Definition

Benign paroxysmal positional vertigo (BPPV) is one of the most common types of vertigo. Vertigo is the sensation of spinning, either you are spinning or your surroundings are spinning. The spinning sensation in BPPV varies from mild to severe, occurs suddenly, and generally lasts briefly.

This condition occurs due to an issue in the inner ear. The spinning or dizziness is usually triggered by changes in head position, such as when moving your head up or down, when lying in bed, turning over, or when you wake up and sit up in bed. BPPV tends not to be a serious problem, but vertigo can increase the risk of falling because patients feel like they are spinning, their bodies are swaying, or they become unbalanced.

Causes

The causes of vertigo can vary, from disorders of the vestibular system in the inner ear, reactivation of the varicella-zoster virus in the ear, head injury, to brain diseases.

In BPPV specifically, vertigo can occur due to a disturbance in the inner ear, a problem during ear surgery, or from lying in a supine position for a long time, such as when lying in a dentist's chair. BPPV can also be associated with migraines.

Relationship between Vertigo and the Ear

Inside the ear, there is a small organ called the vestibular labyrinth. This labyrinth consists of three semicircular canals. These canals contain fluid and fine hairs that act as sensors when the head turns in different directions. Another structure, the otolith organ, monitors head movements up and down, right and left, back and forth, and the head's position relative to gravity. The otolith organ contains calcium carbonate crystals that make you sensitive to gravity.

For various reasons, in people with vertigo, these crystals can become dislodged and move into the semicircular canals in the inner ear. This particularly happens when the person is lying down. The presence of these crystals makes the semicircular canal sensors sensitive to head position changes, causing dizziness.

Risk factor

There are no specific risk factors for BPPV. However, some studies show that BPPV can be inherited. Many people with BPPV have family members who also suffer from BPPV.

Several conditions make a person more susceptible to BPPV, including:

• Being over 50 years old, although vertigo can occur at any age
• More common in women than men
• History of head injury or other disorders of the balance organs in the ear
• Diabetes
• Osteoporosis

Symptoms

The signs and symptoms of benign paroxysmal positional vertigo include:

• Spinning dizziness
• Feeling that you or your surroundings are spinning (vertigo)
• Loss of balance and instability
• Nausea
• Vomiting

These signs and symptoms usually come and go and last less than one minute. BPPV episodes may disappear for a time and then recur.

The activities that trigger complaints can vary among individuals but are almost always caused by head position changes. Some people also feel unbalanced when standing or walking. Abnormal eye movements usually accompany the symptoms of benign paroxysmal positional vertigo. Usually, the spinning dizziness in BPPV is not accompanied by hearing loss or nerve function decline.

Diagnosis

The doctor will conduct a series of tests to determine the cause of the dizziness you are experiencing. During the physical examination, your doctor will look for:

• Signs and symptoms of dizziness triggered by eye or head movements that then decrease within less than one minute
• Dizziness accompanied by specific eye movements when lying on your back with your head turned to one side and slightly tilted over the edge of the examination table
• Unintended side-to-side eye movements
• Inability to control eye movements

If the doctor cannot find the cause of your complaints, additional tests may be required, such as:

• Electronystagmography (ENG) or videonystagmography (VNG): These tests detect abnormal eye movements. ENG (using electrodes) or VNG (using a small camera) can determine if dizziness is caused by inner ear disease by measuring unintended eye movements when the patient's head is placed in different positions or when the balance organ is stimulated with water or air.
• Magnetic resonance imaging (MRI): This test uses magnetic fields and radio waves to produce images of your head and body. Doctors use these images to identify and diagnose various conditions and to rule out other causes of vertigo besides BPPV.

Management

Benign paroxysmal positional vertigo can go away on its own within a few weeks or months. However, to help alleviate symptoms, your doctor will treat your complaints through a series of head movements known as canalith repositioning procedures. Canaliths are crystals that dislodge from the otolith organ and move into the semicircular canals, causing BPPV symptoms.

Canalith Repositioning

This procedure can be performed in the doctor's office. It involves several slow, simple maneuvers to position your head. The goal is to move the canalith particles from the semicircular canals into an open area such as a small pouch (vestibule) that houses one of the otolith organs, the proper place for canaliths.

Each position is held for about 30 seconds after the symptoms or abnormal eye movements stop. This procedure typically results in significant improvement after one or two treatments. The doctor will teach you how to perform this procedure so that you can do it at home if necessary.

Medications

The doctor may also prescribe medications to reduce spinning dizziness. These medications include sedatives that have a drowsy effect, antihistamines, and medications to manage spinning sensations and nausea-vomiting if another attack occurs. However, medications alone are often not effective in treating vertigo.

Lifestyle Changes and Home Care

Living with BPPV can be challenging. This condition can affect relationships with friends and family, productivity at work, and quality of life. However, although BPPV can be uncomfortable at times, it can improve over time if managed properly.

Physical therapy and home care can help reduce dizziness complaints. If you experience dizziness related to BPPV, consider the following tips:

• Be aware of the possibility of losing balance, which can cause falls and serious injuries
• Avoid movements that trigger symptoms, such as looking up
• Sit down immediately when you feel dizzy
• Use good lighting if you wake up at night
• Walk with a cane to be more stable if you are at risk of falling
• Consult a doctor to manage your symptoms

Surgical Alternatives

In rare cases, when canalith repositioning procedures and medications are unsuccessful, and symptoms severely reduce the patient's quality of life, the doctor will recommend surgical procedures. In this procedure, a bone plug is used to close the inner ear section which causes dizziness. This plug prevents the semicircular canals from responding to canalith particle movements or general head movements. The success rate for this canal plug surgery is about 90%.

Complications

BPPV can cause discomfort for the sufferers. The dizziness can make the sufferer walk or stand unsteadily, increasing the risk of falling.

You need to see a doctor immediately if you experience other severe complaints, such as unsuccessful treatment, or if you experience limb weakness, slurred speech, or vision problems. Sometimes, vertigo symptoms can also be related to other more serious medical conditions such as neurological disorders in the head or ear.

Prevention

In most cases, benign paroxysmal positional vertigo cannot be prevented. However, some cases of BPPV caused by head injuries can be prevented by avoiding such injuries. Wearing a helmet when cycling, motorcycling, playing baseball, or participating in other sports activities can protect you from head injuries and BPPV.

When to see a doctor?

Generally, consult a doctor if you experience dizziness or recurrent vertigo, sudden onset, worsening, or prolonged and the exact cause is unknown.

Although dizziness is rarely a sign of a serious illness, see a doctor immediately if you experience dizziness or vertigo accompanied by any of the following symptoms:

• A new, different, or severe headache
• Fever
• Double vision or loss of vision
• Hearing loss
• Difficulty speaking
• Weakness in the arms or legs
• Loss of consciousness
• Falling or difficulty walking
• Numbness or tingling