Positional vertigo

Positional Vertigo is a medical condition characterized by episodes of dizziness and a sensation of spinning with certain head movements. It is also known as Benign Paroxysmal Positional Vertigo (BPPV), which accurately describes the nature of the condition: benign (not life-threatening), paroxysmal (sudden, brief spells), positional (triggered by certain head positions), and vertigo (a false sense of rotational movement). BPPV is one of the most common causes of vertigo.

Causes

BPPV is caused by a disturbance within the inner ear, specifically in the semicircular canals. Tiny calcium carbonate crystals called otoconia, which are normally embedded in the gel of the utricle, become dislodged and migrate into one or more of the three fluid-filled semicircular canals, where they are not supposed to be. When the head is moved in certain ways, these crystals shift, sending false signals to the brain about the body's position.

Symptoms

The primary symptom of BPPV is a sensation of spinning or dizziness that occurs with changes in the position of the head. This might happen when tilting the head up or down, when lying down or turning over in bed, or when making sudden head movements. These episodes of vertigo are typically brief, lasting less than one minute, but can be quite intense and may be accompanied by nausea.

Diagnosis

Diagnosis of BPPV involves a physical examination and the history of the individual's symptoms. A key diagnostic tool is the Dix-Hallpike test, which involves moving the patient from a sitting to a lying position, with the head turned to one side. This maneuver can provoke vertigo and nystagmus (involuntary eye movements), indicating BPPV. Another diagnostic test is the roll test, used to determine if the horizontal semicircular canal is involved.

Treatment

The primary treatment for BPPV is a series of movements known as the Epley maneuver or canalith repositioning procedure. This involves sequential movement of the head into four positions, with the aim of moving the dislodged otoconia out of the semicircular canal and back into the utricle, where they can no longer cause vertigo. Other maneuvers include the Semont maneuver and the Brandt-Daroff exercises, which are designed to dislodge the crystals from the canal. In rare cases where these treatments are not effective, surgery may be considered.

Prevention

Preventative measures for BPPV are limited, as the exact cause of the otoconia becoming dislodged is not always clear. However, maintaining general ear health and avoiding head injuries may reduce the risk of developing BPPV.

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