Benign Paroxysmal Position Vertigo: What is it?

Many cases of vertigo experienced by people can be attributed to benign paroxysmal position vertigo (BPPV). It is characterized by recurrent episodes of positional vertigo, which creates the spinning sensation after rapid movements of the head. It can occur due to certain head movements, turning in bed, or standing up, basically after sudden movements of the head.

Causes of BPPV

In the inner ear is an organ called the vestibular labyrinth, which contains vital parts of the ear, such as the semi-circular canals, fluids and fine hair that work like sensors. These sensors detect rotations of the head by monitoring the fluid movement and keep the body balanced. Another important structure in the inner ear contains the otoliths organs, which have calcium crystals that are sensitive to gravity, keeping track of the head’s position.

In those with BPPV, however, small fragments of the calcium crystals break off from their original structure. Even then, they usually don’t cause any problems on their own, unless it gets into the semi-circular canals. While your head is still, these crystals will lie at the bottom of the fluid-filled canals, and won’t affect anything. However, certain head movements rouse them from the bottom, causing them to be swept along the semi-circular canals, sending confusing messages to the brain.

Besides natural causes, there has been evidence that during certain dental procedures, transmitted forces are capable of detaching otoliths from their original location. This can also lead to BPPV. Cases of trauma to the head, as well as inner ear infections, can also lead to BPPV later in life.

Signs and Symptoms of BPPV

Episodes of vertigo can last anywhere from a few seconds to a few minutes, which is the primary symptom of BPPV. 

Common symptoms:

• Nausea - this feeling is common due to the spinning feeling sufferer’s experience
• Vomiting -  this is not always experience, but may occur depending on the strength of the vertigo
• Nystagmus - after the vertigo experience, you may find your eyes moving uncontrollably, usually horizontally
• Light-headedness - feeling lightheaded and faint is not very common, but it does happen and sometimes the sufferer may actually faint. This feeling can last for a few minutes after the episode and sometimes even longer

These symptoms can be made worse or exacerbated by various factors:

• Lack of sleep
• Changes in barometric pressure
• Stress

Diagnosis and treatment

In order to determine whether symptoms are due to BPPV, diagnosis is done by examination of the patient’s medical records as well as through the Dix-Hallpike maneuver. The maneuver involves reorienting the head to produce BPPV symptoms which are then analysed.

Various maneuvers including the Epley and Semont maneuver can be performed by a health professional. The Semont maneuver, for example, has a 90.3% success rate and can even be performed at home.

In case the cases of BPPV become too severe and unmanageable, there are anti-vertigo medications which include anti-histamines and anticholinergic drugs. They are used to suppress symptoms during the various manoeuvres, allowing for the treatment of the condition.

In the worst case scenario, surgery is available, although it is risky and may lead to a permanent hearing loss.