Stephen Colbert Reveals Benign Positional Vertigo Diagnosis, What Is BPV?

The song “You Spin Me Round (Like a Record)” is not about benign positional vertigo (BPV). It’s not about an actual record either. But the song’s title could in some ways describe the symptoms that comedian and talk show host Stephen Colbert has been experiencing.

An article in Vanity Fair by Joe Hagan described how Colbert recently developed BPV. Colbert is currently the host of the CBS talk show The Late Show with Stephen Colbert, which is why it’s called that and not The Late Show with Someone Else. During the weekend before the U.S. Elections in early November, Colbert began noticing that, as he would stand up, things would start spinning and he would “just fall down.” Of course, many things leading up to the Elections could have left you thinking that things are spinning out of control. But what Colbert was experiencing was different.

BPV is otherwise known as benign paroxysmal positional vertigo (BPPV), in case you want to insert another word into the name or another letter into the acronym. With the condition, you will periodically feel as if either your are spinning or the world is spinning for anywhere from a few seconds to several minutes. This usually occurs when you move head such as when you stand up, tilt your head up (such as when someone says “the mac and cheese is ready”), or roll over in bed. You may have other symptoms such as a loss of balance, nausea, and vomiting, which wouldn’t be surprising if you felt like you were on the Mad Tea Party ride at Disney World. There may also be loss of hearing and problems with your vision, such as a feeling that things are jumping or moving. All of these sensations can start suddenly.

Lots of things can cause vertigo, which is a spinning feeling in general. Riding the Mad Tea Party ride, for example, can cause it. So rule out obvious causes first. Check to see if you are actually on the Mad Tea Party ride. Gigantic tea cups are usually the give away. If there are no obvious, harmless causes, then see your doctor, a doctor familiar with the causes of vertigo. This can be your primary care doctor, a neurologist, or a ear specialist. Someone calling himself or herself a “spin doctor” may be something different.

Besides BPV, possible causes of vertigo include a head injury, ear surgery, a migraine headache, a transient ischemic attack or stroke, a growth inside the ear, an infection of the inner ear like herpes zoster or syphilis, or a nervous system issue like multiple sclerosis. Of course, these can vary significantly in likelihood depending on your medical history, your other symptoms, and risk factors. So just because someone is experiencing vertigo, don’t assume that it is syphilis.

You’ll notice that the ear was mentioned several times above. That’s because your inner ear serves as part of your balance system. The semicircular canals in your inner ear include a trio of fluid-filled tubes lined with teeny tiny hairs. The picture below shows where these canals are located:

Note how these canals are located in your inner ear. If they are elsewhere, like on your nose, see your doctor immediately.

The canals help sense where your head is in space. When your head moves, the fluid inside these tubes moves, which in turn moves the tiny hairs. These hairs are connected to nerves, which then transmit signals over to your brain. Your brain, in turn, can help coordinate the rest of your body to keep everything reasonably balanced. This system is why if you were to stand up, spin around while singing the song “Let It Go” from Frozen, and then suddenly stop spinning, the room might continue to “spin” around you for a little while longer. That is, it should feel like the room is spinning because the liquid in your semicircular canals would be still be sloshing around. If your room were really spinning, that is a structural problem that may require a building contractor or an architect to address.

That’s why messing with your inner ear, especially the movement of fluid in those tubes, can affect your sensation of movement and balance. BPV can result when little pieces of calcium (called canaliths) break away from the bone-like structures in your inner ear. These canaliths then float in the semicircular canal fluid, affecting the movement of the tiny hairs enough to result in confusing signals to your brain.

Therefore, the best way to treat BPV is to reposition the canaliths in your inner ear. You may be able to accomplish this by repeating what’s called the Epley maneuver. The Epley maneuver entails going through a series of steps demonstrated by the following video from the BMJ:

Note that you should always get a person’s permission before trying the Epley maneuver on him or her. You may have to repeat this maneuver each time symptoms return. Your doctor can give you instructions on how to do this at home by yourself.

Balance therapy may help manage symptoms. Medications such as antihistamines, anticholinergics, or sedative-hypnotics may help alleviate the spinning sensation to some degree.

The name BPV includes the word “benign” because typically BPV is not going to lead to much more serious consequences. Of course, it could be hazardous to experience vertigo while doing things like base jumping, bull riding, and carrying uranium. However, it most cases the key is manage symptoms so that they don’t interfere with your daily life.

Nevertheless, don’t assume that all cases of vertigo are BPV. Make sure that you rule out other more serious causes first. The year 2020 may make it seem like everything’s spinning around you. But if you feel like you or the room around you is actually spinning, that may not be normal, unless of course you are actually whirling around or inside a gigantic tea cup.