What is BPPV?
Benign Paroxysmal Positional Vertigo, or BPPV, is a disorder of the vestibular system of the inner ear. To fully understand BPPV, let’s first define each term separately:
- Benign means that it is not life-threatening and does not continue to progress.
- Paroxysmal describes how the symptoms occur suddenly, usually in short attacks.
- Positional is used to describe how changes in head position causes the symptoms.
- Vertigo is the sensation of spinning that occurs following a change in position.
Within the vestibular system of the inner ear there are vestibular organs called the utricle and saccule, and three (3) semicircular canals. Within these organs is fluid called endolymph. When the body and/or head moves, the endolpymph moves within these organs, sending information about the movement to the brain to control balance.
BPPV occurs as a result of microscopic calcium carbonate “crystals”, or otoconia, migrating from the utricle to one of the semicircular canals. When these otoconia are in the semicircular canal, movement of the head will shift the otoconia within the canal, sending false information to the brain which causes the dizziness.
Types of BPPV
BPPV can be classified by which semicircular canal the otoconia have migrated to, anterior, horizontal, or posterior.
It is further classified by whether the otoconia are free-floating in the canal (canalithiasis) or whether they have attached the the membrane, known as the cupula, within the canal (cupulothiasis).
BPPV is most commonly unilateral, meaning in one ear only, however it can be bilateral, meaning both ears.
The most common type of BPPV is unilateral posterior canal canalithiasis.
What Causes BPPV?
BPPV is one of the most common causes of dizziness.
You have a greater chance of getting BPPV if you are over the age of 50. BPPV can occur for no known reason, most commonly associated with the natural age-related degeneration of the vestibular system.
Other causes of BPPV may include:
- Mild to severe head injury
- Surgery causing trauma to the inner ear
- Virus affecting the inner ear such as vestibular neuritis
- Extensive dental work
- Prolonged period of inactivity
What are the symptoms?
Symptoms of BPPV typically include brief episodes of vertigo, or a spinning sensation, triggered by movement of the head.
Head or body movements such as rolling over in bed, getting up from a flat position, looking up or tilting the head down are the most common triggers of BPPV.
Dizziness, vertigo, imbalance or lightheadedness can last from a few seconds to a few minutes following the movement. Abnormal eye movements, known as nystagmus, usually accompanies the symptoms.
Symptoms can range from mild to severe. Severe cases can cause nausea and vomiting.
How is BPPV diagnosed?
BPPV is diagnosed by taking a thorough medical and case history, and performing auditory and vestibular tests to include a comprehensive hearing evaluation and a videonystagmography (VNG) or electronystagmograohy (ENG) test.
A portion of the vestibular test includes a positioning maneuver called the Dix-Hallpike maneuver, which is used to diagnose the type of BPPV. The Dix-Hallpike maneuver is performed by having you turn your head in one direction, right or left, and quickly laying down on your back with head hanging to the side. The tester will monitor or record your eye movements, looking for nystagmus.The maneuver is repeated with the head in the opposite direction.
If you have BPPV, dizziness is likely to occur during the Dix-Hallpike maneuver.
A physician may also order an MRI or blood work to rule out other causes of dizziness. However, an MRI and/or blood work alone can not be used to diagnose BPPV.
How is it treated?
Once BPPV is diagnosed, treatment includes a simple canalith repositioning maneuver performed in the office. The canalith repositioning maneuver involves a specific series of head and body movements and only takes a few minutes to perform. The purpose of the maneuver is to relocate the otoconia from the semicircular canal back into the utricle of the inner ear.
Before a repositioning maneuver can be performed, it is important to determine which ear and which semicircular canal is affected. This information will determine which type of canalith repositioning manuever will be used. The two most common types of repositioning manuevers are the Epley manuever and the Semont manuever.
Following these canalith repositioning maneuvers it is important to limit head movement for a period of 48-72 hours, including sleeping in an elevated position. In some cases, a cervical neck collar may be recommended for a 24 hour period as a way to limit head movement. The purpose of these restrictions is to ensure the otoconia read here to the utricle membrane.
In many cases, BPPV can resolve on it’s own. BPPV can also be treated by performing exercises at home. The most common home exercises are the Brandt-Daroff exercises. These involve repeating a serious of movements 2-3 times per day for up to 3 weeks.
Does BPPV cause lasting problems?
Once diagnosed, BPPV is usually very easy to treat. Once treated, symptoms may never occur again in a person’s lifetime. However, it is common for BPPV to re-occur several times.