Benign Paroxysmal Positional Vertigo (BPPV)
What does BPPV mean?
Benign: not life threatening
Paroxysmal: sudden brief spells
Positional: occurs with head and body movement
Vertigo: sensation of rotational movement
Benign Paroxysmal Positional Vertigo (or BPPV) is a common cause of vertigo, especially for those over the age of 60. It is a mechanical problem in the inner ear which occurs when crystals that are normally embedded in the gel of the utricle become dislodged and begin floating in the semicircular canals, sending false signals to the brain. It causes intense episodes of vertigo, triggered by changes in head or body movement. BPPV can be effectively treated with the appropriate mechanical maneuvers performed by a qualified healthcare professional.
What causes BPPV?
In many people, especially older adults, there is no specific event that causes BPPV to occur, but there are some things that may bring on BPPV such as:
- Mild to severe head trauma
- Keeping the head in the same position for a long time, such as in the dentist chair, hair salon, or strict bed rest
- High intensity sports
- Other inner ear disease
- Aging
- People who have Méniére’s disease or vestibular migraines are also at a higher risk of having BPPV
What are symptoms of BPPV?
People with BPPV may experience an intense spinning sensation and nausea when they move their head or roll over. They may also feel mildly unsteady or foggy in between the positional vertigo.
Symptoms can be scary because of the sudden intensity and are commonly first noticed when waking up in the morning after moving around at night. People can lose their balance and fall when they get up from bed and try to walk.
In some cases, the crystals can dissolve or fall back in place on their own with natural movement. However, in most cases BPPV is treated with canalith repositioning maneuvers from a trained professional.
How is BPPV diagnosed?
When the inner ear sends false information to the brain, it causes the eyes to move in a jerking motion called nystagmus. Tests like the Dix-Hallpike or roll tests trigger nystagmus and vertigo if the crystals are loose. Computerized technology then measures the direction, intensity, and rotation of the eyes in various head and body positions to determine which canal is affected and the type of BPPV. The two types of BPPV are canalithiasis (where the crystals float freely in the fluid of the canal) and cupulothiasis (where crystals are stuck close to the gel). The nystagmus and vertigo normally last longer with cupulothiasis. The affected canals and type of BPPV is necessary to determine the appropriate repositioning maneuvers.
How is BPPV treated?
Canalith repositioning involves sequentially turning the head or body in a way that helps the crystals float out of the semicircular canal back to the gel membrane. The posterior canal is the most common canal that is affected due to the natural pull of gravity and is often treated by Epley, Semont, or modified Semont maneuvers. The horizontal canals are commonly treated with a BBQ roll, and the anterior canals with a deep head hanging maneuver. Repeat repositioning maneuvers performed in the same visit and a session of follow up repositioning may be necessary. BPPV treatment rarely involves medication or surgery.
