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Benign Paroxysmal Positional Vertigo

Overview


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.

BPPV causes brief episodes of mild to intense dizziness. It is usually triggered by specific changes in your head's position. This might occur when you tip your head up or down, when you lie down, or when you turn over or sit up in bed.

Although BPPV can be bothersome, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for BPPV during a doctor's office visit.




Symptoms


The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

1.Dizziness

2.A sense that you or your surroundings are spinning or moving (vertigo)

3.A loss of balance or unsteadiness

4.Nausea

5.Vomiting

The signs and symptoms of BPPV can come and go and commonly last less than one minute. Episodes of BPPV can disappear for some time and then recur.

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 head position. Some people also feel out of balance when standing or walking.

Abnormal rhythmic eye movements usually accompany the symptoms of benign paroxysmal positional vertigo.




Causes

Often, there's no known cause for BPPV. This is called idiopathic BPPV.

When there is a known cause, 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 long periods positioned on your back, such as in a dentist chair. BPPV also has been associated with migraines.




Risk factors

Benign paroxysmal positional vertigo occurs most often in people age 50 and older, but can occur at any age. BPPV is also more common in women than in men. A head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.




Complications

Although BPPV is uncomfortable, it rarely causes complications. The dizziness of BPPV can make you unsteady, which may put you at greater risk of falling.



Diagnosis

Your doctor may do a series of tests to determine the cause of your dizziness. During a physical exam, your doctor will likely look for:

1.Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute

2.Dizziness with specific eye movements that occur when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed

3.Involuntary movements of your eyes from side to side

4.Inability to control your eye movements

If your doctor can't find the cause of your signs and symptoms, he or she may order additional testing, such as:

1.Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air.

2.Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.




Treatment

Benign paroxysmal positional vertigo may go away on its own within a few weeks or months. But, to help relieve BPPV sooner, 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 baglike open area (vestibule) that houses one of the otolith organs 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 usually works after one or two treatments.

Your doctor will likely teach you how to perform the procedure on yourself so that you can do it at home if needed.



Surgical alternative

In rare situations when the canalith repositioning procedure doesn't work, your doctor may recommend a surgical procedure. In this procedure, 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. The success rate for canal plugging surgery is about 90%.



Home remedies

If you experience dizziness associated with BPPV, consider these tips:

1.Be aware of the possibility of losing your balance, which can lead to falling and serious injury.

2.Avoid movements, such as looking up, that bring on the symptoms.

3.Sit down immediately when you feel dizzy.

4.Use good lighting if you get up at night.

5.1.Walk with a cane for stability if you're at risk of falling.

6.Work closely with your doctor to manage your symptoms effectively.

BPPV may recur even after successful therapy. Although there's no cure, the condition can be managed with physical therapy and home treatments.




What is the fastest way to cure BPPV?

What is the fastest way to cure BPPV? The most effective benign paroxysmal positional vertigo treatments involve physical therapy exercises. The goal of these exercises is to move the calcium carbonate particles out of your semicircular canals and back into your utricle.



What is the best medication for BPPV?

Common practice by ED physicians is to rule out serious medical causes for their symptoms. It is presently common for ED physicians to treat these patients mainly with benzodiazepines, antihistamines, and anticholinergic medications, especially if the history and physical is consistent with BPPV.



How should I sleep to avoid BPPV?


Many experts recommend that you try and sleep on your back, as the crystals within your ear canals are less likely to become disturbed and trigger a vertigo attack.



Is sleeping good for BPPV?

In cases of BPPV in particular, changes in head position can trigger a vertigo attack. For Meniere's diseases sufferers, lying down in bed can allow fluid and pressure to build in the inner ear. When vertigo begins to disrupt your normal sleep cycle, the effects can snowball quickly.



How many hours does BPPV last?

For Meniere's disease, vertigo symptoms can range from 20 minutes to 24 hours. Meanwhile, for BPPV, symptoms can last up to a week or longer.



What exercises can I do for BPPV?

If you have left-ear BPPV, your provider will likely walk you through the following steps:

1.Sit upright on the edge of a bed and turn your head 45 degrees to the right.

2.Swiftly drop to the left until your head is on the bed. Hold for 1 minute.

3.In one movement, quickly move your body to the right side. ...

4.Hold for 1 minute.



What should I avoid with BPPV?

What to avoid after BPPV treatment includes bending forward to put on your shoes, leaning back to recline, and tipping your chin down to check your phone. It is important that you just sit upright with your head level for a 20 minute rest break, on a chair or the couch.
































































































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