'Ear crystal' vertigo

What are "ear crystals"

In the inner ear, there are calcium carbonate particles —otoliths— that help detect head position. When one becomes detached and gets into one of the semicircular canals, every movement causes it to shift, sending a false spinning signal to the brain. That is benign paroxysmal positional vertigo, the most common cause of vertigo and, fortunately, one of the easiest to resolve.

How to recognise it

• Brief spinning episodes, lasting seconds, not hours.
• Triggered by specific movements: turning over in bed, lying down, getting up, looking up or bending down.
• They are accompanied by nausea and a strong sense of unsteadiness, but not by hearing loss or tinnitus.
• Between episodes, a feeling of instability and fear of moving may remain.

Diagnosis is made in the clinic

Using provocation manoeuvres —the best known being the Dix-Hallpike test— which reproduce the vertigo and allow observation of nystagmus, the involuntary eye movement that indicates which canal is affected. No imaging tests are needed to diagnose it: it is seen during the examination. And it is the examination that allows it to be distinguished, because not all vertigo that occurs when moving the head is BPPV: there are also positional vertigos of central origin, which is why an evaluation by experienced staff who can differentiate it properly is so important.

Treatment: manoeuvres, not medication

It is treated with repositioning manoeuvres —Epley and others depending on the canal— which return the particles to their proper place. Many people improve significantly in one or two sessions. Vestibular sedatives relieve nausea but do not cure the problem, and overuse delays recovery. If the vertigo recurs, if there is hearing loss or if the clinical picture does not fit, the study is completed with vestibular tests in the Vestibular Unit (otoneurology consultation).