Benign Paroxysmal Positional Vertigo (BPPV)

BPPV or Benign Paroxysmal Positional Vertigo is a condition affecting the inner ear leading to vertigo or intense dizziness. It is more commonly seen in older people. It is named so because of the characteristic symptoms associated. It is believed that 2.4% of all people suffer from this type of vertigo.

Causes of Benign Paroxysmal Positional Vertigo

BPPV is caused when one or more minute particles called otoconia float in the fluid of the inner ear labyrinth. These particles are composed of calcium carbonate crystals that break off from the vestibular lining of the labyrinth. Since the inner ear is that part of body which is responsible for equilibrium and balance against gravity, any disturbance may lead to imbalance in the body causing dizziness or vertigo. It is when a person moves his/her head; these otoconia enters into one of the semicircular canals that may result in imbalance of the body.

This condition affects the posterior canal the most. These fragments get carried away with the flow of fluid on moving the head. The movement of these particles and disturbs the normal functioning of the vestibular nerve in the ear. The formation of otoconia in ear occurs mostly due to an injury or infection in the ear. It is a common symptom of old age especially in those above 40 years of age.

What causes Vertigo?

Types of Benign Paroxysmal Positional Vertigo

BPPV is categorized into 2 subtypes on the basis of involvement of the specific semicircular canal and on the basis of attachment of the otoconia. If these otoconia are freely floating within any of these affected canals, it is called canalithiasis and if these are attached to cupula of the ear, it is known as cupulothiasis.

Symptoms of Benign Paroxysmal Positional Vertigo

One of the major symptoms of BPPV is vertigo. Other symptoms include:

• Dizziness
• Imbalance of the body
• Difficulty in concentrating over work
• Nausea
• Difficulty in various head movements like looking up, getting out of the bed, rolling over while sleeping which occur when the posterior semicircular canal is involved.

These symptoms are triggered on changing the head’s position with respect to gravity.

Diagnosis of Benign Paroxysmal Positional Vertigo

Various methods of diagnosing BPPV include:

• History taking from the patients
• Physical examination

By conducting various vestibular as well as auditory tests including the Supine Roll test as well as Dix-Hallpike maneuvers.

During these tests, the physician observes the nystagmus stimulated in response to movement of head. Electronystagmography (ENG) and Frenzel goggles may be used to observe nystagmus in relation to change of position.

The physician may even advice MRI or magnetic resonance imaging to differentially diagnose BPPV from other problems like stroke, brain tumor, Meniere’s disease or labyrinthitis that may lead to vertigo as well.

Treatment for Benign Paroxysmal Positional Vertigo

BPPV can be treated through various particle repositioning maneuvers to move back the displaced particles from the semicircular canals. These head maneuvers employ a series of movements of head as well as trunk for nearly 15 minutes under the supervision of your physician. Some of the maneuvers include:

• Canalith repositioning procedure or CRP
• The Semont maneuver and the reverse sermont maneuver
• The Gufoni maneuver
• The Vannucchi-Asprella liberatory maneuver
• The Lempert maneuver
• Deep Dix-Hallpike maneuver
• The reverse Epley maneuver

Besides the above clinical maneuvers, there are other methods of treatment including medications, home rehabilitative exercises and surgery.