Introduction to the Symptoms and Treatment Choices for Benign Paroxysmal Positional Vertigo (BPPV)

Vertigo, defined as a sensation of motion where the person or the person’s environment appear to spin and move, is generally regarded as a rather uncomfortable experience. Feelings of vertigo can affect your balance and lead to falls that can be serious in the elderly; it might also be accompanied by dizziness, sensations of spinning in space, and more infrequently, nausea, vomiting, migraine headaches, visual abnormalities including nystagmus, and fainting.

There are many causes for vertigo, but one variety of it – benign paroxysmal positional vertigo, abbreviated BPPV – relates to hearing. It is caused by naturally-forming calcium crystals in the inner ear known as otoliths or otoconia, and which generally cause no problems. In individuals who suffer from BPPV, however, these crystals become dislodged from their normal location and travel into one of the semicircular canals that govern our sense of balance. When somebody with benign paroxysmal positional vertigo reorients their head relative to gravity, these crystals displace endolymph fluid and induce vertigo.

Benign paroxysmal positional vertigo is characterized by the brief (paroxysmal) nature of the vertigo, and can be brought on by such commonplace motions as looking up or down, tilting the head, rolling over in bed, or any other rapid head motion. The resulting vertigo can be made worse by anxiety, lack of sleep, or changes in barometric pressure (for instance, just before a snowfall or rainfall). The condition can present itself at any age, however it most commonly appears in individuals over 60 years of age. It is difficult to determine the specific cause of BPPV for any given patient, however it commonly develops following accidents in which the person sustains a blow to the head.

Benign paroxysmal positional vertigo is different from other forms of dizziness or vertigo because the attacks are transient (typically less than a minute), and because it is always brought on by head movements. Vertigo specialists usually diagnose BPPV by having their patient rest on their back on an exam table, tilting their head to one side or over the edge of the table to observe whether this motion sets off an episode. There are many rigorous tests that 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 principally to rule out other possible causes of the vertigo.

BPPV is generally treated using a method called canalith repositioning which guides the crystals to a position in the inner ear where there are less problematic using a sequence of physical motions. Two forms of canalith repositioning that may be used are the Epley maneuver and the Semont maneuver. Surgical treatment is a possibility in the rare cases where these treatment methods are not effective. If you suspect benign paroxysmal positional vertigo or have been suffering from vertigo or dizziness for over a week, visit a specialist familiar with balance and vertigo disorders.

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