Epley maneuver repositions ear crystals, alleviating vertigo

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I am a 67-year-old male in excellent physical health. The only issue I have is occasional bouts of vertigo. These episodes started when I was about 44 years old. My symptoms are varying degrees of dizziness and, with extreme episodes, nausea. The frequency has increased the past couple of years to about every two weeks. I do the Epley maneuver to relieve the symptoms, which go away one or two days after doing so. Epley is the only treatment available that works for me. Is there any new research or treatments for this? I am also curious about what foods might be contributing to the onset of vertigo. — R.W. ANSWER: Vertigo is a sensation of movement when there isn’t any. Most often, people will describe a spinning sensation. Others say the world is spinning, but swaying or tilting are other descriptors. Although dizziness is a very nonspecific term, vertigo has a fairly limited number of diagnostic possibilities. Further, the fact that you get better with the Epley maneuver (more on that below) tells me the diagnosis is very likely to be benign paroxysmal peripheral vertigo. Each ear contains an organ of balance, also called the semicircular canals, which work by the movement of hair cells inside those fluid-filled bony structures. Sometimes small crystals (called otoconia) form in one semicircular canal. These press on the hair cells and cause the two organs of balance to send conflicting signals to the brain about movement, which is perceived as vertigo. Diet is not likely to have a significant effect on causing or treating BPPV. The Epley maneuver, like other repositioning maneuvers, is designed to move the crystals out of the semicircular canals. A video demonstrating the maneuver can be found at https://www.youtube. com/watch?v=9SLm76jQg3g. Recurrence of vertigo after a successful Epley maneuver is not uncommon, but recurrences as often as every two weeks for over 20 years is outside my experience. I have read about surgical options for refractory BPPV, but I have had success referring patients to vestibular rehabilitation, performed by trained occupational or physical therapists. *** DEAR DR. ROACH: What is your opinion of the alkaline diet? I have several friends who have battled cancer, and they have adopted alkaline diets as adjuncts to their cancer treatments. Do alkaline diets assist in the treatment and prevention of cancers, or is it just another urban myth? — T.F.C. ANSWER: A diet high in fruits and vegetables may have a beneficial effect on cancer treatment, in combination with the best cancer treatments available, whether they are surgical, chemotherapeutic or radiation-based. Some of the “alkaline diets” I have read about do emphasize fruits and vegetables, and they may help and certainly will not hurt. However, there is no diet that is a substitute for comprehensive cancer care. The body has powerful mechanisms for maintaining an exact pH, regardless of the acidity (or alkalinity) of the food you eat. Both the lungs and the kidneys work together to maintain the body’s pH at a slightly alkaline 7.4. Only with severe illness will the body’s pH come out of its narrow range of normal, and when it does, that portends a poor outcome without immediate treatment. The mechanism by which fruits and vegetables have been shown to benefit some cancers is not precisely known, but it probably has to do with healthful components of the food, not through any effect on body alkalinity.