If you experience episodes of vertigo, a sensation of spinning, you may have been told that your ear crystals are “out of place.”  Ear crystals?  It sounds mystical rather than a problem in your ear, right?  Let us dive into the mystical crystals in your ear because they are real anatomic structures that can wreak havoc on your sense of equilibrium and cause intense vertigo symptoms.

Your vestibular system lies in your inner ear, behind the eardrum.  This system has 2 otolith organs in it that sense linear movement of your head (up/down and side-to-side), and 3 semicircular canals full of fluid that sense angular acceleration of your head.  Inside the otolith organs are little hair cells.  When your head moves in a linear fashion, the hair cells bend and trigger a nerve impulse to the brain that tells your brain about that direction of movement.  To help weigh down those hair cells so that they bend easier are little calcium carbonate crystals, called otoconia.  (See – the mystical crystals in your ear are real!).  These crystals are very, very tiny.  In fact, they are smaller than the diameter of a strand of hair and measure less than 30 microns in width.

Typically, these otoconia remain on a sticky surface covering those hair cells in the otolith organs.  However, they are made of calcium.  That means they can break down and fragment off into even smaller pieces, similar to the calcium of our bones.  They can also become dislodged from vibrational forces or strong bumps to the head.  If those displaced otoconia accidentally move from the otolith organs into one of the semicircular canals of the vestibular system, you develop a condition called BPPV – Benign Paroxysmal Positional Vertigo.  In BPPV, the fluid in your vestibular system moves through the semicircular canal along with the displaced otoconia.  This produces a sense of vertigo, or spinning, until the otoconia stop moving.  

The episodes of vertigo in BPPV are very specific to a particular head movement that triggers fluid movement in the involved semicircular canal.  Most often, people will complain of vertigo that occurs with rolling a certain way in bed, bending the head forward to look down toward the floor, or even looking up to place something on a high shelf.  The sensation of vertigo itself lasts less than a minute.  They may also be accompanied by nausea, vomiting, and sweating.  Between these vertigo episodes, the individual can feel off-balance, experience blurred vision, and may complain of feeling “off.”  

The good news is that BPPV is relatively easy to treat.  It requires a trained individual to determine which semicircular canal(s) are involved in the current episode.  Then, a repositioning maneuver is used to move the otoconia from the semicircular canal back into the otolith organ where they are supposed to be.  In a matter of hours, the otoconia “crystals” reattach to the hair cells where they are normally found.  There are repositioning maneuvers specific to each canal of the vestibular system.  Using the wrong maneuver can worsen the BPPV or move the otoconia into a different semicircular canal.  

There is currently no way to prevent BPPV from happening.  New research suggests that Vitamin D supplementation can help reduce the risk of recurrence of BPPV (Kong et. al., 2024).  Controlling chronic medical conditions such as osteoporosis, hypertension, and chronic migraine may also reduce the chance of BPPV from coming back.  Current statistics suggest that once you have an episode of BPPV, there is a 50% chance that it will come back within 2 years.  The good news is that it remains just as simple to treat!

If you experience a new feeling of vertigo (a sensation of spinning), it is possible that it is being caused by BPPV.  Please seek the help of your healthcare provider to get the appropriate help that you need.  Should you have any other questions about BPPV, please feel free to contact us at the Smith Balance+Concussion Center to ask!