Benign Paroxysmal Positional Vertigo: Signs and Care

Vertigo, a sensation of motion in which the individual or the individual’s surroundings appear to whirl dizzily, can be a rather uncomfortable experience. It can affect your balance, causing falls that can be dangerous among older adults, and can be combined with dizziness, a sensation that you’re falling or spinning, and in serious cases migraines, nausea, vomiting, an inability to see properly (nystagmus), as well as fainting.

There are a number of different types of vertigo with different underlying causes. Audiologists typically encounter benign paroxysmal positional vertigo, or BPPV, because it is related to hearing. BPPV occurs from naturally-forming calcium crystals called otoliths or otoconia, which generally cause no problems. In people who are afflicted with benign paroxysmal positional vertigo, however, these crystals become dislodged from their normal location and migrate into one of the semicircular canals which control our sense of balance. When this happens, and the individual with benign paroxysmal positional vertigo changes the orientation of their head relative to gravity, these crystals move around, and cause an abnormal displacement of endolymph fluid, which leads to vertigo.

Benign paroxysmal positional vertigo can be brought on by such common actions as tilting or turning your head, rolling over in bed, and looking up or down, and is characterized by the transient (paroxysmal) nature of the episodes. These symptoms can be worsened by sleep disorders, anxiety, or changes in barometric pressure, such as before rain or snow. BPPV may appear at any age, but it is most commonly seen in people over the age of 60. It is hard to pinpoint the specific cause of BPPV for any given patient, but it commonly occurs after accidents in which the individual sustains a blow to the head.

BPPV differs from other varieties of dizziness or vertigo because the episodes are brief (generally less than a minute), and because it is always brought on by head movements. Diagnosing BPPV commonly involves a straightforward test where the patient lies on an exam table and tilts their head to the side or over the edge. There are more exacting tests which can be used to diagnose BPPV, such as videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, or magnetic resonance imaging (MRI), which is used principally to rule out other potential causes of the vertigo.

Benign paroxysmal positional vertigo is typically treated using a technique called canalith repositioning which guides the crystals to an area of the ear where there are less problematic using a sequence of physical movements. Two types of canalith repositioning that may be used are the Epley maneuver and the Semont maneuver. In about 10 percent of cases, surgical treatment may be suggested if these therapies don’t deliver satisfactory outcomes. See your balance disorder specialist if you have felt symptoms which seem as if they might be related to BPPV, particularly if they last for over a week.