Benign paroxysmal positional vertigo

Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia or otoliths. In people with BPPV, the otoconia are dislodged from their usual position within the utricle, and migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially known as “ear rocks”) within the affected semicircular canal causes abnormal (pathological) endolymph fluid displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis. 

Although BPPV can occur at any age, it is most commonly seen in people over the age of 60. Besides aging, there are no major risk factors known for BPPV, although previous episodes of head trauma or inner ear infection labyrinthitis, may predispose people to future development of BPPV.

It can be triggered by:

• Looking up or down
• Following head injury
• Sudden head movement
• Rolling over in bed
• Tilting the head

BPPV causes severe dizziness when you move your head in a certain way, for example when you turn your head in one direction or bend forward. You may also experience sudden eye movements, nausea or even vomiting. The dizziness can come on suddenly, for example when turning your head in bed. It may be strong enough to wake you up, even if symptoms were mild the night before. An attack usually lasts between 10 and 30 seconds, but can last for up to two minutes.

It is important to seek medical care when you suffer from sudden dizziness. Dizziness is often harmless, but in some cases, it can be a sign of serious illness. If you have been diagnosed with BPPV and have problems with sudden eye movements, it can help to close your eyes. When you feel dizzy, it helps to fix your eyes on a point far away to get rid of the dizziness.

A number of exercises or “maneuvers” have been found to be effective in treating BPPV: the Epley maneuver, the Semont maneuver, Brandt–Daroff exercises and Roll maneuver. 

The Epley maneuver is the most commonly used exercise to treat BPPV. It employs gravity to move the calcium crystal build-up that causes the condition. The maneuver can be performed during a clinical visit by health professionals, or taught to patients to practice at home. Postural restriction after the Epley maneuver increases its effectiveness.

When practiced at home, the Epley maneuver is more effective than the Semont maneuver. The most effective repositioning treatment for posterior canal BPPV is the therapist-performed Epley combined with home-practiced Epley maneuvers. Devices like the DizzyFIX can help users conduct the Epley maneuver at home and are available for the treatment of BPPV.

The Epley maneuver does not address the actual presence of the particles (otoconia) but it changes their location. The maneuver aims to move particles from the location in the inner ear which causes vertigo, repositioning them so they no longer cause any problems. 

Medical treatment with anti-vertigo medication may be considered in acute, severe exacerbation of BPPV, but in most cases is not required.

Surgical treatments, such as a semi-circular canal occlusion, do exist for BPPV, but carry the same risk as any neurosurgical procedure. Surgery is reserved as a last resort for severe and persistent cases which fail vestibular rehabilitation.

Seek medical help if you have any sudden onset of dizziness. If you have already been diagnosed with BPPV and are treating it with the exercise program, but still have symptoms after two weeks, you should also consult your doctor. It is always important to know the cause of any dizziness you may experience.

APPOTEK can connect you with a doctor for diagnosis. treatment or referrals. Doctors can also send videos of any prescribed maneuvers, for patients to practice at home.