What is benign paroxysmal positional vertigo (BPPV)?
BPPV, or positional vertigo, is a spinning sensation of the head (vertigo) brought on by a certain position of the head, usually sudden changes of position. The word “benign” means that it is not life-threatening and does not cause permanent damage to the ear or brain.
What is the cause of BPPV?
In most people the cause is unknown, but it can follow accidents causing neck or head injuries.
There are tiny pieces of floating debris ( calcium carbonate crystals) in the balance centre of the inner ear (the labyrinth). These little bits of sediment somehow upset the balance centre when disturbed.
What are the common triggers for BPPV?
Common triggers of BPPV include sudden head movements, such as rolling over in bed, looking up or down, or bending over. It can also occur after a head injury, as a result of aging, or as a complication of other inner ear problems.
What are the symptoms of BPPV?
- Dizziness: A brief attack of severe dizziness (vertigo), usually for about 10 to 30 seconds, that comes on a few seconds after a certain head movement
- Nausea: The spinning sensation of vertigo can cause feelings of sickness and nausea.
- Headaches: Some people with BPPV may experience headaches during or after an episode of vertigo.
- Ear ringing (tinnitus): BPPV can sometimes cause ringing or noise in the ears.
- Visual disturbances: Some people with BPPV may experience changes in vision, such as blurring or double vision, during episodes of vertigo.
The head movements that provoke an attack can be:
• tilting the head backwards
• changing from a lying to a sitting position
• lying on one ear or the other
• turning the head to the side with the neck injury
How long do the bouts of BPPV last?
Each attack usually lasts less than 30 seconds but can last 60 seconds or so. The attacks tend to come in bursts but usually settle within a few weeks and most people are able to return to work within a week. The bouts tend to come back after months or years, but some people only ever have one attack.
What are the effects of BPPV?
There are usually no ill effects in the long run. Unlike some other causes of severe dizziness, there is usually no vomiting, tinnitus (ringing in the ears) or deafness. The affected person has to be careful with driving.
Who gets BPPV?
Although it can occur at all ages, the elderly are affected most. It is the most common cause of vertigo in the elderly. Women are twice as likely as men to get it. BPPV is a surprisingly common problem.
How is BPPV diagnosed?
BPPV is diagnosed through series of test which will determine the cause of vertigo.
- Medical history: Your doctor will ask about your symptoms, when they started, and if you have a history of head injury, ear disease, or other medical conditions.
- Physical examination: Your doctor will examine your eyes, ears, nose, and throat to look for signs of infection, injury, or other conditions that could cause vertigo.
- Dix-Hallpike test: This test involves rapidly moving your head into specific positions to see if it triggers vertigo. This test can help confirm the diagnosis of BPPV.
- Other tests: Your doctor may perform other tests, such as an audiogram (hearing test), a vestibular evoked myogenic potential test (VEMP), or a balance test, to rule out other conditions that could cause vertigo.
If BPPV is suspected, your doctor may refer you to a specialist for further evaluation and treatment.
How is BPPV treated?
The treatment of benign paroxysmal positional vertigo (BPPV) typically involves a series of procedures designed to move the dislodged calcium crystals back to where they belong in the inner ear. Some of the most common treatment options for BPPV include:
- Particle repositioning maneuver: This procedure involves a series of specific head movements designed to move the dislodged calcium crystals back to their proper place in the inner ear. This maneuver is also known as the “Epley maneuver.”
- Brandt-Daroff exercises: This is a series of repetitive movements that can help reduce symptoms of vertigo and improve balance.
- Vestibular rehabilitation: This is a type of physical therapy that can help improve balance and reduce the symptoms of vertigo.
- Medications: In some cases, medications, such as antihistamines, anticonvulsants, or sedatives, may be prescribed to help relieve symptoms of vertigo.
It is important to note that BPPV can sometimes recur and that multiple treatments may be needed to resolve symptoms completely. In addition, some people may require ongoing vestibular rehabilitation to help improve their balance and reduce the risk of falls.
How long does it take to recover from BPPV?
The attacks tend to come in bursts but usually settle within a few weeks and most people are able to return to work within a week. The bouts tend to come back after months or years, but some people only ever have one attack.
However, some people may experience ongoing symptoms, even after treatment. In these cases, additional treatments or ongoing vestibular rehabilitation may be necessary to manage symptoms.
It is important to follow your doctor’s recommendations and to continue with any recommended treatments to ensure the best possible outcome.
Can BPPV come back after treatment?
Yes BPPV can come back after treatment if there is recurrent of dislodgement of debris in the inner ear.
What can be done to prevent BPPV?
Following steps can be taken to prevent BPPV from recurring
Avoid head and neck trauma: Head and neck trauma can increase the risk of BPPV, so it is important to take steps to protect your head and neck from injury. This can include wearing helmets when participating in sports or activities that carry a risk of head injury.
Maintain good posture: Maintaining good posture can help reduce the risk of BPPV, as poor posture can put strain on the neck and inner ear.
Avoid sudden head movements: Sudden movements, such as turning your head quickly, can trigger BPPV in some people, so it is important to avoid sudden head movements, if possible.
Avoid exposure to irritants: Exposure to irritants, such as chemicals or pollutants, can increase the risk of BPPV, so it is important to avoid exposure to irritants, if possible.
Vestibular rehabilitation: Vestibular rehabilitation, which is a type of physical therapy, can help improve balance and reduce the risk of falls, which can help prevent BPPV from recurring.
Can BPPV be cured?
BPPV can be treated, but it is not considered a curable condition. While particle repositioning maneuvers or other treatments can help resolve symptoms, there is a risk of recurrence, especially in older individuals or those with underlying health conditions.
However, with proper treatment and management, most people with BPPV are able to reduce the frequency and severity of symptoms and improve their quality of life. In some cases, vestibular rehabilitation or other forms of physical therapy can help improve balance and reduce the risk of falls, which can help prevent recurrence of BPPV symptoms.
Are there any lifestyle changes that can help manage BPPV symptoms?
Yes, there are several lifestyle changes that can help manage the symptoms of benign paroxysmal positional vertigo (BPPV):
- Avoid sudden head movements: Sudden movements, such as turning your head quickly, can trigger vertigo in some people, so it is important to avoid sudden head movements, if possible.
- Maintain good posture: Maintaining good posture can help reduce the symptoms of vertigo and improve balance.
- Stay hydrated: Staying hydrated can help reduce the symptoms of vertigo, as dehydration can worsen symptoms.
- Avoid triggers: Certain activities or substances, such as alcohol or caffeine, can trigger vertigo in some people, so it is important to identify and avoid triggers, if possible.
- Exercise regularly: Regular exercise, such as walking or swimming, can help improve balance and reduce the risk of falls, which can help manage the symptoms of BPPV.
- Manage stress: Stress can exacerbate the symptoms of BPPV, so it is important to find ways to manage stress, such as through meditation, yoga, or exercise.