Dear Colleagues:

What prompts this letter to you is my own personal experience with Benign Positional Vertigo (BPV), which is thought to be due to debris that has collected within a part of the inner ear. This can be thought of as “ear rocks”, although the formal name is “otoconia”, which are small crystals of calcium carbonate derived from a structure in the ear called the utricle. In effect these migrate into the semi-circular canals and cause the dizziness one experiences.

The most common cause is trauma under the age of 50 due to head injury. In people over 60, it is due to the degeneration of the vestibular system of the inner ear. The most affected canal is the posterior semi-circular canal. The word benign is a misnomer. It may be benign if you don’t have it, but it affects your quality of living.

I had never experienced this until one night I went from a left lateral decubitus position in bed to a sitting position and promptly fell backwards, luckily on the bed. This happened on two other occasions. I also fell onto the putting green as I tried to retrieve my ball from the cup. Driving was an experience since I had vertigo when looking to the left in order to change lanes. Backing out of parking spaces in Paso Robles was also a challenge. Maybe not malignant, but sure as hell not benign!

I went to Kevin Colton, M.D. who recommended that I go the North County Physical Therapy to see Stephen J. Daillak, MPT. Stephen has had extensive training in evaluating vertigo, determining the canal affected, and trained to do the Epley and Semont Maneuver. These maneuvers are designed to do particle repositioning. The maneuver is effective in 80% of patients with BPV (Herdman et al, 1993).

I went to him with some degree of skepticism. He evaluated me and determined the problem was in my left posterior semi-circular canal. On my first session I went through this maneuver four times. The worst was the first two maneuvers which evoked severe vertigo and moderate nausea. By the fourth maneuver, I had 50% subjective improvement. Two days later, I returned for another session. By the fourth maneuver, my vertigo and nystagmus disappeared. I was still a little light-headed. I spent two nights in a semi-recumbent position and moved my head as little as possible. On my third visit, I had no nystagmus, no vertigo, and no nausea.

I ask those of you unfamiliar with this modality, how many times have you used Anti-Vert or Meclyzine. How many times did your eyes roll up and say another “crock complaint” - what the hell you are over 70 and what do you expect? It will go away in time. I echoed these thoughts many a time. Many of you will think this is voodoo. Ask yourselves the following – how many times has a medical dictum been looked on as sacred doctrine and then appears later as medical heresy? And, vice versa, how often has heresy become doctrine. Look at the Atkins Diet and see who is right. I expect the jury is still out; North County Primary Care Physicians have a unique modality to use in the treatment of BPV. You have someone who has the interest and the training to use a modality that offers an 80% cure and it is far better than being under the influence of still another drug. I strongly urge you to call North County Physical Therapy and talk to Stephen.

For those of you who want more information, go to GOOGLE and type in Epley Maneuvers. You will find an extensive bibliography. Thank you for your time in reading this before you throw it in the round file.

Sincerely,

Joseph E. Nargie, M.D.