The right way to treat vertigo

Vertigo may be triggered by a treatable disorder, such as an ear infection; once the infection clears, the vertigo disappears. But sometimes symptoms are due to a problem known medically as benign paroxysmal positional vertigo (BPPV).

This harmless but infuriating condition causes short episodes of intense dizziness when you move your head in particular directions, especially when rolling over or getting out of bed.

• Although antibiotics are widely prescribed for ear infections, there is controversy over their use.
• This is partly because it is so difficult to distinguish viral from bacterial infections and also because most cases clear up on their own.
• In addition, antibiotics have various side-effects, and their over-use leads to resistant germs that make antibiotics less effective for future infections.
• Antibiotics do slightly reduce the duration of symptoms including fever, but seem to produce only a small reduction in complications arising from ear infections — one study suggested that they prevented complications in only one in seven children treated (most studies have looked at children since they are most prone to ear infections).
• For children, at least, many family doctors take a "watch and wait" approach, giving antibiotics only if symptoms do not improve within 72 hours. But two-thirds of children do fine without them.
• For adults, the jury is still out.

• BPPV is thought to be due to debris formed when some of the tiny granules in the vestibular system of the inner ear, that help to detect head movements and gravity, are displaced.
• These granules float off in the inner ear fluid, irritating movement detectors in the semicircular canals. You might be able to prevent dizziness simply by avoiding movements that trigger it.
• Or a doctor or physical therapist can perform the Epley maneuver — manipulating your head with a series of movements that "clears away" debris and allows it to settle elsewhere in the inner ear, where it causes no problems. This is simple and often successful.
• Anti-nausea drugs may help to relieve symptoms but no medication cures the condition. BPPV often resolves itself within a few weeks, but can recur.

• For other types of vertigo, you may be referred for vestibular rehabilitation therapy (VRT).
• You will be taught a set of exercises to perform daily, involving progressively more difficult head, eye and walking movements.
• These are designed to encourage the brain to adapt to the stimuli that provoke vertigo and compensate, irrespective of the cause. They can help to reduce dizziness, improve balance and prevent falls.