Benign paroxysmal positional vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.
Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.
Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.
The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:
The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of benign paroxysmal positional vertigo and other forms of vertigo can disappear for some time and then recur.
Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo. Although rare, it's possible to have BPPV in both ears (bilateral BPPV).
When to see a doctor
Seek emergency care
The signs and symptoms listed above may signal a more serious problem, such as stroke or a cardiac condition.
About half the time, doctors can't find a specific cause for BPPV.
When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back. BPPV also has been associated with migraines.
The ear's role
Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head's position related to gravity. These otolith organs — the utricle and saccule — contain crystals that make you sensitive to gravity.
For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you're lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy.
Inner ear and balance
Semicircular canals and otolith organs — the utricle and saccule — in your inner ear contain fluid and fine, hair-like sensors that help you keep your eye focused on a target when your ...
Benign paroxysmal positional vertigo occurs most often in people age 60 and older, but can occur at any age. Aside from aging, there are no definite factors that may increase your risk of benign paroxysmal positional vertigo. However, a head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.
Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. In rare cases, if severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration. The dizziness of BPPV can put you at greater risk of falling.
Preparing for your appointment
Make an appointment with your doctor if you have symptoms common to BPPV. After an initial examination, your doctor may refer you to an ear, nose and throat (ENT) specialist or a doctor who specializes in the brain and nervous system (neurologist).
Here's some information to help you get ready for your appointment.
What you can do
Questions to ask the doctor at the initial appointment include:
Questions to ask if you are referred to a specialist include:
Don't hesitate to ask any other questions.
What to expect from your doctor
Tests and diagnosis
Your doctor may do a series of tests to determine the cause of your dizziness. During a physical examination, your doctor will likely look for:
If the cause of your signs and symptoms is difficult to determine, your doctor may order additional testing, such as:
Treatments and drugs
To help relieve benign paroxysmal positional vertigo (BPPV), your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure.
After the procedure, you must avoid lying flat or placing the treated ear below shoulder level for the rest of that day. For the first night following the procedure, elevate your head on a few pillows when you sleep. This allows time for the particles floating in your labyrinth to settle into your vestibule and be resorbed by the fluids in your inner ear.
On the morning after your in-office procedure, your restrictions will be lifted and you'll begin self-care as directed by your doctor. Your doctor likely will have taught you how to perform the canalith repositioning procedure on yourself so that you can do it at home before returning to the office for a recheck.
The inner ear and canalith repositioning
Vertigo usually results from a problem with the nerves and structures of the balance mechanism in your inner ear (vestibular labyrinth). BPPV occurs when particles called otoconia break loose and ...
Lifestyle and home remedies
If you experience dizziness associated with benign paroxysmal positional vertigo (BPPV), consider these tips:
BPPV may recur even after successful therapy. Fortunately, although there's no cure, the condition can be managed with physical therapy and home treatments.
Coping and support
Living with benign paroxysmal positional vertigo (BPPV) can be challenging. It may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find encouragement and understanding in a support group.
Although support groups aren't for everyone, they can be good sources of information. Group members often know about unique coping skills and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.
Last Updated: 2012-07-10
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