My husband has been previously been diagnosed with "ear crystals." He suffers severe episodes of vertigo and aches. The symptoms come and go with no warning. He does not have allergies, and the doctors cannot give us any more information. Please help us.

B.

"Ear crystals" can only mean benign paroxysmal positional vertigo, or BPPV. First, let's make sure that you and I are talking about the same thing. Patients with BPPV experience a severe spinning sensation (vertigo) in response to particular changes in head position. The most common complaint is vertigo after rolling over in bed. Quite often, patients have problems only after rolling over in a particular direction. People with BPPV are often intolerant of other head movements, such as looking upward or looking over one shoulder.

Vertigo in BPPV lasts only for several seconds -- never more than one minute, though feeling off-balance may persist for much longer. A person may have several attacks in a short interval (perhaps a week), followed by a remission that may last for months or years.

Usually, an ear, nose and throat doctor (ENT) can make this diagnosis based solely upon the patient's description of symptoms. The ENT can also put the patient through particular positional changes to provoke vertigo, and then observe the patient's eyes. When the patient is feeling vertigo, his or her pupils will bob up and down (vertical nystagmus) or turn in a characteristic manner (torsional, or rotational nystagmus).

BPPV is "benign" in that it does not signify anything life-threatening to the patient (such as a brain tumor). "Paroxysmal" refers to the fact that the episodes are brief and self-limited. The "positional vertigo" aspect of BPPV should be evident from the description above.

So, what on earth are "ear crystals?" The medical term for these is "otolith" or "otoconia." Everyone has otoliths. They are found in two inner-ear organs, the utricle and the saccule, collectively known as the "otolithic organs." These organs are responsible for our ability to sense a gravitational field. In other words, even if you are in a pitch-dark room, submersed in a swimming pool (thus deprived of visual cues and musculoskeletal cues), you will still know which way is up, thanks to your otolithic organs.

The nerve endings in the otolithic organs are embedded in a gelatinous membrane known as an "otolithic membrane." Also embedded in this membrane, like grapes in jello, are the otoconia. They are tiny calcium carbonate/calcite crystals. Their whole purpose is to make that jello as heavy as possible. That way, when you tilt your head in a gravitational field, the otolithic membrane moves accordingly, thus stimulating the nerve endings underneath.

Now we move from hard scientific fact to the realm of theory. Experts theorize that otoliths may become liberated from the membranes and are then free to float through the inner-ear fluid. These free agents are capable of stimulating other parts of the inner ear. In particular, with regard to BPPV, they are thought to most commonly stimulate a structure responsible for our sense of rotational motion. The result is a sense of rotational vertigo.

Fortunately, there is a very simple and virtually risk-free treatment for BPPV. A positional maneuver (known as the Epley maneuver, for the doctor who developed it) allows the otoliths to "settle out" in a region of the inner ear where they will not cause problems. Patients can be taught this maneuver and can practice it at home. If, in fact, your husband's diagnosis of "ear crystals" corresponds to BPPV, then he needs to ask his ENT about the Epley maneuver.