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February 3, 2000

Head-tilting treatment for vertigo described

Imagine feeling dizzy every time you looked up, reached for something above your head, bent over to tie your shoes or rolled over in bed.

At least one in 1,000 adults has such a condition, called benign paroxysmal positional vertigo. It may be the most common cause of vertigo. A person's first episode of the disorder can be frightening since it is unexpected, sudden and may lead to a visit to an emergency room.

Joseph Furman, professor of otolaryngology and neurology at Pitt's School of Medicine, discussed benign paroxysmal positional vertigo in a review article in The New England Journal of Medicine. Furman is director of the division of balance disorders in the University of Pittsburgh Medical Center's Department of Otolaryngology.

Benign paroxysmal positional vertigo is provoked by certain changes in head position as dislodged microscopic calcium crystals float around in the inner ear, disrupting nerve signals to the brain. The condition can occur spontaneously or following an inner ear injury. Doctors can diagnose and treat benign paroxysmal positional vertigo by performing a bedside maneuver that moves the floating particles back to where they belong by tipping the head backward in certain positions while observing the eyes. This treatment often provides immediate and long-lasting relief of dizziness.

About one in five patients with dizziness treated by Furman and colleagues has benign paroxysmal positional vertigo. The success rate of the head-tilting treatment is nearly 90 percent, according to Furman. But, he said, in some patients benign paroxysmal positional vertigo may suggest a more widespread balance disorder that may require additional attention such as physical therapy or medication. Even if treated successfully, Furman reported, benign paroxysmal positional vertigo recurs at a rate of about 1 percent per month, but recurrences can be treated easily. "Although patients can learn to live with it, the success rate of the treatment options prove they need not do so," Furman said.

Furman co-authored The New England Journal of Medicine review article with Stephen P. Cass, formerly of Pitt, now with the University of Colorado Health Science Center in Denver.

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