that have this type of vertigo like to lean against a wall and close their eyes. It comes and goes, as it is associated with head movement.
“The room is spinning but I am OK.”
“I have vertigo with getting up and lying down.”
“It is helpful to close my eyes when I get vertigo.”
Treatment for BPPV has an incredibly high success rate. The reason for this is that the treatment for BPPV is based on gravity. We all have rocks (crystals) in our heads. A problem arises when these rocks get loose and end up in the tubing of our inner ears. These tubes have one way in and out and are very curved, moving fluid (endolymph) through them every time our head moves quickly in a new direction. Getting these crystals out requires us to use gravity. The Epley maneuver was designed to quickly position your head to allow gravity to slowly move loose crystals through the endolymph towards the end of the tube and back into the tank or vestibule where they are no longer causing a problem. Think of this system like a hot water tank in your house with all the piping. If you had a pebble in the hot water tubing or pipes it would cause all sorts of problems. Some faucets wouldn’t work as well. You would have vibrations and changes in flow. But if this same pebble were sitting on the bottom of your hot water tank you would never know it was there. Here is a link to a video that shows this system and how treatment for BPPV works.
“move the crystal from the tubing to the tank”
Lets get back to GyroStim. We have learned that the treatment of BPPV is allowing gravity to slowly move the crystal from the tubing to the tank. This requires two things, well, actually three.
First you need to know if this is BPPV and is your vertigo associated with crystal movement. There are different forms of testing. The best tests use infrared goggles to record eye movement and look for nystagmus. Nystagmus, or beating of the eye in a specific pattern, when associated with vertigo symptoms can tell us what canal, posterior, anterior or horizontal, and what side. Knowing that you have BPPV and what canal and side is the first step.
Second is head position. This is critical to orienting the canal in the right position to move the crystal using gravity. Wrong angle and the technique will not work. A specific amount of time needs to happen between each position to allow the crystal to move and then settle. Too quick and the crystal does not have time to move along the curve of the tubing and goes back to where it started.
Third, re-positioning the head to orient the canal to continue crystal movement needs to be very quick. Too slow and the crystal goes back to where it came from, still in the tubing and not in the tank.
Here is where GyroStim fails to treat BPPV. While the patient is secured in the seat the head is not. This allows the person to move her head while treatment is occurring. This will typically be in the direction away from the chair movement. Speed of head movement cannot be controlled and for this alone BPPV treatment will not occur.
Another reason is canal orientation with gravity. This is also not controlled for with GyroStim. Transition speed between head positions is too slow and for this reason BPPV correction will not occur.
Finally, when testing with goggles is independent of treatment and not associated with your symptoms we lose a lot of helpful information in guiding treatment. The best treatments for BPPV include video oculography or goggle testing during treatment as well as during the assessment. Linking your dizziness with the nystagmus is a key factor in determining if you have BPPV.
GyroStim will not treat vertigo associated with BPPV
With the current setup of GyroStim if you have BPPV or vertigo this technology will not correct a crystal problem. A great question to ask is this, “If I get better temporarily but my symptoms return am I getting the right treatment?”
There is hope! If you have BPPV there is a good chance this is a posterior canal issue and the Epley maneuver is a great first step in self-treatment. The great news is that attempting to treat your BPPV rarely makes you worse in the long term and if done properly can correct over half of BPPV problems! If you are not getting better then it is time to see an ENT physician or Physical Therapist to accurately diagnose where your dizziness is coming from. If you do not know where your dizziness is coming from you can spend a lot of time and money in treatments that may not be right for you.
Here are some questions to ask when seeking medical help for vertigo.
· Did your doctor give you a reason for your dizziness? Why are you dizzy?
· Did testing include imaging such as infrared goggles?
· Were other systems checked, such as your upper neck and vision? These can be a significant source of dizziness.
“Got Goggles?”
I have included a link to Positional Vertigo and the Epley maneuver and a list of Physical Therapists and ENT’s in Colorado Springs who have a background in treating BPPV.
“If you do not know where your dizziness is coming from you can spend a lot of time and money in treatments that may not be right for you.”
Timothy Hain MD is a professor at Northwestern University Medical School and one of our countries top vestibular practitioners. Check out his perspective on Gyrostim and Vertigo treatment through his post – “Fraudulent, Irrational and unproven Vestibular Treatments”.
Colorado Springs Practitioners that Treat Vertigo
Cornerstone Physical Therapy
Colorado ENT
The Balance Center, Orthopedic Rehabilitation Associates
Balance Point
Cameron Shaw MD
