Benign paroxysmal positional vertigo (BPPV)
Although benign paroxysmal positional vertigo (BPPV) can be an uncomfortable problem, it is rarely serious unless it increases the risk of falls.
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, the sudden sensation of spinning or turning inside the head.
Benign vertigo symptoms are just vertigo that is triggered by specific changes in head position, such as bending the head up or down and lying down, turning over, or sitting up in bed. You may also feel dizzy while standing or walking.
Although benign vertigo can be an uncomfortable problem, it is rarely serious unless it increases the risk of falls. Benign vertigo can be effectively treated with an appointment with a doctor.
Signs and symptoms of benign vertigo may include:
A feeling that one's self or surroundings are rotating or moving.
Blurred vision combined with feeling dizzy.
Signs and symptoms of benign vertigo can come and go, with symptoms usually lasting less than a minute. The episodes of benign orthostatic vertigo occur only on the days of the onset of the disease, and the form of vertigo may disappear after a while and then recur.
The activity that triggers the signs and symptoms of benign vertigo can vary from person to person but is almost always due to a change in head position. Irregular eye movement rhythms (nystagmus) often accompany symptoms of benign vertigo.
In general, see your doctor if you experience any unexplained dizziness or lightheadedness for more than a week. Although dizziness signaling a serious illness is uncommon, see a doctor immediately if dizziness or lightheadedness is accompanied by the following:
Other dizziness before or severe headache.
Fever 38oC or higher.
Double vision or loss of vision.
Talking is difficult.
Weak legs or arms.
Loss of consciousness.
Falling or having trouble walking.
Numbness or itching.
Chest pain, or a fast or slow heartbeat.
The signs and symptoms listed above could signal a more serious problem, such as a stroke or heart condition.
About half, doctors can't find a specific cause of benign vertigo.
When the cause can be determined, benign orthostatic vertigo is often associated with severe juvenile head trauma. Less common causes of benign vertigo include damage to the inner ear, or rarely, damage that occurs during ear surgery or during prolonged spinal positioning.
The role of the ear
Inside the ear is a small organ called the vestibular labyrinth. It consists of three loop-shaped structures (semicircular channels) containing liquid, which is senses when the head is rotated. Other ear structures (otoliths) track head movement up and down, right and left, back and forth, and head standing position relative to gravity. The otolith organs - the utricle and the saccule - contain crystals that make them sensitive to motion and gravity.
For a variety of reasons, these crystals can be in the wrong place. When they become misplaced, it is possible to move one of the semicircular canals, especially while lying down. This makes the semicircular canal sensitive to changes in head position. The result is feeling dizzy.
Benign paroxysmal positional vertigo (BPPV) occurs most often in people 60 years of age and older but can occur at any age. Other than aging, there are no identifiable factors that may increase the risk of benign vertigo. However, previous head trauma or other disorders of the balance ear organs may predispose to benign postural vertigo.
Although BPPV is uncomfortable, it rarely causes complications. In rare, if severe, persistent orthostatic vertigo causing frequent vomiting, there may be a risk of dehydration.
Testing and diagnosis
Your doctor may do a series of tests to determine the cause of your dizziness. During the physical exam, your doctor will likely look for:
Dizziness signs and symptoms then subside in less than a minute.
Specific dizziness occurs when lying on your back with your head turned to one side.
Involuntary movement from side to side (nystagmus).
Inability to control eye movements.
If it is difficult to diagnose the cause of your signs and symptoms, your doctor may do additional self-examination, such as:
Record electroconvulsive nystagmus (ENG) or (VNG). The purpose of this test is to detect abnormal eye movements. ENG (which uses electrodes) or VNG (which uses a small camera) can help determine if vertigo is caused by inner ear disease by measuring involuntary eye movements while the head is in other positions each other, or the balance organs are stimulated by water or air. Other tests can assess the ability to maintain an upright position in easy and difficult conditions.
Magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create cross-sectional images of the head and body. Doctors can use these images to identify and diagnose a variety of problems. An MRI may be done to rule out a neuroma - a mass of the nerve that carries sound and information from the inner ear to the brain, or other damage that could be the cause of vertigo.
Treatments and drugs
To help relieve benign vertigo, an audiologist or physical therapist may perform a vestibular rehabilitation procedure.
Performed in the doctor's office, the vestibular rehabilitation procedure involves changing some simple slow head positions. The goal is to move the particles from the fluid contained in the semicircular canal of the inner ear to the area of the opening in one of the cochleae where the particles cause no trouble and are reabsorbed more easily. Each position for approximately 30 seconds after the onset of any symptoms or abnormal eye movements. This procedure is usually effective after one or two courses of treatment.
After the procedure should avoid lying with or placing the treated ear underneath that day. For the first night, it is advisable to elevate the head above the pillow. This allows the particles floating in the labyrinth time to enter the anterior chamber and be reabsorbed by the fluids in the inner ear.
The day after the procedure, restrictions will be lifted and self-care will begin as directed by your doctor. Your doctor will likely teach you to perform vestibular self-rehabilitation procedures so that you can do it at home before testing again.
In rare situations where vestibular rehabilitation procedures aren't effective, your doctor may recommend surgery in which a bony plug is used to block the parts of the inner ear that cause dizziness. The cushion will prevent particles from the semicircular canal from moving into the ear in response to general head movement. The surgical success rate is greater than 90 percent.
Lifestyle and remedies
If you have benign vertigo, consider these tips:
Be aware of the potential for loss of balance, which can lead to falls and serious injury.
Sit down immediately when feeling dizzy.
Use a light at night.
Walk with a cane for stability if there is a risk of falling.
Work closely with your doctor to manage your symptoms effectively.
Benign vertigo can recur even after successful treatment. Fortunately, this condition can be managed with physical therapy and home treatments.
Coping and supporting
Living with benign vertigo can be challenging. It can affect interactions with family, productivity at work, and overall quality of life. Encouragement and understanding can be found in a support group.
While support groups are not for everyone, they can be a good source of information. Group members often know about coping skills and tend to share their own experiences. If interested, your doctor can recommend a group in your area.