BPPV

1 What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo.

It may cause a sudden sensation that you are spinning or you may feel like the inside of your head is spinning.

BPPV also causes brief episodes of mild to intense dizziness.

It is usually triggered due to specific changes in the position of your head such as when tilting your head up or down, lying down, or when you turn over or sit up in bed.

Although BPPV causes annoyance, it is rarely serious except when it results in falls due to dizziness.

Over time, the condition tends to resolve spontaneously. Additionally, highly effective treatment is available for BPPV.

2 Symptoms

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include dizziness or lightheadedness.

A sensation that you or your surroundings are spinning or moving around (vertigo), blurred vision, a loss of balance or unsteadiness, nausea, vomiting.

The symptoms of BPPV may be transient as these commonly last for less than one minute. Episodes of BPPV may totally disappear for some time and then come back again.

A number of activities can lead to the symptoms of BPPV, and it varies from one person to the other. However, most commonly symptoms occur as a result of a change in the position of your head.

Abnormal rhythmic eye movements called nystagmus may usually accompany the symptoms of BPPV. Although very rare, BPPV symptoms can occur in both ears.

In extremely severe cases of BPPV, dehydration may develop as a result of severe vomiting.

Consult your doctor if you have any unexplained dizziness or vertigo that occurs repeatedly for more than one week.

Seek emergency medical care: Although dizziness rarely indicates a serious illness, see your doctor immediately if you feel dizziness or vertigo along with any of the following symptoms:

  • A new, different or a severe headache
  • A fever
  • Loss of vision or double vision
  • Loss of hearing ability
  • Trouble speaking
  • Weakness in the legs or arms
  • Loss of consciousness
  • Loss of balance resulting in falls or difficulty in walking
  • Numbness or tingling sensation
  • The above signs and symptoms indicate a more serious problem.
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3 Causes

Often, there is no known cause for Benign Paroxysmal Positional Vertigo (BPPV), and hence, it is called idiopathic BPPV. Whenever a cause can be determined, BPPV occurs in association to a minor to severe blow on your head.

Less commonly, BPPV may occur as a result of disorders that damage your inner ear or, rarely, damage caused by ear surgery or because of prolonged positioning on your back, such as in a dentist chair.

BPPV has also been associated with migraine headaches. It can also be caused by a problem in the inner ear.

Within your ear, there is a tiny organ called the vestibular labyrinth. It consists of three loop-shaped structures that are fluid-filled that are called semicircular canals.

These canals contain hair-like sensors that monitor the rotation of your head, which makes these canals very sensitive to any fluid movements.

When you move, fluid inside these tubes move, and this sensation is sent to the brain so that you are aware of your body position. This mechanism also helps to maintain your balance.

Other structure of the ear called otolith organs monitor movements of your head in directions such as up and down, right and left, back and forth, and your head's position in relation to gravity.

These otolith organs have crystals that make you sensitive to gravity. For certain reasons, these crystals get dislodged and move into one of the semicircular canals — particularly when you are lying down.

This causes passage of erroneous messages about your body position to your brain. The semicircular canal becomes sensitive to head position changes it would normally not respond to, because of which you may feel dizzy.

4 Making a Diagnosis

A physician can make the diagnosis of Benign Paroxysmal Positional Vertigo (BPPV) based on history, findings on physical examination and other tests.

Make an appointment with your doctor if you think you have symptoms of BPPV.

After an initial examination, your doctor may refer you to an ear, nose and throat (ENT) specialist or a doctor who specializes in the brain and nervous system disorders (neurologist).

Here is some information that helps you get ready for your appointment.

What you can do Write down your symptoms, including when they started first and their frequency of occurrence. Note any recent blows on your head, including minor accidents or injuries.

Make a list of your key medical information, including other conditions for which you are being treated and all your regular medications, vitamins, and supplements.

Write down questions you may want to ask your doctor.

Questions that can be asked at the initial appointment include:

  • What are the most likely causes of my symptoms or condition?
  • Which diagnostic tests do you recommend?
  • If these tests do not determine the accurate cause of my symptoms, what additional tests may be needed?
  • Do I need to follow any restrictions while I am awaiting a diagnosis?
  • Should I consult a specialist?
  • Questions to ask if you are referred to a specialist include:
  • What kind of treatments are most likely to relieve my symptoms?
  • How soon after beginning the treatment will my symptoms start improving?
  • If the initial treatment is not effective, what will you recommend next?
  • Am I a candidate for surgery? Why or why not?
  • What self-care steps do you advise to manage this condition?
  • Do I need to restrict my activities? If yes, for how long?
  • Am I at risk of having this problem repeatedly?
  • How can I best manage other health conditions together?
  • What handouts or websites do you recommend for learning more about BPPV?

A doctor who evaluates your symptoms of BPPV may ask a number of questions, such as:

  • What are your symptoms, and when was it noticed first?
  • Do your symptoms come and go? How often?
  • How long do your symptoms last during an episode?
  • Is there anything, in particular, that seems to trigger your symptoms, for example, certain types of movement or activity?
  • Do your symptoms include vision problems, headache, nausea or vomiting?
  • Have you lost your hearing ability?
  • Are you on treatment for any other medical conditions?

Your doctor may perform a series of diagnostic tests to determine the cause of your dizziness.

During a physical examination, your doctor will look for:

Signs and symptoms of dizziness that are prompted by eye or head movements.

Dizziness that occurs with specific eye movements that are tested when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed.

Involuntary eye movements that occur from side to side (nystagmus).

Inability to control your eye movements. 

If the reason for your signs and symptoms is difficult to determine, your doctor may order additional testing, such as:

Electronystagmography (ENG) or video nystagmography (VNG): These tests detect abnormal eye movements.

ENG (which uses electrodes) or VNG (which uses small cameras) can find out whether dizziness is due to inner ear problem by measuring the involuntary eye movements that take place while your head is moved in different positions or when your balance organs are stimulated either with water or air.

Magnetic resonance imaging (MRI): This test employs a magnetic field or radio waves to create a cross-sectional image of your head and body.

These images help to identify and diagnose a wide range of conditions. MRI may be ordered to rule out other possible causes of vertigo.

5 Treatment

Benign paroxysmal positional vertigo (BPPV) may resolve in a few weeks to months without any treatment.

To help relieve your symptoms of BPPV sooner, your doctor, audiologist or physical therapist may perform a series of movements called the canalith repositioning procedure or Epley's maneuver.

Canalith repositioning: This procedure is performed at your doctor's office, and consists of several simple, slow maneuvers for positioning your head.

The objective is to move the small particles from the fluid-filled semicircular canals of your inner ear into a bag-like open area (vestibule).

The vestibule consists of one of the otolith organs in your ear, and here these particles do not cause any trouble as they get resorbed.

Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. Th effectiveness of this procedure can be appreciated only after one or two treatments.

Your doctor will teach the way to perform the canalith repositioning procedure on yourself so that you are able to do it at home, if necessary.

Medications: To relieve the spinning sensation, medications such as antihistamines, anticholinergics, and sedative-hypnotics may be prescribed.

Surgical alternative: Rarely, if the canalith repositioning procedure becomes ineffective, your doctor may recommend a surgical procedure in which a bone plug is placed to block the portion of your inner ear that is causing dizziness.

This plug also prevents the semicircular canal in your ear from responding to particle movements or head movements in general. The success rate for canal plugging surgery is approximately 90%.

6 Prevention

The best possible way to prevent Benign paroxysmal positional vertigo (BPPV) is to avoid the positions of your head that are known to trigger the condition. 

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with Benign paroxysmal positional vertigo (BPPV).

Here are some tips you can follow to manage the dizziness associated with BPPV.

As there is a possibility of losing your balance, be aware of your surroundings and avoid falls and serious injuries.

  • When you feel dizzy, sit down to avoid falling
  • Use good lighting around if you have the habit of getting up at night
  • Use a cane while walking for stability
  • Work closely with your doctor and try to know what triggers your episodes of dizziness to manage your symptoms effectively.

Coping up with this condition is very challenging as it can affect your relationship with your family and friends, quality of life, and also your performance at work.

Although there is no definitive cure for BPPV, the condition is manageable with physical therapy and home treatments, and fortunately, it improves with time.

BPPV may recur without any indication, even after successful treatment.

8 Risks and Complications

No major risk factors exist for Benign paroxysmal positional vertigo (BPPV), but you may have an increased risk of developing this condition if you are:

  • Aged 50 or older, although it can occur at any age.
  • A woman
  • Having a previous head injury, osteoporosis, diabetes, inner ear infection (labyrinthitis) or any other disorder of the balance organs of your ear
  • Having multiple relatives with BPPV

Although BPPV causes some discomfort, it does not lead to any complications. The dizziness of BPPV can cause unsteadiness, which may put you at a greater risk of falling.

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