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Benign Paroxysmal Positional Vertigo (BPPV): What Exactly Is It and What Should be Done About It

Vertigo, a perception of motion where the individual or the individual’s surroundings appear to spin and whirl, is usually a rather unpleasant experience. Sensations of vertigo can affect your balance and lead to falls that can be critical among older adults; it can also be combined with sensations of spinning in space, dizziness, and more rarely, nausea, vomiting, migraine headaches, visual irregularities such as nystagmus, and fainting.

There can be many causes for vertigo, but one variety of it – benign paroxysmal positional vertigo, or BPPV – is related to your sense of hearing. It is caused by naturally-forming calcium crystals in the inner ear called otoconia or otoliths, and which in most people cause no problems. In individuals who are afflicted with BPPV, however, these crystals become dislodged from their normal location and travel into one of the semicircular canals of the inner ear which control our sense of balance. Once inside the semicircular canals, the crystals cause an abnormal displacement of endolymph fluid every time a person changes the position of their head (relative to gravity). This is actually the root cause of the vertigo feelings in cases of BPPV.

BPPV is characterized by the episodic (paroxysmal) nature of the episodes, and can be triggered by such commonplace movements as looking up or down, tilting the head, rolling over while laying down, or any other rapid head motion. Changes in barometric pressure, lack of sleep and anxiety can worsen the symptoms. BPPV can occur at any age, but it is most commonly seen in individuals over the age of 60. The initial trigger for the BPPV is generally hard to pinpoint. An unexpected blow to the head (such as in a motor vehicle accident) is among the more common causes.

Benign paroxysmal positional vertigo is different from other forms of dizziness or vertigo because the attacks are quite short (generally less than a minute), and because it is always prompted by movements of the head. Doctors usually diagnose benign paroxysmal positional vertigo by having the individual rest on their back on an exam table, tilting their head to one side or over the edge of the table to observe whether this action triggers an episode. Other tests that can be used to diagnose BPPV include videonystagmography or electronystagmography, which test for abnormal eye movement, and magnetic resonance imaging (MRI), primarily to rule out other potential causes, such as brain abnormalities or tumors.

The standard treatment for BPPV is canalith repositioning, such as the Semont maneuver and the Epley maneuver, both of which are a sequence of physical movements used to guide the crystals to a position in the inner ear in which they no longer cause trouble. In some cases (less than 10%), if these treatments don’t provide relief, surgery may be proposed. See your doctor

Benign Paroxysmal Positional Vertigo (BPPV): What Exactly Is It and What Should be Done About It

if you have experienced symptoms that seem as if they might be related to BPPV, especially if they last for over a week.

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