What will stop my chronic dizzy spells?

QI WAS badly concussed by a fall in the snow four years ago and, although a scan was clear, I have been left with bouts of dizziness.

Blood and other tests are OK and I am told I have benign paroxysmal positional vertigo. Can you suggest a treatment? I am 74.

AAllan Dodd, Liverpool. IT musT be frustrating for you to have suffered from this for four

years, especially when the fall itself did not cause any serious injury. I am pleased to say that, if the diagnosis of benign paroxysmal positional vertigo (BPPV) is correct, then there is a simple, effective treatment that can minimise, or even halt, the recurrent bouts of dizziness.

First, let me explain a little about the condition. BPPV is the most common form of vertigo — ‘vertigo’ in this context does not refer to the fear of heights we often associate with the term, but a spinning sensation, much like the feeling you’d experience as a child after jumping off a roundabout in the playground.

It can often be traced back to a head injury (as in your case) or whiplash, but, in a third of cases, there is no obvious cause. It’s more common in women and the elderly, but each of us has a 2 to 3 per cent chance of developing it in our lifetime.

The symptoms tend to come and go, with episodes of dizziness typically lasting up to a minute at a time. These may be provoked by seemingly innocuous movements, such as rolling over in bed or turning to reach for the seat belt when settling into a car seat.

The bouts can be so severe that they trigger nausea or vomiting, rather reminiscent of the motioninduced vertigo of seasickness.

It can also cause unsteadiness or loss of balance.

BPPV is caused by tiny calcium crystals moving about in your inner ear, specifically in the socalled semicircular canals. These three loop- like structures are integral to our sense of balance and contain fluid and microscopic hairs that detect when the head moves and in which direction, and send that information to the brain.

In BPPV, the calcium crystals normally found in another nearby part of the ear collect in the semicircular canals. There, they roll around as the head moves, tripping the hairs, which then transmit to the brain erroneous information about the head’s position — the feeling of dizziness then ensues.

The condition is treated by dislodging troublesome particles from the semicircular canals and sending them rolling back to where they belong.

This is achieved by a series of exercises known as the Epley manoeuvre — developed by Dr John Epley, an American ear, nose and throat expert, some 40 years ago — and can be carried out by an ear specialist, trained physiologist or audiologist in their clinic.

It involves moving the patient’s head through a series of rotations and other positions, both seated and when lying down.

It is a skilled procedure, but harmless, requiring no anaesthetic or medication, and is almost always effective. In fact, studies have shown it to remedy the condition after just one treatment in more than 80 per cent of patients — the remainder may need a second or third treatment to move the crystals.

An alternative you can carry out at home are Cawthorne- Cooksey exercises. You can be taught these by a physiotherapist and, over time, the regimen can be as effective as the Epley manoeuvre.

I strongly advise that you ask your GP about these treatments.

Despite four years having passed since your fall, I believe that there is every reason to be optimistic about resolving your dizziness.