|
BENIGN PAROXYSMAL POSITIONAL VERTIGO |
About BPPV
Benign Paroxysmal Positional Vertigo (BPPV) is characterized by brief episodes of vertigo (spinning sensation) and/or dizziness with certain head positions or head movements. This is caused by displaced tiny crystals that have collected in an area of the inner ear. These crystals are properly named otoconia and are sometimes referred to as ear “rocks” because they are composed of calcium carbonate. These crystals should |
 |
reside in a portion of the inner (middle ear) called the saccule. They function in assisting us with determining our head position in space. The saccule can be damaged by a head injury, concussion, infection or degenerated as a result of the aging process. This can cause a displacement of the crystals out of the saccule and into a network of semi-circular canals. This causes the canals to be sensitive to gravity, stimulating a reflexive response of vertigo. BPPV is a common cause of dizziness or vertigo. Across all populations about 20% of dizziness is due to BPPV, but above the age of 50, one's odds jump to 50% of all dizziness. Symptoms are not limited to dizziness and vertigo alone. Other common symptoms include lightheadedness, imbalance, and nausea. Activities which bring on the symptoms are almost always precipitated by a change of head position. This is especially common when rolling over in bed, looking up, bending over, or any quick head motion. An intermittent pattern of symptoms can be common. BPPV may be present for a few weeks (untreated), then stop, and then come back again, usually 6 months from the initial onset. There is a 40% recurrence rate.
back to top |
 |
Types of BPPV
There are 2 main forms of BPPV, the most common being canalithiasis, the other being cupulolithiasis. With the more common canalithiasis type of BPPV, the crystals are displaced into one of the three semi-circular canals located in the middle or inner ear. The cupulolithiasis type is where the crystals are stuck to a structure called the cupula.
back to top
|
Diagnosis
The diagnosis for Benign Paroxysmal Positional Vertigo is based on your history, symptoms, physical examination, and the results of diagnostic testing that includes both vestibular (inner ear) and auditory tests. If the onset is associated with a head injury, concussion, or other traumatic event, the diagnosis can be based on history and physical examination. However, in more subtle cases where positional dizziness gets worse with standing rather than lying down, further testing to rule out certain blood pressure conditions (orthostatic hypotension) are in order. Other tests such as electronystagmography (ENG) or videonystagmography (VNG) may be needed to look for certain reflexive eye movements as a person's head is moved into various testing positions. These tests can be very helpful in the determination of which particular type of BPPV a person has and the specific canal of involvement, both of which are very important for proper specific treatment.
back to top
Treatment
The treatments for BPPV are referred to as canalith repositioning maneuvers (CRM) or canalith repositioning techniques (CRT) and involve certain sequential head positions or movements to relocate the crystals back into the saccule. They are performed upon order from a physician by a specially trained physical therapist. These treatments are well known as the “Epley maneuver” after an individual who was one of the first to describe these procedures. There are also forms of these treatments known as the “Liberatory” or “Semonts” techniques required if the crystals are adhered to the cupula. Usually symptoms improve immediately following the procedure especially in acute cases. Post treatment precautions usually include avoiding extreme head flexion/extension for the remainder of the day, and sleeping more upright for the first night. Also it is recommended to not sleep on the involved side for the day of treatment. All of these are to prevent gravity from re-displacing the crystals post treatment. A follow-up appointment is usually scheduled 3 days after the initial treatment to assess effects of the treatment and to make a determination as to other needed BPPV treatments or other forms of vestibular rehabilitation.
back to top
back to Vertigo/Balance Disorders
|
|
 |
