Benign Paroxysmal Positional Vertigo

Definition

Definition of Benign Paroxysmal Positional Vertigo
Benign paroxysmal positional vertigo (BPPV) is a disorder caused by problems in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in the position of the head.

Symptoms

Symptoms of Benign Paroxysmal Positional Vertigo

1. Vertigo: Spinning dizziness, which must have a rotational component.
2. Short duration (Paroxysmal): Lasts only seconds to minutes
3. Positional in onset: Can only be induced by a change in position.
4. Nausea is often associated
5. Visual disturbance: It may be difficult to read or see during an attack due to the associated nystagmus.
6. Pre-Syncope (feeling faint) or Syncope (fainting) is unusual.
7. Emesis (Vomiting) is uncommon but possible.

Causes

Causes of Benign Paroxysmal Positional Vertigo
Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia or otoliths. In patients with BPPV, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially "ear rocks") within the affected semicircular canal causes abnormal (pathological) fluid endolymph displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis.

In rare cases, the crystals themselves can adhere to a semicircular canal cupula rendering it heavier than the surrounding endolymph. Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles thereby inducing an immediate and maintained excitation of semicircular canal afferent nerves. This condition is termed cupulolithiasis.

Diagnosis

Diagnosis of Benign Paroxysmal Positional Vertigo
The condition is diagnosed by taking a patient history, and by performing the Dix-Hallpike maneuver and/or the roll test. Patients with BPPV will report a history of vertigo as a result of fast head movements. Many patients are also capable of describing the exact head movements that provokes their vertigo.

The Dix-Hallpike test is a common test performed by examiners to determine whether the posterior semicircular canal is involved. It involves a reorientation of the head to align the posterior semicircular canal (at its entrance to the ampulla) with the direction of gravity. This test will reproduce vertigo and nystagmus characteristic of posterior canal BPPV.

Treatment

Treatment of Benign Paroxysmal Positional Vertigo
The most effective treatment is a procedure called "Epley's maneuver," which can move the small piece of bone-like calcium that is floating inside your inner ear. Other exercises that can readjust your response to head movements are less effective.

Occasionally, medications may be prescribed to relieve the spinning sensations. Such drugs may include:

1. Antihistamines
2. Anticholinergics
3. Sedative-hypnotics

Prognosis

Prognosis of Benign Paroxysmal Positional Vertigo
Benign positional vertigo is uncomfortable, but usually improves with time. This condition may occur again without warning.

Prevention

Prevention of Benign Paroxysmal Positional Vertigo
Avoid head positions that trigger positional vertigo.