Benign Paroxysmal Positional Vertigo (BPPV) tends to be the commonest form of dizziness seen in patients over the age of 60. It is more frequently seen in women than men.
Patients often describe the dizziness as a spinning sensation which occurs in specific situations. These situations tend to be one or more of the following:
- Rolling over in bed – usually to a particular side
- Getting into or out of bed
- Looking up when decorating, getting something from a high shelf etc.
Dizzy episodes usually last from a few seconds to a few minutes. Patients can often carry on as normal afterwards, but for some they leave behind a feeling of nausea or tiredness.
Patients tend to find that episodes may occur several times a day (or night) for weeks at a time before resolving without treatment. Unfortunately the clusters of attacks can occur again a few weeks or months later. For an unlucky few the episodes never settle and require active treatment in order to get relief
Most patients learn to cope with symptoms by avoiding the positions that cause the problem. Although this may be effective some of the time, usually the problem position occurs eventually and tends to produce even worse dizziness than originally experienced.
No hearing loss or ringing in the ears is associated with this condition. Its official title is Benign Paroxysmal Positional Vertigo (BPPV).
Patients may have a history of one or more of the following:
- Previous head trauma
- A severe episode of dizziness lasting days
Some patients however get this condition spontaneously for no obvious reason.
Cause of BPPV
Within the inner ear balance organs are small crystals tethered to the balance organ membranes. If these crystals break free they can roll around until they fall into a passage leading to an area called The Posterior Semicircular Canal. This structure is designed to tell the brain when the head is turning in a particular direction. Although it normally does this very well, when crystals are rolling around in it, the result is abnormal messages sent to the brain leading to a feeling of spinning dizziness. Sometimes the crystals find their own way out of the canal or are absorbed within the inner ear. On these occasions the dizzy episodes settle without treatment.
Treatment of ongoing BPPV
After taking a full history and establishing a diagnosis with an investigation called a Dix Hallpike test (designed to replicate the dizzy symptoms), a balance specialist is usually able to fix the problem by a series of head manoeuvres that reposition the crystals in the correct area. Although this tends to fix the problem in up to 80% of patients it is sometimes necessary to repeat it in a few weeks. There are a number of head manoeuvres designed to treat BPPV. The commonest are The Epley Manoeuvre, and the Semont Manoeuvre. In a small percentage of patients these manoeuvres can cause unwanted balance problems. The symptoms are quickly recognized by Balance Specialists and immediately dealt with but are often missed by the inexperienced, leading to a worse predicament for patients. For this reason it is inadvisable for patients to perform these manoeuvres on themselves or on family members they feel may have this condition.
After successful treatment for BPPV, patients are warned to expect a slight imbalance for up to two weeks as the balance organs reset themselves.