What
is vertigo?
Vertigo
represents a sensation of movement, typically spinning and sometimes rocking.
It is almost always accompanied by a sensation of
nausea. Benign Paroxysmal
Positional Vertigo (BPPV) is the most common cause of vertigo originating
from the inner ear. Its name describes it well. Benign means
there is no cancer or worrisome cause of the symptoms. Paroxysmal
means the dizziness starts abruptly and is very brief. Positional
means that it is triggered by changes in head position. Vertigo means
the sensation of spinning. It is a common disorder that fortunately
is easily treated.
What
are the symptoms of BPPV?
BPPV
is characterized by recurrent attacks of spinning lasting for seconds,
and triggered by rapid head movement. For example, looking up rapidly,
rolling over in bed, or bending over. There are usually no associated symptoms
of hearing loss or other problems.
What
causes BPPV?
BPPV
is caused by microscopic debris accumulating within a part of the balance
portion of the inner ear, referred to as the posterior semicircular canal.
Debris within this canal causes it to malfunction and leads to the sensation
of vertigo with changes in head position. When the patient steadies
him/herself the debris settles and the vertigo stops. However, a
recurrent rapid movement will cause this canal again to be stimulated by
the debris and a sensation of vertigo will return.
What
causes the debris to accumulate?
Nobody
knows what causes this debris to accumulate within the posterior canal.
Some patients will describe a history of a blow to the head or a viral
infection immediately prior to the onset of symptoms. Usually there
is no identified cause.
Who
is affected by BPPV?
BPPV
can affect men or women of all ages. It is uncommon in children.
The elderly may have more difficulty coping with the vertigo.
How
is BPPV Diagnosed?
BPPV
has a very characteristic pattern of severe episodes of vertigo triggered
by head motion in specific directions. Getting into or out of bed,
or rolling over in bed are common triggering motions. The vertigo
usually lasts for 30 seconds or less. During examination, your physician
will try to trigger the vertigo by placing the head through a strong triggering
motion. During the vertigo, a patient will have highly characteristic
eye movements easily observed by the physician. If the history and
findings on examination are typical, there is no need for further testing.
Is
there a treatment for BPPV?
Yes!
There is a very effective treatment for BPPV. While most people with
BPPV will improve without any treatment, it may take weeks or months.
The most effective treatment is called the Canalith Repositioning Maneuver
or the Epley Maneuver - named after Dr. John Epley who discovered it.
This maneuver is quickly and easily performed in the office. There
are no medications administered and no surgical procedures performed.
The basic maneuver requires placing the patient into the position that
stimulates the vertigo and then gently rolling them in an opposite direction
so that the debris will fall out of the posterior canal into an area where
it will no longer cause problems. A vibrating device may be placed
on the back of the ear to help in dislodging the debris. After the
maneuver we recommend that patient not lie flat for 48 hours, but rather
sleep in an easy chair or with their heads propped up on several pillows.
This maneuver is successful in over 90% of the cases and results in a near
immediate cure from the disorder. Occasionally the maneuver has to
be repeated if the BPPV is particularly persistent.
Once
treated, will the BPPV ever recur?
Symptoms
may occur months or years after the initial episode. Up to half of
patients with BPPV will have it again in the future, and there is no way
of predicting who will have a recurrence. However, the Epley Maneuver
can be used again if needed, and most patients can actually perform the
maneuver themselves at home. If this is unsuccessful the patient
should return to the clinic to ensure that there is no other cause of the
vertigo, and to be treated appropriately.
Is
there a role for medication in the treatment of BPPV?
The
common medications for vertigo sedate the part of the brain involved in
balance which is helpful in severe prolonged vertigo. The side effect
of drowsiness is very common. These medications are generally unhelpful
in BPPV. Occasionally such medication is helpful in severe cases
to enable the patient to tolerate dizziness during the Epley Maneuver.
Is
there a role for surgery in the treatment of BPPV?
Surgical
treatments for this disorder are available. However the vast majority of
patients with BPPV will not require surgery.
