I am a 71-year-old man who, last week, began to experience severe dizziness, as though the room was spinning. I actually vomited, and was taken to the emergency room. An ear, nose, and throat specialist saw me, jerked my head around, and sent me home. I was not too impressed by his treatment. What is your opinion?

Your question actually made us smile, but your diagnosis is not a laughing matter. You most probably have benign paroxysmal positional vertigo (BPPV), which is the most common type of vertigo.

The condition manifests itself with symptoms of spinning sensations, usually lasting less than a minute, but associated with nausea and—as in your case—occasionally vomiting. It is usually precipitated by changes in head position, so it often comes on as one gets out of or into bed. Movement of the head makes it worse. The condition may even manifest itself in the dental chair or at the barber’s.

There are problems that may result from BPPV, such as falls and impairment of daily functions, such as driving a car.

The condition is more common between the ages of 50 and 60, and two to three times more common in women than in men. Some have suggested it is seen more in people with osteoporosis, and also those with a vitamin D deficiency.

Balance is a very complex mechanism.

Balance is a very complex mechanism, requiring multiple position sensors (or monitors) throughout the body, but it’s also assisted by wonderfully designed balance mechanisms in the inner ear. We have three little tubes in each of the inner ears that are positioned at angles to one another. Within the canals is a fluid and little calcified particles called otoconia; these are bathed in the fluid. Gravity pulls these otoconia downward, and changes in position move them around, giving us a sense of physical orientation in relation to our surroundings. The semicircular canals are called anterior, posterior, and horizontal canals. Trapping of the otolithic debris (fragments of the calcified particles) in one or the other of these canals may result in the movement of the otoliths (larger particles) with head movement. This gives rise to the sensation of head spinning.

The posterior (rearmost) semicircular canal is the most frequent place for the otoliths to become lodged, and accounts for 60 to 90 percent of all cases of BPPV.

Once other potential causes of vertigo are excluded, such as a tumor or possible stroke, and once movement of the head is shown to provoke vertigo, the diagnosis must be seriously considered. Jerking movements of the eyes, called nystagmus, are often present, and specialists familiar with this condition can usually tell which of the semicircular canals is involved by the pattern of nystagmus (or unusual jerking eye movement).

It has been shown that rapid movements of the head in directions appropriate to the canal involved can dislodge the otolithic debris, often with gratifying results and relief of symptoms. What you referred to as “jerking of your head” is, in fact, a very appropriate treatment. This is not just any old movement, but a precisely calculated maneuver. Of course, sometimes the treatment is associated with some symptoms, but relief can be quite dramatic.

You would, of course, be wise not to drive your car yourself to and from such appointments for therapy. An explanation needs to be given when you are over the worst of the episode of vertigo; this may accompany or precede treatment in order for you to fully understand what the doctor is telling you.

The mechanism of balance and physical orientation is delicate, intricate, and carefully designed. We are fearfully and wonderfully made, and we are blessed to have the assurance of a soon-returning Savior, whose second advent will usher in an eternity where sickness and suffering will be no more.