What is Benign Paroxysmal Positional Vertigo?
The name describes the condition. Benign indicates that the condition is not sinister, although for people suffering from this it can be extremely unpleasant. Paroxymsal means that the symptoms come in brief bursts or paroxysms. Positional refers to the symptoms only occurring in certain positions and Vertigo describes the type of dizziness typically experienced.
Most people with BPPV will feel brief episodes of spinning vertigo caused by certain movements, most typically lying in down in bed and rolling over in bed often rolling to one side only. Looking up ,bending over, looking under something, reversing the car, being at dentists or hairdressers may also provoke symptoms. Although usually felt as a spinning, some people feel like they are tilting or falling backwards or find it hard to describe the feeling. Around half of people will have a general feeling of dizziness between episodes which may be more profound after a flurry of attacks.
Is it common?
It is very common and is in fact the commonest diagnosis in those with vertigo. It is estimated that by the age of 70 years, around 30% will have had this on at least one occasion.
Why do you get it?
Often there is no specific cause. Although it is more common with increasing age, it can affect any age group. It is known to occur after head injuries, ear operations, prolonged bed rest and can occur after other types of injury to the balance system. It is more common in those who have migraine. It also appears to be more common in certain professions e.g plumbers and mechanics. It is more common in women.
How it it diagnosed?
The diagnosis is made by reproducing the symptoms and observing the movement of the eyes at the same time. This test is called the Dix-Hallpike test and is performed in clinic on your attendance. It can be quite unpleasant as it is designed to provoke the symptoms.
How is it treated?
Without treatment it will often settle by itself. In around 50% of those affected the symptoms have settled by three months, although it can recur months or years later.
Specific manouvres are used to treat this condition in order to reposition the crystals. There are several manouvres but the commonest, at least in the first instance, is the Epley manouvre. This is normally performed when you attend clinic and have the diagnosed confirmed. You can feel quite dizzy after the procedure and you should attend clinic with someone who can take you home afterwards. It is expected that on a single attendance, in the vast majority, the symptoms will cease (approx. 95%).
This can be performed at home (home Epley- better than 90% cure rate after one week) although it is better if, on the first occasion, you are treated by someone familiar with the techniques (video).
There is no drug treatment for this and medicines should not be prescribed routinely.
Operations are very rarely recommended as the other methods of treatment are so effective.
Does it work?
Epley manouvre is highly successful in resolving the situation. There are other treatments for the small number who do not settle with this. It is important to note that similar symptoms can occur in other rare conditions and if it does not settle readily then further investigation is required to ensure the diagnosis is correct.
Will it come back?
There is a chance that it will come back which may be as high as 50% over two years. However, the treatment is the same and is usually successful in resolving the issue.
More information- the following websites may be helpful
More detailed information from US Website by Dr T Chain
Manouvres to diagnose and treat BPPV
Further details- vestibular org
What causes BPPV?
The short answer is crystals in the ear that get stuck in the wrong place.
In the balance organ there is a central fluid filled chamber (utricle). Within this chamber there is a membrane attached to tiny hairs. This membrane responds to gravity but in order for it to do so it has to be heavier than the fluid - to make it heavy little crystals of chalk are embedded in it. At times these crystals can break off and float in the fluid. Provided they remain within the chamber they appear to cause little in the way of problems. However if they leave the leave the chamber they can cause issues. From the chamber there are three semicircular canals (or tubes) that are attached to the central chamber. Although they open into the central chamber at both ends, one end is blocked. If the crystals find themselves in one of these canals they can become trapped and when the head is put in a certain postitions they stimulate the balance organ within and cause the sympotms of vertigo. Treatment involves moving the head in such a way as to physically move the crystals back into the central chamber where they belong.
The posterior semicircular canal is the main culprit because of its orientation when upright.