Benign paroxysmal positional vertigo (BPPV) is a disorder arising from a problem in the inner ear. Symptoms are repeated, brief periods of vertigo with movement, characterized by a spinning sensation upon changes in the position of the head. This can occur with turning in bed or changing position. Each episode of vertigo typically lasts less than one minute. Nausea is commonly associated. BPPV is one of the most common causes of vertigo.
BPPV is a type of balance disorder along with labyrinthitis and Ménière's disease. It can result from a head injury or simply occur among those who are older. Often, a specific cause is not identified. When found, the underlying mechanism typically involves a small calcified otolith moving around loose in the inner ear. Diagnosis is typically made when the Dix–Hallpike test results in nystagmus (a specific movement pattern of the eyes) and other possible causes have been ruled out. In typical cases, medical imaging is not needed.
BPPV is easily treated with a number of simple movements such as the Epley maneuver or Half Somersault Maneuver (in case of diagonal/rotational nystagmus), the Lempert maneuver (in case of horizontal nystagmus), the deep head hanging maneuver (in case of vertical nystagmus) or sometimes the less effective Brandt–Daroff exercises. Medications, including antihistamines such as meclizine, may be used to help with nausea. There is tentative evidence that betahistine may help with vertigo, but its use is not generally needed. BPPV is not a serious medical condition, but may present serious risks of injury through falling or other spatial disorientation-induced accidents.
When untreated, it might resolve in days to months; however, it may recur in some people. One can needlessly suffer from BPPV for years despite there being a simple and very effective cure. Short-term self-resolution of BPPV is unlikely because the effective cure maneuvers induce strong vertigo which the patient will naturally resist and not accidentally perform.
The first medical description of the condition occurred in 1921 by Róbert Bárány. Approximately 2.4% of people are affected at some point in time. Among those who live until their 80s, 10% have been affected. BPPV affects females twice as often as males. Onset is typically in people between the ages of 50 and 70.
Signs and symptoms
Symptoms: Paroxysmal—appears suddenly, and in episodes of short duration: lasts only seconds to minutes Positional—is induced by a change in position, even slight Vertigo—a spinning dizziness, which must have a rotational component Torsional nystagmus—a diagnostic symptom where the top of the eye rotates toward the affected ear in a beating or twitching fashion, which has a latency and can be fatigued (vertigo should lessen with deliberate repetition of the provoking maneuver): nystagmus should only last for 30 seconds to one minute Pre-syncope—(feeling faint) or syncope (fainting) is unusual, but possible Visual disturbance—due to associated nystagmus, making it difficult to read or see during an attack Nausea—is often associated Vomiting—is common, depending on the strength of vertigo itself and the causes for this illness
Many people will report a history of vertigo as a result of fast head movements. Many are also capable of describing the exact head movements that provoke their vertigo. Purely horizontal nystagmus and symptoms of vertigo lasting more than one minute can also indicate BPPV occurring in the horizontal semicircular canal.
The spinning sensation experienced from BPPV is usually triggered by movement of the head, will have a sudden onset, and can last anywhere from a few seconds to several minutes. The most common movements people report triggering a spinning sensation are tilting their heads upward in order to look at something and when rolling over in bed.
People with BPPV do not experience other neurological deficits such as numbness or weakness. If those symptoms are present, a more serious etiology, such as posterior circulation stroke or ischemia, must be considered.
The most significant symptom is nystagmus as it is essential to determine the kind of nystagmus ( horizontal, vertical, or diagonal ) to select the correct cure maneuver.