BPPV

Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is a disorder arising from a problem in the inner ear. It is one of the most common causes of vertigo, especially in older adults. BPPV is characterized by brief episodes of mild to intense dizziness associated with changes in the position of the head.

Pathophysiology

BPPV occurs when small calcium carbonate crystals, known as otoconia, become dislodged from their usual position in the utricle and migrate into one of the semicircular canals of the inner ear. These canals are responsible for detecting rotational movements. When the head changes position, the displaced otoconia shift, causing abnormal fluid movement in the canal and sending false signals to the brain, resulting in the sensation of vertigo.

Symptoms

The primary symptom of BPPV is vertigo, which is a false sensation of spinning or movement. Other symptoms may include:

• Dizziness
• A sense of imbalance or unsteadiness
• Nausea
• Vomiting

These symptoms are typically triggered by specific changes in head position, such as:

• Rolling over in bed
• Getting out of bed
• Looking up or down

Diagnosis

BPPV is diagnosed based on the patient's history and a physical examination. The most common diagnostic test is the Dix-Hallpike maneuver, which involves moving the patient quickly from a sitting to a lying position with the head turned to one side. A positive test is indicated by the presence of nystagmus (involuntary eye movements) and vertigo.

Treatment

The most effective treatment for BPPV is a series of head movements known as the Epley maneuver or canalith repositioning procedure. This maneuver aims to move the dislodged otoconia out of the semicircular canal and back into the utricle where they can no longer cause symptoms.

Other treatments may include:

• Vestibular rehabilitation therapy
• Medications to alleviate nausea and dizziness

Prognosis

BPPV is generally a benign condition, and many patients experience relief from symptoms after treatment. However, recurrences are common, and some patients may require repeated treatments.

Epidemiology

BPPV is more common in older adults, with a higher prevalence in women than men. It can occur spontaneously or following head trauma, prolonged bed rest, or other vestibular disorders.

See Also

• Vertigo
• Vestibular system
• Otoconia

References

• Baloh, R. W. (1998). "Clinical practice. Benign paroxysmal positional vertigo." The New England Journal of Medicine, 339(21), 1590-1596.
• von Brevern, M., Radtke, A., Lezius, F., et al. (2007). "Epidemiology of benign paroxysmal positional vertigo: a population based study." Journal of Neurology, Neurosurgery & Psychiatry, 78(7), 710-715.