Benign paroxysmal positional vertigo relief on a roller coaster

Abstract

Sir—At age 42 years, I felt increasingly dizzy over a time of about 4 weeks when I sat up or moved my head to the left. Vertigo attacks lasted 5–10 min and arose several times a day. After waking up during the night with vertigo, nausea, and vomiting, I visited an ear, nose, and throat specialist who diagnosed benign paroxysmal positional vertigo (BPPV). There was no spontaneous but inducible nystagmus that could be provoked by rapidly lying back or turning the head. I was recommended a manoeuvre known as BrandtDaroff exercise, which includes three sets per day of movements from sitting upright to the side-lying position and going back to the upright position. Symptoms increased during the next week until I attended an amusement park. Since children had to be accompanied on the rollercoaster by their parents, I had to ride two rounds. Although maximum acceleration and speed was moderate (2·5 g and 48 km/h), the symptoms were relieved immediately and never came back. Annual visits to a rollercoaster at the Munich Oktoberfest have prevented further symptoms for the past 2 years. The vestibular system comprises three semicircular canals and the otolithic apparatus that transduces angular acceleration and static gravitational forces. According to the main hypothesis, BPPV is thought to be attributable to debris—small crystals of calcium carbonate, also called otoconia—derived from the utricle. They can accumulate because of head injury, infection, or simply degeneration due to advanced age. Otoconia can be dissolved, reabsorbed, or—in the case of BPPV—displaced via gravity to the posterior semicircular canal located directly inferior to the otoconia. If these otoconia particles become attached to the cupula of a semicircular canal, linear and gravitational acceleration can stimulate the cupula (cupulolithiasis hypothesis). The classic physical manoeuvres intended for particle repositioning are effective in most patients and could underly the same mechanism effective during acceleration on a rollercoaster. Unfortunately, only a few treatment studies have been reported up to now, although BPPV is probably the most common cause of vertigo. I suggest that riding a rollercoaster could be a new treatment option for further studies, even in severe or atypical BPPV for which surgical canal plugging has been recommended.