1Overview

In some cases, you might feel dizzy, as if you’re moving in circles. However, when this happens but instead of you feeling like you’re moving in circles, your surrounding is the one moving, it’s termed as vertigo.

One of the most common types of vertigo is the benign paroxysmal positional vertigo (BPPV). This condition is also one of the most common causes of vertigo in adults.
It is characterized by intense dizziness when you move your head in some directions.
This condition stems from a problem in the ears.

BPPV is a condition affecting the inner ear and as a result, leads to vertigo or a state of intense dizziness. This is commonly felt by older adults. Though this condition may lead to a great feeling of discomfort, it is not serious and will not lead to severe complications.
The only concern is that it may increase the risk of falls.

The condition occurred when the calcium carbonate crystals called otoconia, which are normally embedded in the utricle become dislodged into one of the three fluid-filled semicircular canals. These crystals alter the normal fluid movement that the canals use to detect head movement, leading to false signals being detected by the brain.

The term benign paroxysmal positional vertigo means:

Benign – not severe or serious

Paroxysmal – sudden but short bouts or spells

Positional – Caused by sudden changes in head positions or movements

Vertigo – A form of dizziness wherein there is a rotational movement

In a population-based survey, the lifetime prevalence of BPPV is about 2.4 percent, and this will increase as a person grows old. The prevalence is also expected to increase seven-fold in those people who are older than 60 years old.

Understanding the Inner Ear

The inner ear is the innermost part of the ear after the middle ear. There are three main parts of the inner ear – the cochlea, the vestibular or the balance mechanism and the auditory nerve.

The cochlea is responsible for transforming sound waves into electrical impulses that are forwarded to the brain for translation. The brain is responsible for translating these impulses to sounds that people understand. This snail-shaped hose has fluid called perilymph.

Meanwhile, the other part of the inner ear is called the auditory nerve. This is a bundle of nerve bundles that work to carry the information from the cochlea to the brain. Lastly, the balance mechanism or vestibular part of the inner ear is responsible for registering the movements of the body to ensure that the balance is maintained.

The vestibular has three passages, which are fluid-filled and contain countless hair fibers to detect movement of the fluid, sending information to the brain. The brain uses the information to keep the body’s balance.

2Symptoms

People with BPPV may experience vertigo during sudden movement when turning over in bed, getting out of bed or looking up to a high shelf. These movements create a huge change in the orientation of the head in correlation with the pull of gravity. As a result, the patient may feel imbalanced when they suddenly move.

The most common signs and symptoms of benign paroxysmal positional vertigo (BPPV) include:

  • Vertigo (a feeling of a spinning environment)
  • Dizziness
  • Loss of balance
  • Sometimes accompanied by nausea and vomiting

The symptoms become worse when:

  • Lying down
  • Turning over
  • Getting up
  • Tilting the head up or down

Dizziness is usually not a serious symptom. However, you should seek immediate medical help if you feel the following symptoms accompanying your dizziness:

  • Severe headache
  • Fever
  • Hearing loss
  • Slurred speech
  • Double vision
  • Falling or inability to walk properly
  • Numbness
  • Tingling
  • Leg or arm weakness
  • Loss of consciousness

These symptoms may cause a more serious health problem.

3Causes

In most cases of BPPV, there is no known cause, which means it’s idiopathic. However, many experts have linked BPPV to the disturbance of fluids inside the inner ear. The fluid in the tubes, called semicircular canals, move as you change your position. These canals sense this movement and send the messages to the brain.

In BPPV, however, the calcium carbonate crystals that are usually in another space inside the ear, dislodge and move into the semicircular canal. As a result, the movements of the fluids are altered. This leads to the brain receiving confusing messages about the body’s position.

In some patients, the other causes of BPPV include:

  • Head in the same position for a long time
  • Biking on rough roads
  • Mild, moderate or severe head trauma
  • Conditions of the Labyrinth
  • Vestibular migraines
  • Meniere’s disease

4Risk Factors

Some individuals are at a higher risk of developing benign paroxysmal positional vertigo like those who are:

  • Older people and seniors
  • History of head injury
  • Had ear surgery
  • Vestibular neuritis – the inflammation of the inner ear

5Complications

Though this condition may increase the risk of falls because of feeling imbalanced, it does not cause other serious complications.

6Diagnosis

Usually, the diagnosis of benign paroxysmal positional vertigo is created based on the symptoms and through the presence of nystagmus, the jerking movement of the eyes that go along with vertigo most patients experience.

  • Dix-Hallpike Maneuver

The Dix-Hallpike Maneuver is a common test conducted by doctors to see whether the posterior semicircular canal is affected. The test aims to reproduce vertigo and nystagmus.

In performing this test, the doctor will rotate the head 45 degrees away from the side being examined. The eyes are then observed for nystagmus. The test is positive if Vertigo will develop and there is nystagmus.

  • Roll Test

The roll test is done to see if the horizontal semicircular canal is affected. This test is made when the patient is lying down in a supine position with the head in a 30 degrees cervical flexion.

Then the doctor or examiner will quickly rotate the head 90 degrees to the left side, and if vertigo and nystagmus develop, it’s positive.

The doctor will also observe for:

  • The presence of the signs and symptoms of dizziness (vertigo) when the head is moved
  • Vertigo and dizziness prompted by specific eye movements
  • Involuntary movements of the eyes from one side to another (nystagmus)
  • Difficulty in controlling the eye movements

Further tests can be done to confirm a diagnosis:

Electronystagmography (ENG) or video-nystagmography (VNG)

These tests are done to see any abnormal eye movement. ENG works by using electrodes while VNG is done through small cameras. These tests also determine if the dizziness or vertigo is due to inner ear problems.

Magnetic Resonance Imaging (MRI)

Imaging tests are done to acquire cross-sectional and 3D images of the head and body. The doctor can determine various conditions, including those that cause vertigo.

7Treatment

Benign paroxysmal positional vertigo (BPPV) is a condition that can go away on its own after a few weeks. However, some doctors can treat the condition to make it go away sooner and provide comfort to the patient.

Repositioning Maneuvers

There are various maneuvers that are said to relieve BPPV.

  • Epley Maneuver

The Epley maneuver uses the pull of gravity to move the calcium crystals that cause the condition. This is a simple procedure and can be done inside the clinic. Some doctors teach the patients this maneuver to be tried at home.

However, this maneuver does not necessarily remove the crystal build up but rather, changes their position.

  • Semont Maneuver

The Semont maneuver has an efficacy rate of about 90.3 percent. The doctor will perform the maneuver while the patient is sitting on the treatment table with the legs hanging on the side. The therapist or doctor will tilt the head toward the good ear by 45 degrees.

Then he will tilt the head so he is lying on the affected side and this position is maintained for about three minutes. The patient will be moved quickly to he is lying on the good ear with the head in the same position and maintained for three minutes. Lastly, the patient is slowly assisted to the upright position. Some patients may need more than one treatment procedures before the condition is alleviated.

Other maneuvers:

  • Roll Maneuver
  • Brandt-Daroff exercises

Medications

Vestibulosuppressant medication

This drug does not stop vertigo but can provide relief for some patients. However, this type of medication just provides relief of dizziness but does not solve the underlying problem.

The other medicines used to relieve the symptoms of BPPV include:

Surgery

In rare cases, when the repositioning maneuvers are not effective, the doctor may recommend a surgical procedure to close the hole in the inner ear that has been causing the dizziness. There is about 90 percent success rate of surgery in correcting BPPV.

Can It Come Back?

Unfortunately, once you have BPPV, it can re-occur from time to time. In fact, there is a 50 percent chance of long-term recurrence within five years, especially those who had the condition as a result of trauma.

To prevent re-occurrence, the doctor or therapist will teach the patient to perform the maneuvers to solve the problem. However, it is still important to make sure that the patient will still visit his therapist now and then. This is because the symptoms of BPPV may mimic other conditions. Hence, a thorough evaluation is needed.