DEAR DR. ROACH: I am a 67-year-old male in excellent physical health. The only issue I have is occasional bouts of vertigo. These episodes started when I was about 44 years old. My symptoms are varying degrees of dizziness and, with extreme episodes, nausea. The frequency has increased the past couple of years to about every two weeks.

I do the Epley maneuver to relieve the symptoms, which go away one or two days after doing so. Epley is the only treatment available that works for me. Is there any new research or treatments for this? I am also curious about what foods might be contributing to the onset of vertigo. — R.W.

ANSWER: Vertigo is a sensation of movement when there isn't any. Most often, people will describe a spinning sensation. Others say the world is spinning, but swaying or tilting are other descriptors. Although dizziness is a very nonspecific term, vertigo has a fairly limited number of diagnostic possibilities. Further, the fact that you get better with the Epley maneuver (more on that below) tells me the diagnosis is very likely to be benign paroxysmal peripheral vertigo.

Each ear contains an organ of balance, also called the semicircular canals, which work by the movement of hair cells inside those fluid-filled bony structures. Sometimes small crystals (called otoconia) form in one semicircular canal. These press on the hair cells and cause the two organs of balance to send conflicting signals to the brain about movement, which is perceived as vertigo. Diet is not likely to have a significant effect on causing or treating BPPV.

The Epley maneuver, like other repositioning maneuvers, is designed to move the crystals out of the semicircular canals. A video demonstrating the maneuver can be found at https://www.youtube.com/watch?v=9SLm76jQg3g.

Recurrence of vertigo after a successful Epley maneuver is not uncommon, but recurrences as often as every two weeks for over 20 years is outside my experience. I have read about surgical options for refractory BPPV, but I have had success referring patients to vestibular rehabilitation, performed by trained occupational or physical therapists.