• Benign Paroxysmal Positional Vertigo

    (BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)

    Definition

    Vertigo is a feeling of movement, including spinning. Benign paroxysmal positional vertigo (BPPV) happens when the vertigo is caused by changes in the position of the head. This might include standing after bending down, turning the head in bed, or extending the neck to look up. People with BPPV can often identify which moves cause the most problems.

    Causes

    The inner ear contains tiny crystals. These crystals can sense movement and help you keep your balance. BPPV occurs because of a shift in location of these crystals or the clumping of these crystals. When this happens, your brain gets signals that you are moving when you are really not moving. Vertigo results.
    Inner Ear
    Inner ear deposits
    The clump of ear crystals can lead to BPPV.
    Copyright © Nucleus Medical Media, Inc.
    BPPV may be caused by:
    • Unknown causes
    • Head injury
    • Viral infection, such as labyrinthitis (infection of the nerve to the ear)
    • Disorders of the inner ear
    • Prolonged immobility of the head
    • Age-related changes to inner ear

    Risk Factors

    These factors increase your chance of BPPV:
    • Advancing age
    • Head injury
    • Prolonged immobility of head

    Symptoms

    If you have any of these symptoms, do not assume it is due to BPPV. These symptoms may be caused by other conditions.
    • Sudden dizziness that lasts less than a minute
    • Feeling of spinning
    • Dizziness with certain movements
    • Loss of balance
    • Nausea
    • Vomiting
    • Feeling unsteady
    • Fatigue
    • Swaying

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will look for symptoms of dizziness as you move your head. Abnormal eye movements common to BPPV may be found. You may be referred to a doctor who specializes in treating ears (otolaryngologist) or to a neurologist.
    Often no further testing besides and history and exam are needed.
    Your doctor may need to measure your eye movements. This can be done with electronystagmography (ENG).
    Your doctor may need images of your body structures. This can be done with an MRI scan.

    Treatment

    Many times BPPV can resolve on its own, usually within months of onset. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Vestibular Exercises (Vestibular Rehabilitation)

    Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.

    Canalith Repositioning

    This procedure is done in your doctor’s office. Your doctor will move your head in different positions to try and resettle the tiny crystals. The procedure is sometimes repeated and you may be taught how to do it at home.

    Surgery

    Some people with BPPV undergo surgery. During surgery, a piece of wax may be used to plug one area of your ear. This will prevent fluid in your inner ear from moving. Another type of surgery that may be done involves cutting the nerve from the inner ear.

    Prevention

    There are no known guidelines for preventing BPPV.

    RESOURCES

    American Academy of Family Physicians http://familydoctor.org

    American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org/

    CANADIAN RESOURCES

    Canadian Academy of Audiology http://www.canadianaudiology.ca/

    Canadian Society of Otolaryngology http://www.entcanada.org/

    References

    Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 20, 2012. Accessed January 2, 2013.

    Benign paroxysmal positional vertigo (BPPV). Family Doctor website. Available at: http://familydoctor.org/online/famdocen/home/articles/200.html . Updated July 2010. Accessed January 2, 2013.

    Kerber KA, Baloh RW. Dizziness, vertigo, and hearing loss. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice . 5th ed.  Philadelphia, PA: Butterworth Heniemann Elsevier; 2008:237-254.

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