What Is Benign Paroxysmal Positional Vertigo (BPPV)?
Benign Paroxysmal Positional Vertigo or BPPV is a benign condition of the inner ear that causes momentary giddiness in the form of vertigo. Vertigo is a sensation of spinning. This sensation is almost always related to a disorder of the inner ear.
What Happens During An Attack Of BPPV?
Just a few seconds after lying down and rolling over to one side you experience a feeling that everything is spinning around you. This sensation lasts for a few seconds. It may seem like a lot longer; but if timed, it would really be only about 15 seconds. BPPV is not usually associated with nausea and vomiting as some of the other inner ear disorders are. If you continue lying on that side the spinning would stop in less than a minute. Upon arising, there is usually a brief spin again. This sensation can also be triggered by looking up and over one’s shoulder. With BPPV spontaneous dizziness does not occur. It is always correlated with some change of head position. It is not accompanied by any change in hearing, numbness, paralysis, or slurred speech.
What Causes BPPV?
BPPV is caused by some loose calcium particles in the inner ear. The utricle is one of the five organs of balance in the inner ear. The little nerve endings of the utricle are embedded into a calcium matrix. Occasionally, some of this matrix breaks loose. These particles can migrate into one of the three balance canals. When the head is turned a certain way, the calcium particles hit the nerve endings of the balance canal and send an irregular signal to the brain. This is interpreted by the brain as an unusual spin. The signal also causes a relay to the eye resulting in a rotation of the eyes.
What Is The Treatment For BPPV?
BPPV is a self limiting condition. Most people will get better by themselves in a few weeks. You may benefit from a particle repositioning maneuver. This consists of a brief head manipulation by your doctor to try and rotate the labyrinth, or inner ear, to get the calcium particles out of the balance canal and back into the vestibule (that portion of the inner ear where the particles came from). This is not a painful maneuver and only takes a few minutes. After the repositioning maneuver is accomplished you need to follow these instructions:
- Do not lie flat on your back for 48 hours. At night, sleep in a recliner, but do not recline more than 45 degrees
- Do not bend forward all the way over or put your head way back for 48 hours (Be careful while putting on shoes, or when looking at the bottom or top cabinets. Bend at the knees instead.)
- After the 48 hours, do not lie on your affected side for 5 days
Only few patients find the above options ineffective. In that case there is one more option in the form of surgery. The surgery requires a general anesthetic. In this surgery, the balance canal is blocked up and rendered mute. This surgery is not to be done unless the problem is really severe because there are risks involved. This surgery can result in deafness and/or some constant unsteadiness. Nevertheless, it is a good option for those with severe problems and for those who are unresponsive to the more conservative therapies.