Wednesday, June 22, 2016

My BPPV experience (Benign paroxysmal positional vertigo)

Some of you were shocked to learn that I have stones in my ears but actually everybody has them. In normal circumstances, they stay inside a chamber with a membrane to keep them from going out. However when a person ages or suffer from a head trauma, these small stones may dislodge and float around in the ear fluid tubes that disturbs the body's balance system (aka vestibular system) and the mind perceives the room as spinning although it isn't, aka vertigo giddiness. The term BPPV means the vertigo is aggravated by certain head positions, comes suddenly and although it seems serious, it is actually not life threatening. However during a vertigo attack, it is very uncomfortable as the whole room seems spinning.

BPPV is common among elderly and people with head trauma. So the only thing I recalled doing out of the blue was an aerial yoga session 2 days before and an attempt on tripod headstand the day before. I only felt fatigue on that day and suddenly woke up to a spinning room the next day. Luckily, it only lasts a few seconds. I thought it would go away but when I laid down at night, the room spun again too so I decided to go to a polyclinic (subsidised government clinic) the next day fearing something serious.

The doctor said it could be an ear fluid imbalance problem so he referred me to Tan Tock Seng Hospital's ENT department. Sadly for me it was a month's wait (SGH is like 6 months). Meanwhile, I continued to do my yoga. But during the yoga session, my neck ached very badly and I wondered if it was actually neck injury causing my vertigo problem. Out of anxiety (and long wait to ENT), I went to visit a chiropractor and 2 TCM (Traditional Chinese Medicine) clinics. Frankly speaking the acupuncture was more effective in relieving the muscle ache than chiropractor's.

Thinking back I should have visited the ENT specialist earlier and pay the full rate instead of delaying treatment.

Treatment: Epley's Maneuver

When I went to see the ENT specialist, he checked my ears and made me lie down and observe my eyes because BPPV patient's eyes will display a particular movement during a vertigo attack. He was nice to clean my right ear, because it seemed to be the one affected and did 3 rounds of Epley's maneuvers on me. Usually one round is enough, but you know why 3 rounds? Because each time he got his new nurse to help hold my head for 20 secs and I later found out that she did not hold low enough at a particular angle. She is untrained and the doctor did not check and went off to type at his computer or exit the room each time. Hence after the 3rd time, I developed motion sickness (yeah try spinning your head continuously for minutes) and wanted to vomit. My head was so giddy I couldn't walk straight and my limbs went weak. Unfortunately both doctor and nurse did not escort me out and just told me to sit down outside the room to wait. According to the doctor, patients are usually giddy for a while. I was hungry too and wanted to drink milo but the nearest dispenser was down. I finally couldn't stand it anymore and asked the nurse to help me with a cup of milo but no... the other dispenser was also down... (government hospital is severely cost-cutting). So there I was alone, giddy, weak and wanting to puke but hungry at the same time...

Why I got hospitalised... 

The doctor checked on my constantly but each time my face was pale and my limbs were weak. He finally said that I should go to the Emergency department to see if I had a stroke. But before that I had to pay first... So I struggled by myself to the payment counter. Seriously, I cannot remember what the lady said, I just kept nodding my head and gave her my card. I asked where is the Emergency and she asked if I needed a wheelchair... Finally a kind sympathetic nurse!!! But I needed to go ladies first so she wheeled me there. For the first time, I needed to hold the rails in the toilet...

I SOS my good friend and she said she could come and look for me, plus deliver my much needed MILO!!! (the only energy beverage that won't cause me to puke). Sadly she could not stay by my side at the Emergency department and I waited alone for my turn to be wheeled in.

Accident and Emergency Department
It was my first time at the emergency and I was asked if I could get up by myself to the bed. Sure enough I could and the young doctor/nurse? asked a series of questions and took my blood for testing. She also did the touch nose and touch her finger testing. Due to my giddiness, I was tagged "Fall risk" and before I knew it, she said I have to be hospitalised for brain scans and a valve was inserted on my right arm! I grew panic and messaged my family and sure enough they were shocked that a visit to ENT could result in hospitalisation. I cried when my sister called to ask if I needed anything from home... I was afraid that my brain was damaged. The first thing I requested was a portable battery pack and a cable for my iphone, because you know, nothing else to do besides closing eyes and messaging family and friends to ease anxiety.

I was then wheeled to another observation room where most patients were elders. I had to wait there for my MRI scan and bed availability, which was a long 6-24 hours wait due to severe shortage. Luckily my friend brought me sandwich, cakes and green tea latte because the room only had biscuits and milo (so that's where all the milo went!). One of the patients had no visitors and was very hungry, so he kept cursing the poor nurses (with "chicken goodbye"). I couldn't help feel sorry for both of them.

Then I was all wired up...

By the time it was my turn to get MRI, it was already past midnight and I was feeling pretty sleepy. I was wheeled to the MRI suite and strangely the room did not spin when I laid down on the scanning bed! Anyway I was sleepy, cold and could not think properly and went through the 10mins scan with ear plugs and all. I was then wheeled to another large room, where it was closed off to visitors. Patients there were either in pain or unconscious and I seemed to be the most "healthy" one. Because that was a closed off area, I was hooked up to a blood pressure and oxygen sensor equipment and was told I could not get off the bed, even to pee! I had to use a urinal pot and get helped by a nurse... I also could not move both arms because the other arm had the valve that poked into my skin whenever I bend.

An hour later, a doctor came to tell me good news that there was no stroke but a while later another doctor told me that I might have nerve dissection which could be life threatening! OMG... I was scared again and not sure who I could message at 2-3am... I could only pray that it was nothing.

The doctor recommended me to do a CTA scan, which is a high contrast scan with a dye inserted into my veins. So I was wheeled into the same place. When the dye flowed though the valve on my arm into the body, I could feel my veins heated up and the odd sensation went down my body, as if I was peeing... I thought I was losing control but luckily the effects did not last long. This time I dared not swallow like I did towards the end of the MRI scan.

An hour later, the doctor came to tell me there was nothing and the "nerve dissection" seemed to be an artefact on the MRI (never swallow saliva during scanning!). With nothing wrong in the brain, there was only one cause for my vertigo problem: my ears!

Still bed ridden, I was more awake now after all the scare and thirst for water. I dared not drink because I dread using the urinal pot. Finally my bed was ready around 4.30am and I could be disconnected from the wires and go to the toilet and drink all I wanted. I was told that I was lucky I got my bed early as some had to wait 24hr! O_O;;; Although I got a bed, I did not dare adjust the height too low for fear of another vertigo attack when I lie down.

Visit by the therapists (who were much nicer and serious than the ENT specialist)

Just when I could finally sleep, a doctor came to wake me up to ask questions at 7am. Half-awakened, I did what I was told, which were some tests to see if I was still giddy and in the right mind. When I wanted to sleep again after she left, breakfast came! Good, I was hungry, but to my dismay, it was watery rice noodles and milo....sob... I ate half of it and decided to eat the delicious pandan cakes my friend brought me when suddenly a young therapist appeared. She advised me to eat later after the maneuver treatment in case I want to puke again...

With a plastic bag standing by, she helped me with the maneuver like what the ENT specialist did. We were happy that it was mostly ok with still a bit of vertigo when getting up. She even got her senior to come again at a later time to make sure she was doing it correctly, THUMBS UP!!!

I was told that since it is ear stones problem and I wasn't giddy most of the time, I could be discharged on that day, so I told my family the good news :)

After discharging from hospital

My parents were worried that I might fall so I packed my clothes to return home to stay with them for the weekend. Meanwhile no giddiness at all! But I was too happy too early and the vertigo returned the next day, tho in lesser power. The therapists did not tell me that I should avoid looking down and sleeping flat for next 24 hrs... =_=;;

My next appointment with ENT is 2 weeks later so I am going to try the maneuver myself and not move my neck till the end of the day. Although I am very grateful for the doctors, nurses and therapists at TTSH, I think I will go to another hospital's ENT clinic for treatment as I am worried to be handled by an untrained nurse again.

This link is for my personal reference what to do after treatment to prevent recurrence.

UPDATE 2021:
I have been receiving quite a number of emails over the years to recommend a good ENT specialist to treat vertigos. I received the Epley's manoeuvre treatment from Chee Ear Nose Throat Surgery in 2016 (when I first wrote this article) and have not recurred since then. So I highly recommend Dr. Chee. He is stationed at Mt Elizabeth hospital (Orchard).


  1. Hey Eva, sorry to hear about your bppv problems. Must have been very worrying. I have my own health issues for past 2 years, so I can empathize with the worries. Hope you get will soon. 元気を出して!

    1. Thanks Kelvin! Let's catch up when I am well again!

  2. I had the same bppv after yoga headstand practice. Just wanted to confirm that it is possible as back then when I waa googling connection between yoga headstand and bppv I havent found much. In general there is very little on yoga injuries....but I think as it becomes more popular we will hear more stories. Hope you are well! Tika

    1. It has been more than 6 months and no recurrence yet, hope it stays that way! The therapist who saw me for the post-hospitalisation care told me that I was the 3rd person who has bppv due to headstand, so indeed this pose is not for everyone! From then on I never tried any sort of inversion except for shoulder stand.

  3. So it is the bbpv exercises that help? Or you got see any tcm after?

    1. I went to an ENT specialist at a private hospital who did an Epley's manoeuvre as well. But he's much better and serious than the TTSH specialist. He held my head at the correct angles and durations and advised me not to tilt/bend down for 48 hours (I think). He also advised me to sleep at an angle for first night. Never reoccured since then.



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