A loss of balance and equilibrium suggests injury to the

When facing down a ferocious lion, an oncoming car or maybe just an impending deadline, our bodies trigger a physical stress response that prepares us to either fight or flee the scene. This “fight-or-flight” response is driven by the sympathetic nervous system, a normally harmonized network of brain structures, nerves and hormones that, if thrown off balance, can result in serious complications.

An automatic response

The sympathetic nervous system makes up part of the autonomic nervous system, also known as the involuntary nervous system. Without conscious direction, the autonomic nervous system regulates important bodily functions such as heart rate, blood pressure, pupil dilation, body temperature, sweating and digestion, according to a review in the American Journal of Pharmaceutical Education. Research suggests that distinct types of nerve cells, called neurons, control these different physical reactions by directing the action of skeletal muscle, cardiac muscle and gland secretion. The system allows animals to make quick internal adjustments and react without having to think about it.

The sympathetic nervous system directs the body’s rapid involuntary response to dangerous or stressful situations. A flash flood of hormones boosts the body’s alertness and heart rate, sending extra blood to the muscles. Breathing quickens, delivering fresh oxygen to the brain, and an infusion of glucose is shot into the bloodstream for a quick energy boost. This response occurs so quickly that people often don’t realize it’s taken place, according to Harvard Medical School. For instance, a person may jump from the path of a falling tree before they fully register that it’s toppling toward them.

The sympathetic nervous system doesn’t destress the body once the tree is felled or the danger has passed. Another component of the autonomic nervous system, the parasympathetic nervous system, works to calm the body down, according to the Clinical Anatomy of the Cranial Nerves, published in 2014 by Academic Press. To counter the fight-or-flight response, this system encourages the body to “rest and digest.” Blood pressure, breathing rate and hormone flow return to normal levels as the body settles into homeostasis, or equilibrium, once more.

The sympathetic and parasympathetic nervous systems work together to maintain this baseline and normal body function.

Anatomy and organization

Structures in the brain, spinal cord and peripheral nervous system support the function of the sympathetic nervous system, according to a 2016 review in the journal BJA Education. Receptors in internal organs of the chest and abdomen collect information from the body and send it up to the brain through the spinal cord and cranial nerves. The hypothalamus, a brain structure important for regulating homeostasis, receives signals from the body and tunes the activity of the autonomic nervous system in response.

This brain structure also gathers information from areas higher in the brain, such as the amygdala, according to a review in the journal Biological Psychiatry. Often called the emotional brain, the amygdala pings the hypothalamus in times of stress.

The hypothalamus then relays the alert to the sympathetic nervous system and the signal continues on to the adrenal glands, which then produce epinephrine, better known as adrenaline. This hormone triggers the profuse sweating, rapid heartbeat and short breaths we associate with stress. If the danger persists, the hypothalamus sends a new message through the nerve system grapevine, instructing the adrenal glands to produce the hormone cortisol to keep the stress response rolling.

Outgoing commands from the sympathetic nervous system exit the spinal cord in the thoracolumbar region, or the mid to lower spine. Sympathetic neurons exit the spinal cord and extend in two columns on either side of it. These neurons then tag a second set of nerve cells into the relay, signaling them with help from the chemical messenger acetylcholine.

Having picked up the baton, the second set of neurons extends to smooth muscles that execute involuntary muscle movements, cardiac muscles and glands across the body. Often, the parasympathetic nervous system communicates with the same organs as the sympathetic nervous system to keep the activity of those organs in check.

What happens when it doesn’t work?

The sympathetic and parasympathetic nervous systems rest on either side of a wobbling scale; each system remains active in the body and helps counteract the actions of the other. If the opposing forces are mostly balanced, the body achieves homeostasis and operations chug along as usual. But diseases can disrupt the balance.

The sympathetic nervous system becomes overactive in a number of diseases, according to a review in the journal Autonomic Neuroscience. These include cardiovascular diseases like ischemic heart disease, chronic heart failure and hypertension. A boost of sympathetic signaling raises the blood pressure and enhances tone in smooth muscles, which may cause hypertension.

Beyond cardiovascular ailments, sympathetic dysfunction has been associated with kidney disease, type II diabetes, obesity, metabolic syndrome and even Parkinson’s disease.

“Everyone thinks about Parkinson’s disease in terms of its motor symptoms, but these autonomic symptoms actually appear long before,” said Dr. Marina Emborg, director of the Preclinical Parkinson’s Research Program at the University of Wisconsin-Madison. Changes in sympathetic nervous activity are evident in the skin, pupils and especially the heart.

“Some patients describe that they are more tired or have fatigue, but really, problems in the heart contribute to these overall symptoms,” Emborg told Live Science.

Parkinson’s damages the sympathetic neurons that help maintain levels of epinephrine and norepinephrine in the body — chemicals that tell the heart when to pump harder, such as when you move to stand up or exercise. Damage to these neurons can result in a lack of blood flow in patients with Parkinson’s, so they often feel lightheaded upon standing, which dramatically increases their risk of falls.

Sympathetic dysfunction also underlies mental health conditions such as anxiety, depression and chronic stress, an article in Forbes reported. In short bursts, the body’s physical stress response can be useful and grant an energizing boost of mental focus. If prolonged, however, the stress signals whizzing through the body wreak havoc. Besides maintaining a mental feeling of constant stress, the extra epinephrine and cortisol damage blood vessels, increase blood pressure and promote a buildup of fat.

So, while the fight-or-flight response serves a purpose, you don’t want it switched on all the time.

Additional resources:

  • Read more about the body’s response to stress at this page from the National Institute of Mental Health.
  • Find more information about autonomic disorders from the Cleveland Clinic.
  • Watch this video explainer on the basics of the sympathetic nervous system from CrashCourse.

Peripheral Vestibular Disease in Dogs

Overview
If you spin around in circles as fast as you can and then attempt to walk in a straight line, you’ll experience what your dog probably feels like if she’s suffering with vestibular disease. There are two types of vestibular disease: peripheral and central. In this article, we will discuss the peripheral form, which, with treatment, generally carries a good prognosis and is much more common than central vestibular disease, which attacks the central nervous system and brain.

Dogs with peripheral vestibular disease have a breakdown in communication between the inner ear and the brain, causing dizziness. Though this disease can be debilitating for your furry friend, it is not life-threatening. Peripheral vestibular disease generally affects senior and geriatric dogs over 8 years of age. Its most common cause is inflammation of the nerves that connect the ear to the brain, most often caused by chronic or recurrent ear infections. In some situations, vestibular disease can result from a lesion or infection in the brain, a stroke, or a head injury. In some older dogs, vestibular disease occurs suddenly, with no known underlying cause.

Symptoms
The most common symptom of vestibular disease is loss of balance. No, your pooch hasn’t been hitting the bottle…but it may look as though she has! If the disease only affects one ear, your dog may walk with a tilt or in circles.

Other symptoms might include:

  • Inability to stand
  • Falling
  • Repetitive eye movement (nystagmus)
  • Stumbling
  • Incoordination (ataxia)

Diagnose/Treatment
Once consulted, your veterinarian will perform a thorough physical exam, looking carefully at your pet’s ears, and may recommend diagnostic tests to look for concurrent conditions and to rule out other disorders that mimic vestibular disease.

These tests could include:

  • Chemistry tests to evaluate kidney, liver, and pancreatic function, as well as sugar levels
  • A complete blood count (CBC) to rule out blood-related conditions
  • Electrolyte tests to ensure your pet isn’t dehydrated or suffering from an electrolyte imbalance
  • Urine tests to screen for urinary tract infection and other disease, and to evaluate the ability of the kidneys to concentrate urine
  • A thyroid test to determine if the thyroid gland is producing too little thyroid hormone
  • A cortisol test to rule out Addison’s disease
  • Antibody/Antigen tests to rule out parasitic infections
  • Ultrasound examination of the abdomen to rule out tumors

Treatment will depend on the discovery of any concurrent conditions or underlying causes, such as an ear infection. If no cause is detected, your veterinarian will suggest supportive care that you can provide for your dizzy pooch as she recovers. The good news: most cases resolve quickly, with dogs recovering within a few weeks.

Prevention
Keeping your pooch free of infection and clean will help to prevent vestibular disease caused by an inflammation of the nerves. Routine health care and physicals including diagnostic tests can identify—sooner rather than later—any underlying conditions that could possibly cause vestibular disease. Call your veterinarian immediately if your dog seems dizzy or “drunk”—vestibular disease can happen quickly and can be scary, for both you and your pet!

If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.

Balance Test

The Human Vestibular (Balance) System

The human balance system is the coordinated effort of several systems: The vestibular system is the balance portion of the inner ear. This system tells the brain where the head is in space. The visual (the eyes) and the somatosensory systems (the body and sense of touch) give the brain information about the movement and stability of the world around us. Our central nervous system (the brain) then processes the information. It is conflicting information provided by these systems that results in dizziness or balance problems. The appropriate coordination of all these systems provides us with normal equilibrium.

What is a Videonystagmography (VNG) balance test?

The balance system is a complex one involving coordination of the vestibular (inner ear), visual (eyes), and sensory nerves throughout the body. The videonystagmography (VNG) test is a balance test used to evaluate problems with balance and equilibrium.

Considered the gold standard for balance testing, during a VNG test goggles are placed on the patient with cameras above each eye. These cameras record all eye movements throughout testing. In the first VNG test the camera tracks and measures the eye reflexes in both active and resting states. In the second test you will be moved into different positions to test for dizziness caused by movement or motion. In the third test a caloric evaluation will be completed in both the right and left ears. In this test, warm and cool water will be put into the ear canal to stimulate responses of the inner ear system. The resulting eye movements are then measured. Each ear is evaluated separately.

Test Duration: 1 to 1.5 hours

CEENTA has audiologists in locations across North and South Carolina who can provide balance tests using the most up-to-date technology in comfortable environments.

Request an Appointment for a Balance Test

Visiting ENT, diagnosis and testing

After visiting their GP most people with severe vertigo are referred to their hospital’s audiology, ear nose and throat (ENT) or neurology department for investigation, diagnosis and management of their condition. Many people often notice dizziness before tinnitus and hearing loss. Episodes of dizziness can have many causes. To diagnose Ménière’s disease it is necessary to exclude many other possible causes during the consultation and investigations at the hospital.

Why perform these tests?

The various tests are performed to:

  • Confirm the diagnosis
  • Exclude other conditions which require different treatment
  • Find out how bad the condition is
  • Monitor the progress of the disease so treatment can be given at the right time
  • Monitor the response to treatment.

First consultation

The health professional will want a detailed history of the patient’s condition.

Questions they may ask:

  • How the dizziness started?
  • How often the symptoms occur?
  • What affect they have on the patient?

The doctor will also want to know about any hearing loss, distortion of sounds, tinnitus, the patient’s general balance and other symptoms along with the patient’s general health.

Information about any treatments taken and if they were beneficial will be discussed along with any fears or concerns about the illness, such as work, family or quality of life. The first consultation will involve a physical examination of the patient’s ears, nose and throat looking for local problems such as infection, and a full examination of the nervous system especially the balance system and eyes.

The Tests

Here is a list of the tests which you may undergo as part of your diagnosis and ongoing management of your condition.

Audiogram

An audiogram tests a patient’s hearing. The test is carried out in a soundproof room. The patient wears headphones and a machine produces tones which are heard through the headphones. This test measures air conduction thresholds, i.e. how sounds are normally heard, coming through the air, down the ear canal and onto the eardrum. The patient also wears a hair band on their head with a bone vibrator which usually sits behind the ear which tests inner ear function. The hearing test does not explain how well everyday sounds are heard but tests response to the quietest sounds which may be heard in a totally artificial scenario. This test is well standardised and does give a reliable guide as to what level a patient’s hearing is at. The machines used are highly calibrated, and there are regulations stating what the sound environment needs to be like to get a reliable test.

Caloric test

The caloric test investigates the function of the horizontal semicircular canal in the inner ear. It gives useful information about balance function and may indicate which ear is affected. It involves stimulating the canal and recording the eye movements (nystagmus) produced and is the test used by most hospital departments. Although the test involves little sophisticated equipment it is complicated and requires the patient’s co-operation. It produces the sensation of vertigo, and the test needs to be repeated several times. The semicircular canal is stimulated by introducing warm or cold water or air into the outer ear canal. The patient lies on their back with their head on an angled rest and asked to fix their eyes on a point or light on the ceiling. The nystagmus will be recorded either visually or by small electrodes adhered to the temples. The sensation of vertigo will stop within a minute or two of the water or air flow stopping. It can be unpleasant for many people as it may resemble the start of an attack. For this reason it is important the patient is calm and fully understands the procedure. The caloric test produces vertigo and nystagmus in a normally functioning ear.

In Ménière’s disease the caloric test is used, together with other evidence, to make a diagnosis. The caloric test gives essential information when surgical procedures are considered, and can give useful information about progression of the disease. Many people have the test at some time, either prior to surgery or when being examined for bilateral disease.

Electrocochleography

This is an electrical test of the organ of hearing. Sound goes into the organ of hearing. The cells inside which register sound fire off little electrical impulses into the brain. With the patient lying down a long thin probe is pushed into the ear canal, either so it touches the ear drum, or alternatively, a needle is used to pass through the ear drum (under local anaesthetic). A speaker playing loud clicks is set up next to the patient while electrodes are places on their head to pick up the nerves firing. The computer is programmed to look at the first few thousandths of a second after each click and then averages out the electrical activity, taking out the background brain activity.

In Ménière’s disease there is a lot of pressure in the inner ear, ballooning out of endolymphatic space, pressing on the cells of the inner ear. When these little cells are pressed the electricity they produce changes, so the test is a measure of how much the cells are being pushed. The test is not always performed in the UK because it is quite invasive and fairly advanced skills are required to interpret the results. But it can be useful in making a diagnosis.

Electronystagmography

Electrodes are placed on the patient’s head and their eye movement tracked by glasses which are linked up to a computer. As the eyes move they create a little electric field and changes in this electric field are measured and traced onto a computer screen. Patients start off looking at a bar with a red dot. The system is calibrated so the computer knows how far their eyes move. The patient is then asked to follow the dot with their eyes as it rocks back and forth like a pendulum. They are then asked to look at dots jumping around the bar. These tests work out how well the eyes are wired into the brain and how well the nerve responds controlling the eyes.

Glasgow Benefit Inventory

The Glasgow Benefit Inventory is a patient-orientated questionnaire. There are other questionnaires to choose from but the Glasgow Benefit Inventory allows overall impact to be assessed. Validated questionnaires are useful as they show the impact the condition has on day-to-day living.

Hallpike test

When attacks of BPPV are occurring, the Hallpike positional test is diagnostic. The patient sits on the examination couch and lies rapidly backwards, head over the end (30 degrees below the horizontal) and turned 45 degrees to the side. The position is maintained for a minimum of half a minute. If the test is positive, the patient will become briefly very dizzy and will develop a characteristic repetitive eye movement called nystagmus. From the exact pattern of the nystagmus, the doctor can determine which semi-circular canal and which ear is involved. The treatment depends critically on this information. At the same time the other (mainly neurological) causes of these symptoms can be positively ruled out. When the patient is sat up again, further vertigo will usually be experienced, with the nystagmus reversing direction. The test is then repeated with the head turned the other way. In the commonest form of BPPV, involving the posterior semi-circular canal (over 90% of all cases), the Hallpike test is positive (i.e. induces vertigo and nystagmus) when the affected ear is downmost. Up to ten percent of cases may involve both ears.

Magnetic resonance imaging (MRI) scan

Scans are a routine part of the investigation of many diseases. Visualising the middle and inner ear is difficult and MRI scans are the most useful. The MRI scan will not confirm a diagnosis of Ménière’s disease, nor will it show which ear is affected or how severe the condition is. During initial investigation it is important to exclude many serious conditions which can cause vertigo or unilateral hearing loss and tinnitus. The scan looks for the presence of some of these illnesses. It can show the internal auditory canal and exclude the presence of tumours. It can also check that other areas of the brain are structurally normal and help to exclude brain tumours and multiple sclerosis. It is useful during the early stages of the disease especially if symptoms are severe and the other diagnoses need to be considered. The MRI scan uses a strong magnetic field, not x-rays. The scan of the head to include both inner ears takes about 30-40 minutes. During this time the patient has to keep their head perfectly still. The scan is painless and can be noisy, but there is a necessity for the head and upper body to be in a tunnel like space and this can make the MRI scan a difficult and unpleasant procedure for many people. Because of the strong magnetic field involved, patients with cardiac pacemakers and surgical brain clips cannot have an MRI scan. The MRI scan is a diagnosis of exclusion. As there is no definitive test for Ménière’s disease other causes of the symptoms need to be excluded and a normal test is sought. This is probably the most important and reassuring element of the MRI scan; that it is entirely normal.

Posturography

Posturography is a computerised test of balance. This system looks at a patient’s balance function in its entirety. Normal balance is a coordination between the body’s balance system, eyes (how the body is moving in space relevant to its surroundings) and joints (where the body is in space). The posturography system looks at all these inputs and allows the health professional to confuse each patient’s input by moving the floor, surroundings and by wearing a blindfold. The patient stands up in the machine and is secured with a harness. During the test the patient is constantly moving; although not very much. The body constantly allows movement backwards and forwards. If it tilts too far one way, the body senses bring it back again, and vice versa. The test watches how far people sway; the less of a balance mechanism a person has, the more they sway. This system can give useful information on the relative weighting of the patient’s eyes, joints and balance system. It also helps to train the patient’s remaining systems to help compensate after a balance loss.

Speech audiometry

Speech audiometry is a measure of the patient’s ability to understand speech. The patient listens to a recording of ten words. Each word has three phonemes (blocks of sounds which make up words) e.g. mat is made up of the sounds ‘m’, ‘a’ and ‘t’. The patient listens to each word and the audiologist asks them to repeat the words they hear. If they hear ‘mat’ the patient gets three points, because they heard all three sounds. There are ten words in total so the test gives a total score of 30. If the patient hears ‘bat’ but the word was ‘mat’ then they get two points for hearing the ‘a’ and ‘t’ but not the ‘m’. The words are played at different volumes, starting quietly and getting louder. There are likely to be more mistakes on the quieter words, but patients are asked to produce their best guess.

Tympanometry

A small rubber bung on a probe attached to the tympanometer is placed in the ear. The patient feels a pressure change and usually a varying noise. This machine measures how well the Eustachian tube is working by bouncing sound off the eardrum. The eardrum is floppy when the pressure on each side of it is the same. When the pressure increases on one side of the drum it becomes tight and the sound bounces off more easily. The machine produces a measure of middle ear pressure. If middle ear pressure is equalising well under normal circumstances, then it will be at atmospheric level, the same pressure as the pressure around us. If the Eustachian tube becomes blocked, then that pressure goes down; it becomes a vacuum because the blood supply of the middle ear resorbs the air. This makes the pressure lower in the middle ear which stiffens the eardrum up and the pressure then becomes negative.

Vestibular evoked myogenic potentials (VEMPs)

In recent years VEMPs have been receiving increasing attention. VEMPs are generated by the vestibular system, they have to be evoked in some way, they are myogenic, which means it is a muscle response, and they are an electrical potential, i.e. an electrical pulse that can be picked up. VEMPS tap into the fact that the balance organ responds to sound to see if it is actually functioning or not. This is one of the positive aspects of VEMPs and why they are likely to become more prominent. VEMPs are non-invasive and don’t really cause any discomfort. However the sound used to elicit a response can be loud and therefore care should be taken if the patient has tinnitus. Recording leads with sticky pads are put on the patient, along with the standard sort of headphones used in hearing tests.

The test itself takes less than five minutes; even quicker than a hearing test. An auditory stimulus is put into the ear which stimulates the otoliths. It goes through some neurological pathways and manifests itself as a muscle response that is measured either at the neck or around the eyes. VEMPs can be cervical or ocular. The established of the two is the cervical or C-VEMP. The C-VEMP tests the saccule (up and down movement). Electrodes are placed on the sternocleidomastoid (SCM) muscle on the side of the neck to measure this test. The ocular VEMP (O-VEMP) is a more recent adjunct to the vestibular test battery. It is thought to be a test of the utricle (forward and back movement). O-VEMPs are measured by electrodes placed just below the eye. The stimulation and setup is otherwise the same as the C-VEMP. Evidence supporting the use and interpretation of this test is increasing and it is hoped that it will become more routinely available over the next few years.

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Vertigo treatment

Once BPPV has been diagnosed (abnormal eye movements are a giveaway), a clinician will lead you through an exercise to move the crystals into another ear chamber where they’ll be absorbed by the body. Think of the exercise as one of those water-filled puzzles that you shake in order to move small beads from one place to another. Research has shown that the most successful of these moves is called the Epley maneuver.

It’s a fairly simple exercise: You sit at the end of an exam table with your head turned 45 degrees toward the affected side. The clinician will then tilt you back quickly so you’re lying on your back with your head hanging off the table, still turned to the affected side. Your head is held in this position for 20 to 30 seconds, then rotated 90 degrees to the unaffected side and held for another 20 to 30 seconds. Then, looking in the same direction, you’ll quickly roll onto your side while the clinician rapidly rotates your head another 90 degrees, until you’re lying nearly facedown. You’ll stay like that for another 20 to 30 seconds before the clinician rapidly brings you back up to a sitting position.

The maneuver is easy enough to do at home—as long as you know how. Many people who recognize the onset of BPPV turn to Internet videos for instructions. One of the most popular is produced by the American Academy of Neurology.

Important steps

If the maneuver doesn’t work for you, you may be neglecting two important steps.

First: Identify which ear is causing the vertigo. If you get dizzy every time you roll left in bed, then your left ear is the likely culprit. Once you know which ear has some loose calcium crystals, it’s important that you look to that side when you begin the Epley maneuver.

Second: Try to stabilize your neck after the Epley maneuver. “Typically, we advise patients to avoid positions that invoke the vertigo,” says Dr. Santos. “You don’t have to wear a neck brace, but we ask patients to avoid extreme flexion of the neck that would induce vertigo for 48 hours. Eventually, the goal is to get patients to return to normal activity and not restrict their head movements.”

Some people don’t even need the maneuver. Medications also used for motion sickness may help relieve symptoms and the BPPV symptoms may resolve on their own within a few days.

If it does linger for weeks or even months, BPPV usually still does go away eventually. If you don’t want to suffer through intense room spinning, you might want to consider looking at a video and trying the Epley maneuver yourself.

If it doesn’t help, it’s possible that you didn’t do it right, or that the crystals are in a part of your ear canal that requires another simple maneuver (called the Log Roll). But Dr. Santos says it’s best to leave it to the experts. “The advantage of seeing someone is that you can confirm you’re treating the correct side and the correct canal. We can pinpoint where the calcium crystals are and how to move them along,” says Dr. Santos.

Benign Paroxysmal Positional Vertigo (BPPV): Diagnosis and Tests

How is benign paroxysmal positional vertigo (BPPV) diagnosed and treated?

With advances in medical technology, BPPV can easily be diagnosed and treated. The diagnosis can usually be made in the office based on medical history and a physical exam. Treatment also involves a short, simple in-office procedure known as the particle repositioning maneuver. (See the treatment section).

How can I identify the side that is affected by benign paroxysmal positional vertigo (BPPV)?

Steps to determine affected side:

  1. Sit on bed so that if you lie down, your head hangs slightly over the end of the bed.
  2. Turn head to the right and lie back quickly.
  3. Wait 1 minute.
  4. If you feel dizzy, then the right ear is your affected ear.
  5. If no dizziness occurs, sit up.
  6. Wait 1 minute.
  7. Turn head to the left and lie back quickly.
  8. Wait 1 minute.
  9. If you feel dizzy, then the left ear is your affected ear.

Right position

Left position

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Mike from ATI Physical Therapy in Munster South, IN gives helpful tips to test yourself for Benign paroxysmal positional vertigo, or BPPV.

Transcript

Hi, this is Mike from ATI Physical Therapy in Munster South. Have you ever gotten dizzy when you went to lay down in bed, or when you were rolling over in bed, or getting out of bed? Well then you may have a condition called BPPV… Benign Proximal Position Vertigo.

So if you’re feeling dizzy and you want to test for BPPV you would get in, what we call, the long sitting position with two or three pillows behind you. You’ll turn your head forty-five degrees to the right or left, doesn’t matter which way you do first, and you’ll quickly lower yourself down over those pillows. You’re still turned to the right and your head is tipped over the pillows. You’ll stay there for thirty seconds. If you’re feeling dizzy during this time, the room is actually spinning, then you have BPPV in your posterior canal in your inner ear.

After thirty seconds come up, you’ll wait about one minute, then you’ll test the other ear to make sure it’s not in the other ear. Forty-five degrees to the left, go back quickly, make sure your head is tipped over these pillows, you want to use enough pillows to make sure you’re tipped back, it’s very important. You’ll stay there for thirty seconds and you’re looking for the same thing, if you get dizzy in this position. After thirty seconds, you come up. Usually, you’ll be dizzy coming down in one position, but not the other position. Also, most people will get actual spinning of the room in this position. This will, in other words, reproduce your symptoms.

So if you think you may have BPPV, you can stop in at any ATI location for a complimentary screening.

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