If you have trouble sleeping or often feel dizzy when turning your head, you may be suffering from benign paroxysmal positional vertigo, or BPPV.
What is BPPV?
While vertigo is often associated with the dizziness experienced at great heights, it also refers to spinning sensations experienced during head movements. BPPV is a specific type of vertigo, both paroxysmal (sudden in onset) and positional (rotational movement-based), that is the result of a dysregulation in the vestibular system of the inner ear. The symptoms of BPPV include:
- Nausea/feeling faint
- Difficulty concentrating
- Slight imbalance
- Spinning dizziness with quick onset and short duration
- Involuntary eye movements, also known as nystagmus
People with BPPV are often able to replicate the exact head movements that make them feel vertigo. This also makes BPPV easy to diagnose via head-positioning maneuvers that trigger nystagmus.
The cause of BPPV
Normally, the body’s sense of balance is determined by several factors, including proprioception (the body’s ability to sense its movements), visual stimuli, and vestibular (balance-related) stimuli. When any one of these systems is compromised, balance is affected in a very noticeable way.The vestibule, located in the inner ear, is part of the same structure that houses the cochlea. It is comprised of the labyrinth, which includes the utricle, saccule, and the three vestibular canals.
Whenever someone turns their head, the fluid endolymph in the vestibular canals is displaced because of inertia and exerts pressure against the cupula at the base of each canal. This pressure is then registered as rotational movement by the brain.
In BPPV, ear rocks (i.e., otoconia, or calcium carbonate crystals) from the utricle become displaced and lodge inside one or more of the vestibular canals. This causes specific rotational head movements to be registered by the brain improperly because the dislodged otoconia affect the displacement of the fluid endolymph. These types of false signals cause both vertigo and nystagmus.
BPPV treatment
More than 20% of all diagnoses by physicians who specialize in dizziness are due to BPPV, making it the most common vestibular disorder. People under 50 may have BPPV without knowing it after suffering a head injury like a concussion. For people over 50, BPPV is much more pervasive, and is the cause of up to 50% of all dizziness-related diagnoses among older individuals. Fortunately, there are many non-invasive treatments for the condition.
The most common type of BPPV, accounting for 90% of all cases, is single-sided canalithiasis (i.e., otoconia dislodgment) in the posterior semicircular canal. Single-sided BPPV can be treated with a number of head repositioning procedures, including canalith repositioning procedure (CRP) for right-sided and left-sided BPPV.
Demonstration of CRP for right-sided BPPV
STEP ONE
The patient lies down from a seated position.
STEP TWO
The head is turned 45 degrees in the direction of the affected ear, and the position is held for 15–20 seconds.
STEP THREE
The head is turned 90 degrees in the opposite direction, so that the unaffected ear is facing down. The patient then turns her body to follow her head so that she is lying on her side. The position is held for 15–20 seconds.
STEP FOUR
The patient returns to a seated position.
This right-sided CRP treatment is intended for posterior canal BPPV; there are different repositioning treatments for horizontal canal BPPV and anterior canal BPPV.
All cases of BPPV can be diagnosed by an audiologist, who can demonstrate correct repositioning treatments that encourage the otoconia to migrate back into the utricle. If repositioning treatments do not produce results, other options for BPPV treatment include medication, such as antihistamines and benzodiazapines that treat drowsiness. Individuals with BPPV are encouraged to avoid quick head movements and should not sleep on their affected side.
