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Benign Paroxysmal Positional Vertigo (BPPV)

Definition :
Vertigo is the sudden sensation that you are unsteady or that your surroundings are moving. You may feel like you're spinning around on a merry-go-round or that your head is spinning inside. Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo.

The condition is characterized by brief episodes of intense dizziness associated with a change in the position of your head. It may occur when you move your head in a certain direction, lie down from an upright position, turn over in bed or sit up in the morning. Moving your head to look up also can bring about an episode of benign paroxysmal positional vertigo.

Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in your inner ear that sense movement and changes in the position of your head.

Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.

Causes :
The organ of balance, located in your inner ear, is the vestibular labyrinth. It includes loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head. These canals all attach to the utricle, which contains tiny granules or crystals of calcium carbonate (otoconia). These particles are attached to sensors that help detect gravity and back-and-forth motion.

BPPV occurs when the particles within the labyrinth loosen and float in the fluid. In certain positions they can irritate the nerve endings associated with balance, giving a false signal of movement and causing a brief sensation of spinning.

BPPV most often is a result of aging. It also can occur after a blow to your head. Less common causes of BPPV include a virus affecting your ear, or the combination of trauma to your ear during ear surgery and prolonged positioning on your back (supine) during the procedure.

Doctors usually can determine the cause of BPPV. It may require a consultation with an ear, nose and throat (ENT) specialist or a doctor who specializes in the brain and nervous system (neurologist). However, sometimes no cause can be determined.

Risk Factor :
Aside from aging, there are no significant factors that may increase your risk of BPPV. However, a prior head injury or an infection of the balance organs of your ear (labyrinthitis) may make you slightly more susceptible to BPPV.

When to seek medical advice :
Generally, see your doctor if you experience any unexplained, recurrent or severe dizziness. Although it's uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following :

  • A new, different or severe headache
  • Double vision or loss of vision
  • Hearing loss
  • Speech impairment
  • Leg or arm weakness
  • Loss of consciousness
  • Falling or difficulty walking
  • Numbness or tingling
  • Chest pain, or rapid or slow heart rate

These signs and symptoms may signal a more serious problem, such as stroke, brain tumor, Parkinson's disease, multiple sclerosis or diseases of your heart or blood vessels (cardiovascular disease).

Symptoms :
The signs and symptoms of BPPV may include :

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • Lightheadedness
  • Unsteadiness
  • A loss of balance
  • Blurred vision associated with quick head movements
  • Nausea
  • Vomiting

The signs and symptoms of BPPV can come and go, with episodes commonly lasting less than one minute. Episodes of BPPV can disappear for some time and then recur.

Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Abnormal rhythmic eye movements (nystagmus) usually accompany BPPV. Although unlikely, it's possible to have BPPV in both ears (bilateral BPPV).

Diagnosis :
Your doctor may conduct a series of tests to determine what form of vertigo you have and whether your positional disorientation is a symptom of a different disorder. During a physical examination, your doctor will likely look for :

  • Signs and symptoms of vertigo that generally decrease in less than one minute
  • Vertigo that occurs when you tip your head back or lie on a particular side
  • Involuntary movements of your eyes from side to side (nystagmus)

If the cause of your signs and symptoms is difficult to diagnose, your doctor may order additional testing, such as :

  • Electronystagmography (ENG). The purpose of this test is to detect abnormal rhythmic eye movement often characteristic of BPPV. ENG can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your balance is stimulated in different ways.
  • Magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these detailed, clear images to identify and diagnose a wide range of conditions. MRI may be performed to rule out acoustic neuroma — a noncancerous brain tumor of the acoustic nerve, which carries sound from the inner ear to the brain — or other lesions that may be the cause of vertigo.

Complications :
Although BPPV is uncomfortable, it rarely causes complications. If severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration.

To help relieve BPPV, your doctor may treat you with a series of movements known as the canalith repositioning procedure.

Performed in your doctor's office, the canalith repositioning procedure consists of several simple maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of your inner ear (vestibular labyrinth) into a tiny bag-like structure (utricle) where these particles don't cause trouble. Each position is held for about 30 seconds. The success rate for this procedure is as high as 90 percent to 95 percent.

After the procedure, you must avoid lying flat for 24 to 48 hours and elevate your head on a few pillows when you sleep. This allows time for the particles floating in your labyrinth to settle into your utricle or be reabsorbed by the fluids in your body. You may need to wear a neck collar to prevent tilting your head. It may be necessary to repeat the procedure several times. Your doctor also may show you some therapeutic exercises that you can perform at home.

Surgical alternative
If the canalith repositioning procedure isn't effective, your doctor may recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear that is causing dizziness. The plug prevents the floating particles in your ear canal from moving. This success rate for canal plugging surgery is about 90 percent. Less than 5 percent of people who undergo this procedure experience long-term hearing loss.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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