CRYSTAL DISEASE | Symptoms, diagnosis, exercises, measures and treatment
Crystal disease, also called benign job-related dizziness, is a relatively common ailment. The diagnosis of dizziness crystal disease affects as many as 1 in 100 in one year. The diagnosis is also often called benign paroxysmal positional vertigo, abbreviated BPPV. Fortunately, the condition is often relatively easy to treat for knowledgeable therapists - such as ENT doctors, chiropractors, physiotherapists and manual therapists. Unfortunately, it is not common knowledge that this is a diagnosis that responds very well to specific treatment measures (such as Apple's repositioning maneuver which often improves the condition of 2-4 treatments), so many stay for several months with the condition. Contact us at Our Facebook page if you need advice or recommendations - or see an overview of our clinics here.
Join the Facebook group «Krystallsyken - Norway: Research and news»For the latest updates on research and media writing about this disorder. Here, members can also get help and support - at all times of the day - through the exchange of their own experiences and advice.
What Causes Crystal Sickness?
Crystal sickness (benign postural dizziness) is due to accumulations inside the structure we call the inner ear - this is a structure that gives signals to the brain about where the body is and in what position it is. fluid called endolymph - this fluid moves depending on how you move and thus tells the brain what is up and down. The accumulations that can occur are called otoliths, a form of small "crystals" made of calcium, and it is when these end up in the wrong place that we get symptoms. The most common is that the rear archway is hit. Incorrect information from these can cause the brain to receive mixed signals from the eyesight and the inner ear, thus causing dizziness in certain movements.
What is the inner ear?
This is the innermost part of the human ear - and it is this area that is responsible for hearing and balance. Here we find, among other things, the labyrinth with the snail shell and the balance organ. More specifically, it is divided inside the cochlear system and the vestibular system. It is the latter that is responsible for sending signals about position and balance to the brain. Here we find the archways - which can be divided into rear, front and lateral archways. Crystal disease affects the posterior archway in up to 80% of cases, after which it is more common for the lateral archway to be affected in front of the anterior archway. In the illustration below, we see how otoliths have been misplaced in the posterior and lateral arch, this will then give the wrong signals to the brain - and dizziness occurs.
What Are Common Symptoms Of Crystal Sickness?
The most common symptoms of crystalline or benign postural dizziness are vertigo, dizziness caused by special movements (eg lying on one side of the bed), a feeling of being 'light headed' and nauseous. The symptoms may vary from person to person - but the characteristic symptom is that it is always produced through the same movement, often a twist to one side. Thus, it is common for people affected by crystal sickness to describe the condition as they turn in bed to a side or roll over to the right or left.
Symptoms can also occur when the person tiltes their head back, such as at the hairdresser or at certain yoga positions. A dizziness caused by crystal sickness can also produce nystagmus (the eyes move back and forth, uncontrolled) in the eyes and always last less than one minute.
How common is crystal sick?
Studies have shown that as many as 1.0 - 1.6% of the population are affected by crystal melanoma annually. Approximately 20-25% of all dizziness presented at clinics and treatment facilities is due to this diagnosis. The condition becomes more common the older you get and the condition has its highest incidence in those over 60 years - here it is estimated that as many as 3-4 out of 100 are affected by crystal melanoma each year.
What are the risk factors and reasons why you get crystal sick?
The most common cause of crystalline or benign postural dizziness among those under 50 is head trauma or Head Injury - this does not have to be extensive direct damage or the like, but can also occur if the person has received whiplash or whiplash, e.g. in the event of a fall or car accident. If you are affected by migraine attacks then you also have a higher chance of being affected by crystal sickness. As mentioned earlier, higher age is a risk factor and may also be due to age-related wear of the balance system. Other, more rare causes, are certain medications and a higher incidence of postural dizziness has also been seen after dental consultations.
How to diagnose crystal disease - and how to diagnose position-related dizziness?
A clinician will make the diagnosis based on history and clinical examination. The symptoms of crystal melanoma are often so characteristic that a clinician will be able to estimate the diagnosis based on the anamnesis alone. To make the diagnosis, clinicians use a special test called "Dix-Hallpike" - this is often very specific and is developed specifically to diagnose crystal disease / positional dizziness.
Dix-Hallpike test for crystal sick
In this test, the clinician quickly brings the patient from sitting to supine position with his head twisted 45 degrees to one side and 20 degrees backwards (extension). A positive Dix-Hallpike will reproduce the patient's dizziness attack along with characteristic nystagmus (rapid flick of the eyes back and forth). This symptom is often very easy to see, but can also be less obvious - it may be helpful for the clinician to equip the patient with so-called Frenzel glasses (a kind of video glasses that record the reaction).
Other diagnoses that may be misinterpreted as crystal sick
The key finding in diagnosis is positive Dix-Hallpike and that the symptoms are produced by the patient turning from one side to another. Other differential diagnoses that can mimic crystalline illness are orthostatic hypotension (postural low blood pressure) and virus on the balance nerve (vestibular neuritis). Migraine-based vertigo can also cause symptoms similar to crystal sickness.
What Is Common Treatment For Crystal Sickness?
Crystal disease is, as mentioned, a job-related dizziness that is considered "self-limiting", as it often lasts for 1-2 months before it disappears. However, those who seek help can recover significantly faster, as it often only takes two to four treatments to correct the diagnosis with a qualified therapist. But here it is important to mention that the number of treatments can vary based on the severity of the condition. Modern chiropractors, manual therapists and ENT doctors are all trained in this form of treatment. Crystal disease can persist for much longer than 2 months, and considering how troublesome this diagnosis is, we recommend that you seek expert help and have the condition assessed.
Apple's maneuver or Semont maneuver
Said therapists are well trained in this technique and studies have shown that as many as 80% are cured with repositioning maneuvers. The most common is Apple's maneuver.
Apple's maneuver in the treatment of crystal disease
This maneuver or treatment technique is also known as the crystal repositioning procedure and was, hence the name, developed by Dr. Epley. The maneuver is performed through four positions where the clinician holds the four positions for about 30 seconds at a time - the main purpose is to get the misplaced otoliths (ear stones) in place in the inner ear. The treatment is very effective and it is common with full recovery during 2 treatments.
Often called the little brother of Apple's maneuver, as it is not as effective and often requires more than 3-4 treatments for full recovery. Apple's maneuver is often preferred by the two.
What if the repositioning maneuvers don't work for me?
Apple's maneuver works in approximately 50-75% of treated cases already at the first consultation. This leaves 25-50% who do not experience complete improvement or any improvement at all after the first treatment. About 5% will also experience a worsening of the condition. This is why it is said that up to 4 treatments with Epley's maneuver should be carried out before giving up this form of treatment. The posterior archway in the inner ear is most often affected, but sometimes there may be other archways - and then the maneuver should be modified accordingly. Some clinics and facilities have so-called "dizziness chairs" that are supposed to make repositioning more efficient, but this is often totally unnecessary. A modern clinician will normally have a good effect with the manual repositioning maneuver Apple's maneuver.
- Combination Dizziness: When The Cause Is Due To Both Crystals And Neck
An incredibly important point, which we often feel is significantly undercommunicated, is that dizziness is often due to a combination of several factors. One of the most common risk factors is trauma to the head and neck - including whiplash. The common factor for such traumas is that they very often involve significant incorrect loading on the neck muscles, ligaments and joints. This can, among other things, involve stretch injuries or soft tissue tears / ruptures - which in turn leads to a higher concentration of pain-sensitive tissue. The sensors in the neck, proprioceptors, also provide information to the brain in relation to the body's position and position. In addition to physical therapy, self-measures such as trigger point balls (see example here - the link opens in a new window) be useful.
And that is precisely why poor function in the neck can contribute to dizziness. By our clinics (see an overview of our clinics by clicking here) you will therefore, as a new dizziness patient, experience that our clinicians also carry out a thorough functional examination of your neck, upper back and shoulders. Professional expertise in the assessment and treatment of dizziness is in high demand with us - so that you will receive the best assessment and follow-up of your dizziness problems.
Also read: - 4 Home Exercises Against Crystal Disease
Crystal Disease and Relapse: Can You Get Relapse?
Unfortunately, yes, it is the case that those affected by crystal melanoma are often affected again. Research has shown that 33% will have a relapse within one year and that 50% will have a relapse within five years. If Crystal Disease recurs, and you have had a good effect of Apple's maneuver before, you should see the same clinician for treatment again.
- Vestibular Exercise and Stimulation Can Prevent Relapse
Studies have shown that exercise that also stimulates the vestibular system (almost all types of movement do this, however) can help reduce the chance of relapse (1). In the video below you see a simple and customized program that can be useful for you who want better balance.
VIDEO: Strength and Balance Training for the Elderly
In this training program shows chiropractor Alexander Andorff, fra Lambertseter Chiropractor Center and Physiotherapy (the link opens in a new window), develop a customized training program that can give you better balance.
Join our family! Subscribe for free to hundreds of exercise programs and health education videos on our Youtube channel (the link opens in a new window).
Click on the image above to proceed to the next page.
Feel free to follow us in Social Media
- Please follow Vondt.net on YOUTUBE
- Please follow Vondt.net on FACEBOOK
Images: Wikimedia Commons 2.0, Creative Commons, Freestockphotos and submitted reader contributions / images.
Sources / research:
1. Chang et al, 2008. Balance improvement in patients with benign paroxysmal positional vertigo. Clin Rehabil. 2008 Apr; 22 (4): 338-47.
Frequently Asked Questions (feel free to ask other questions in the comments section below:
What is the difference between crystal disease and cervicogenic dizziness?
Answer: The crystal disease is due to misalignment of otoliths (crystals) in the archways inside the inner ear. Cervicogenic dizziness is neck-related dizziness from the joints and muscles of the neck - but sometimes one can be affected by both; this is then called combination dizziness.