Houston ENT and Allergy Blog

Benign Paroxysmal Positional Vertigo (BPPV): Causes, Symptoms, and Treatment Options

By:
Mark Nichols, MD
February 01, 2019

 

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Have you ever felt like your head was spinning, even though obviously it isn't? Perhaps you feel light-headed or that your balance is off. If you're experiencing any of these, you could potentially be dealing with a condition known as benign paroxysmal positional vertigo (BPPV).

What is Benign Paroxysmal Positional Vertigo (BPPV)?

The best benign paroxysmal positional vertigo definition would be: BPPV is a common cause of vertigo — a sudden feeling as though you're spinning or your head is spinning.

To break it down, each part of BPPV's name explains an important part of this inner-ear condition:

  • Benign: It's not that serious and doesn't threaten your life.

  • Paroxysmal: It comes on suddenly, lasting a brief time.

  • Positional: Vertigo is triggered by certain movements or postures.

  • Vertigo: The sensation of swaying or spinning.

BPPV is typically due to certain changes in head position. You may trigger BPPV when you sit up in bed, lie down, turn over in bed or tip your head up or down.

BPPV is quite common with an approximate 107 per 100,000 per year incidence rate and 2.4 percent lifetime prevalence. In fact, the American Academy of Otolaryngology — Head and Neck Surgery reports it is the most common cause of vertigo and inner ear problems. More than 40 percent of patients with a vertigo complaint ultimately receive a BPPV diagnosis.

It’s believed to be very rare in children, but may affect adults no matter what their age is, particularly seniors.

Most cases of BPPV occur for no apparent reason and many individuals report the room spins when they get out of bed. There have, however, been associations with:

  • Migraines

  • Trauma

  • Diabetes

  • Inner ear disease or infection

  • Reduced blood flow

  • Osteoporosis

There could also be a connection with an individual’s preferred sleeping side.

While BPPV can be a nuisance, it's rarely a serious problem except when it increases your risk of falling. There is effective treatment for the condition you can receive right in your doctor's office.

 

Causes of Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo is a mechanical issue in your inner ear. The most common BPPV causes revolve around the crystals in your ear. It occurs when you have some of the (calcium carbonate crystals, otoconia  that are usually embedded in the utricle (the larger of the cavities filled with fluid and form part of your inner ear labyrinth) gel and become dislodged, migrating into one or more of your three fluid-filled semicircular canals (bony inner ear channels), where they shouldn't be. 

When you have too many of these particles accumulating in one of your canals, they impact the regular fluid movement your canals use for sensing head motion and cause your inner ear to send your brain false signals. Semicircular canal fluid doesn't usually react to gravity. But, the crystals move with gravity which moves the fluid when it would usually be still. As the fluid moves, your canal nerve endings are excited and start sending your brain a message your head is moving, even when it's not.

This false information doesn't match what your other ear is sensing, with what your joints and muscles are doing and what your eyes are seeing and your brain perceives the mismatched information as vertigo, or a spinning sensation. This usually lasts for only a minute. Some individuals feel symptom-free between vertigo spells, while other people may feel a mild sense of disequilibrium or imbalance.

 

Benign Paroxysmal Positional Vertigo Symptoms

The symptoms of BPPV might include:

  • Dizziness

  • Unsteadiness or loss of balance

  • Nausea

  • Vomiting

  • A sense you or your surroundings are moving or spinning

The BPPV symptoms can come and go and usually last less than a minute.  Spells of BPPV can go away for some time and then recur.

Activities that trigger BPPV symptoms can vary from person to person, however, are usually always triggered by a change in head position. Some individuals also feel out of balance when they walk or stand.

It's essential you know BPPV doesn't give you continuous dizziness that's unaffected by a change in position or movement. It won't produce a headache, fainting or neurological symptoms like "pins and needles", numbness, trouble coordinating your movements or trouble speaking. It won't affect your hearing. If you are experiencing any of these symptoms, see your doctor right away as other conditions could be misdiagnosed initially as BPPV.

Nystagmus (abnormal rhythmic eye movements) typically accompany the symptoms of BPPV.

 

Benign Paroxysmal Positional Vertigo Treatment Options

BPPV might go away by itself within a few weeks or months. However, if you’re concerned about your dizziness and risk of falling, it’s essential to visit a physician to discuss your BPPV treatment options. Your doctor, physical therapist or audiologist can help relieve the condition sooner through a repositioning procedure involving a series of movements.  

Canalith Repositioning

Canalith repositioning can be performed in the doctor's office. It consists of various simple and slow maneuvers for head positioning. There are several maneuvers that your ENT specialist can perform, including the following common ones:

The Epley Maneuver

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It's performed to move particles from your inner ear's fluid-filled semicircular canals into a vestibule (tiny bag-like open area) that contains one of your ear's otolith organs where the particles are more easily reabsorbed and don't cause trouble.  The Epley maneuver depends upon gravity to reposition the calcium crystals out of the chambers of your ear. After the maneuver, the crystals are absorbed harmlessly by the body over a period of several days to weeks.

To conduct the Epley Maneuver, the doctor holds each position for around 30 seconds after any abnormal eye movements or symptoms stop, which may take up to six times until the vertigo is relieved. The procedure is typically effective after you receive one or two treatments. In some situations, your physician may hold a hand-held vibrator to the bone behind your bad ear to assist in dislodging the stones that may be stuck on semicircular canal wall.

The doctor may also teach you how to perform these maneuvers on yourself so you can use them at home, if needed, however, for the safest approach you should have your ENT specialists perform these maneuvers.

The Semont Maneuver

With the Semont maneuver, your doctor tilts your head in various directions while you’re sitting down. They then tilt your head and help you lie down on the unaffected ear with your nose pointing down. You’ll stay in this position for several minutes and then the doctor will assist you into a seated position again.

 

Surgical Alternative

If the repositioning procedure doesn't work, which is rare, your doctor might suggest a surgical procedure where the surgeon uses a bone plug to block the part of your inner ear causing the dizziness. This plug prevents your ear's semicircular canal from responding to head movements or particle movements.

 

Seek BPPV Evaluation and Treatment from Houston ENT & Allergy Services

If you are experiencing symptoms of BPPV, schedule an appointment with Houston ENT & Allergy Services.  Our multidisciplinary team is dedicated to treating vestibular and neuro-visual conditions to improve our patients' lives.

Our specialists have treated many patients with BPPV, and utilize techniques that can help to relieve benign paroxysmal position vertigo symptoms during an in-office appointment at any of all Houston ENT clinic locations. Call us today at 281-623-1212 or request an appointment online.

 

Request an appointment with Houston ENT today!

By Mark Nichols, MD

 

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