Benign paroxysmal positional vertigo (BPPV)
Definition:
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.
Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.
Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.
Symptoms:
The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:
Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo. Although rare, it's possible to have BPPV in both ears (bilateral BPPV).
When to see a doctor
Generally, see your doctor if you experience any unexplained dizziness or vertigo that recurs periodically for more than one week.
Seek emergency care
Although it's uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:
Causes:
About half the time, doctors can't find a specific cause for BPPV.
When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back. BPPV also has been associated with migraines.
The ear's role
Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.
Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head's position related to gravity. These otolith organs — the utricle and saccule — contain crystals that make you sensitive to gravity.
For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you're lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy.
Complications:
Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. In rare cases, if severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration. The dizziness of BPPV can put you at greater risk of falling.
Treatments and drugs:
To help relieve benign paroxysmal positional vertigo (BPPV), your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure.
Canalith repositioning
Performed in your doctor's office, the canalith repositioning procedure consists of several simple and slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs (utricle) in your ear where these particles don't cause trouble and are more easily resorbed. Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure is usually effective after one or two treatments.
After the procedure, you must avoid lying flat or placing the treated ear below shoulder level for the rest of that day. For the first night following the procedure, elevate your head on a few pillows when you sleep. This allows time for the particles floating in your labyrinth to settle into your vestibule and be resorbed by the fluids in your inner ear.
On the morning after your in-office procedure, your restrictions will be lifted and you'll begin self-care as directed by your doctor. Your doctor likely will have taught you how to perform the canalith repositioning procedure on yourself so that you can do it at home before returning to the office for a recheck.
Surgical alternative
In very rare situations in which the canalith repositioning procedure isn't effective, your doctor may recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear that's causing dizziness. The plug prevents the semicircular canal in your ear from being able to respond to particle movements or head movements in general. This success rate for canal plugging surgery is greater than 90 percent.
Definition:
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.
Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.
Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.
Symptoms:
The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:
- Dizziness
- A sense that you or your surroundings are spinning or moving (vertigo)
- Lightheadedness
- Unsteadiness
- A loss of balance
- Blurred vision associated with the sensation of vertigo
- Nausea
- Vomiting
Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo. Although rare, it's possible to have BPPV in both ears (bilateral BPPV).
When to see a doctor
Generally, see your doctor if you experience any unexplained dizziness or vertigo that recurs periodically for more than one week.
Seek emergency care
Although it's uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:
- A new, different or severe headache
- A fever of 101 F (38 C) or higher
- Double vision or loss of vision
- Hearing loss
- Trouble speaking
- Leg or arm weakness
- Loss of consciousness
- Falling or difficulty walking
- Numbness or tingling
- Chest pain, or rapid or slow heart rate
Causes:
About half the time, doctors can't find a specific cause for BPPV.
When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back. BPPV also has been associated with migraines.
The ear's role
Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.
Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head's position related to gravity. These otolith organs — the utricle and saccule — contain crystals that make you sensitive to gravity.
For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you're lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy.
Complications:
Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. In rare cases, if severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration. The dizziness of BPPV can put you at greater risk of falling.
Treatments and drugs:
To help relieve benign paroxysmal positional vertigo (BPPV), your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure.
Canalith repositioning
Performed in your doctor's office, the canalith repositioning procedure consists of several simple and slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs (utricle) in your ear where these particles don't cause trouble and are more easily resorbed. Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure is usually effective after one or two treatments.
After the procedure, you must avoid lying flat or placing the treated ear below shoulder level for the rest of that day. For the first night following the procedure, elevate your head on a few pillows when you sleep. This allows time for the particles floating in your labyrinth to settle into your vestibule and be resorbed by the fluids in your inner ear.
On the morning after your in-office procedure, your restrictions will be lifted and you'll begin self-care as directed by your doctor. Your doctor likely will have taught you how to perform the canalith repositioning procedure on yourself so that you can do it at home before returning to the office for a recheck.
Surgical alternative
In very rare situations in which the canalith repositioning procedure isn't effective, your doctor may recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear that's causing dizziness. The plug prevents the semicircular canal in your ear from being able to respond to particle movements or head movements in general. This success rate for canal plugging surgery is greater than 90 percent.
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