Benign paroxysmal positional vertigo
Description, Causes and Risk Factors:
Alternative Name: Cupulolithiasis.
A recurrent, brief form of positional vertigo occurring in clusters; believed to result from displaced remnants of utricular otoconia.
Benign paroxysmal positional vertigo (BPPV) is a common type of dizziness caused by debris that has collected in the semicircular canals of the inner ear and that interferes with their normal function. This disorder increases in incidence with age, but may be seen in persons of any age. In persons over the age of 50, about half of all dizziness symptoms are attributable to BPPV. In general, about 20% of dizziness is caused by BPPV and 9% of all older persons have Benign paroxysmal positional vertigo.
BPPV is caused by a displacement of tiny calcium carbonate crystals called otoconia (ear stones) from the utricle (a small pouch into which the semicircular canals open, a balance organ in the inner ear) into the semicircular canals, where they remain trapped and interfere with the normal function of the balance canals. After otoconia are loosened, they are normally absorbed by special cells (dark cells) around the utricle where they arise. If too many otoconia fall off at once, they may find their way into the semicircular canals before they can be absorbed. This typically occurs while the patient is lying down. The trapped particles continue to move within the semicircular canals after the head changes position, and cause the canals to send the brain inaccurate signals that the head is still moving. The result is bursts of severe vertigo brought on by changes in head position.
Risk factors may include infection, trauma, degeneration of the peripheral end-organ and spontaneous occurrence without defined antecedent cause, neurolabyrinthitis.
Do not drive if there is any chance that vertigo could strike and make you lose control.
- At home, keep floors and walkways free of clutter so you do not trip.
- Avoid heights.
- Do not use tools or machines that could be dangerous if you suddenly get dizzy or lose your balance.
The symptoms of BPPV include vertigo
, light-headedness, disorientation, disequilibrium, imbalance and nausea.The most characteristic symptom of benign paroxysmal positional vertigo is a violent spinning which lasts for only 5 to 15 seconds.
Activities which bringon symptoms will vary in each person but always involve movement or position changes of the head or body. A patientmay be sensitive to certain position changes for days, weeks, or months. The strength of the symptoms tends to diminishbefore they disappear. Approximately 30% of patients experience recurrences of benign paroxysmal positional vertigo symptoms. The mostcharacteristic provocative motions include rolling over in bed and tipping the head back to back to look up.
Your physician can make the diagnosis based on your history, findings on physical examination, and theresults of vestibular and auditory tests. Electronystagmography (ENG) testing may be needed to look for thecharacteristic nystagmus (jumping of the eyes). A magnetic resonance imaging (MRI) scan will be performedif a stroke or brain tumor is suspected. A rotatory chair test may be used for difficult diagnostic problems.
Benign paroxysmal positional vertigo usually goes away by itself within six months of onset because of changes which occur both within the semicircular canals and in the brain. These processes cannot take place if the central nervous system has lost its ability to adapt to chronic abnormal stimulations, if the patient carefully avoids positions which provoke the vertigo, or if the ear continues to be injured by processes such as aging, migraine, or trauma. Such patients may have symptoms for years before presenting to the clinic. Vestibular suppressant medications are rarely effective because the characteristic symptoms are so violent and brief.
The treatment of this common vestibular disorder involves head movements designed to either displace the otoconia from the affected semicircular canals back into portion of the inner ear where there is an active mechanism for their resorption or to move the otoconia back and forth within the canal to promote their dissolution. Physical maneuvers to displace otoconia from the affected semicircular canal differ according to the canal affected.
The Semont maneuver (also called the liberatory maneuver) involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other. It is a brisk maneuver that is not currently favored in the United States.
The Epley maneuver also called as canalith repositioning procedure (CRP) is a series of head maneuvers which displaces debris collected within the posterior semicircular canal out of the canal back into the utricle where they can cause few symptoms. This maneuver is successful in approximately 85% to 90% of cases and is usually performed in the office by a clinician with special expertise in balance disorders. To be effective, the clinician must correctly determine which ear is affected. Patients who choose to have this done must be willing to sleep semi-recumbent or vertically the night after the maneuver is performed. In patients with chronic, recurrent benign paroxysmal positional vertigo, the canalith repositioning procedure can safely be done at home, following specific instructions given by their clinician.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.