Benign Paroxysmal Positional Vertigo
The normal inner ear includes small calcium particles located on the balance nerve endings. These particles give the nerve endings mass. As we move in space, the nerve endings bend within the fluid of the ear causing the nerves to fire and to send a signal to the brain from the balance organ of the inner ear. In some cases, the particles become dislodged and float to abnormal positions in the inner ear. In these instances, certain positions cause brief but intense periods of a perception of motion called vertigo. Elderly patients may be at risk of falling due to the balance disturbance. Precipitating causes can be a blow to the head or a viral illness although the majority of cases happen apparently without cause.
Physical examination by an experience Physician or a video infrared electronystagmogram make the diagnosis. In most patients symptoms abate without therapy. In the remaining patients the particles can be re-positioned using the Epley Maneuver with relief afforded to over 90% of patients. In rare instances, a surgical procedure is necessary (Singular Neurectomy, Posterior Semicircular Canal Occlusion).
Frequently Asked Questions
WHAT IS BENIGN PAROXYSMAL POSITIONAL VERTIGO?
Benign Paroxysmal Positional Vertigo (BPPV) is dizziness caused by calcium particles called otoliths (or otoconia) that are inappropriately displaced into the semicircular canals of the labyrinth of the inner ear. These otoliths are normally attached to hair cells on a membrane inside the inner ear. Because these otoliths are denser than the surrounding endolymph fluid of the inner ear, changes in head movement cause the otoliths to tilt the hair cells. It is this action that allows our brain to know which way is up or down.
HOW DO THE OTOLITHS BECOME DISPLACED?
The otoliths may become displaced by aging, infection, head trauma or labyrinthine disease and then become free-floating within the inner ear. Changing the position of the head causes the otoliths to move, which in turn causes the endolymph to stimulate the hair cells, causing the resulting vertigo.
WHAT IS THE CAUSE OF BENIGN PAROXYMAL POSITIONAL VERTIGO?
Most cases of BPPV begin without a known cause. The most common known cause of BPPV in individuals under the age of 50 is head injury. In older individuals the most common cause is degeneration of the vestibular system of the inner ear. Meniere’s disease, surgical procedures, minor strokes and viruses are also associated with BPPV.
WHAT ARE THE SYMPTOMS OF BENIGN PAROXYMAL POSITONAL VERTIGO?
The symptoms of BPPV include vertigo, lightheadedness, imbalance and nausea usually associated with certain head positions. Any movement which involves changing the position of the head including getting out of bed or rolling can aggravate this condition. BPPV can be intermittent and may be present for a few weeks or only for a day, or disappear and return.
HOW IS BENIGN PAROXYMAL POSITONAL VERTIGO TREATED?
Motion sickness medications are sometimes helpful in controlling the nausea that is associated with BPPV, but a series of physical exercises have proved a more effective treatment.
These exercises, known as the Epley Maneuver (also referred to as “canalith repositioning”), successfully reduces or eliminates symptoms for approximately 90 % of patients. The Epley Maneuver employs gravity to move the otoliths from their current position (where they are causing vertigo symptoms) to another position which is asymptomatic. The Epley Maneuver can be performed during a clinic visit by a specially trained otologist or therapist. All California Ear Institute Otologists have specific training on administering the Epley Maneuver. Once the Epley Maneuver has been completed, the patient must remain still in the clinic for approximately half an hour after the maneuver has been performed. If these treatments are non-effective and the BPPV symptoms continue to exist and be severe, the Otologists may recommend a surgical approach called Posterior Semicircular Canal Occlusion which blocks the posterior canals without affecting the functions of the other canals of the inner ear. In some cases, a Singular Nerve Section is recommended to stop the symptoms from the abnormally placed otoliths.
Diagnosis of BPPV requires a comprehensive medical examination and specialty care from an Otologist, who is an otolaryngologist (ENT) who has undergone two additional years of training and specializes in issues related to the nerves of hearing. With appropriate medical treatment and therapy, individuals with BPPV frequently make a full recovery. In rare instances, surgery is necessary to become symptom free.
Click here to make an appointment with the California Ear Institute to consult with one of our board certified Otologists regarding your condition.