A Look at Benign Paroxysmal Positional Vertigo or BPPV: Signs and Treatment

People with vertigo mistakenly experience motion (commonly a spinning motion) in their surroundings. Vertigo can hinder balance, causing falls which can be dangerous in the elderly, and may be accompanied by dizziness, a feeling that you are spinning or falling, and in extreme instances migraines, vomiting, nausea, an inability to see properly (nystagmus), and even fainting spells.

There are a number of different types of vertigo with varied underlying causes. Audiologists frequently encounter benign paroxysmal positional vertigo, abbreviated BPPV, since it is related to your sense of hearing. BPPV is caused by calcium crystals that form naturally in the inner ear known as otoconia or otoliths, and which in most people cause no problems. For those who have BPPV, however, these crystals travel from their normal position into one of the semicircular canals, which are critical for our sense of balance. When this happens, and the individual with BPPV reorients their head relative to gravity, these crystals move around, and cause an abnormal displacement of endolymph fluid, which results in vertigo.

BPPV is characterized by the brief (paroxysmal) nature of the episodes, and can be triggered by such common movements as looking up or down, tilting the head, rolling over while laying down, or any other sudden head motion. The resulting vertigo can be worsened by anxiety, sleep disorders, or changes in barometric pressure (for example, just before a snowfall or rainfall). Although BPPV may start at any age, it’s more common in individuals over 60 years of age. The initial trigger for the BPPV is typically difficult to pinpoint. A sudden blow to the head (such as in an automobile accident) is among the more common causes.

BPPV differs from other varieties of vertigo or dizziness because the episodes are brief (generally under a minute), and because it is always triggered by head movements. Vertigo specialists usually diagnose BPPV by having their patient lie on their back on an exam table, rotating their head to one side or over the edge of the table to observe whether this motion triggers an episode. There are more rigorous tests which can be used to diagnose BPPV, such as videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, or magnetic resonance imaging (MRI), which is used primarily to eliminate other possible causes of the vertigo.

There is no complete cure for BPPV, but it can be successfully treated using canalith repositioning (either the Epley maneuver or the Semont maneuver), both of which use bodily movements to shift the crystals to an area in which they no longer cause problems.In rare cases (less than 10%), if these therapies don’t provide relief, surgery may be suggested. See your doctor if you have experienced symptoms which seem as if they could be associated with BPPV, especially if they last for over a week.

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