What is Benign Paroxysmal Positional Vertigo?
Benign Paroxysmal Positional Vertigo (BPPV) is a very common condition. It causes brief episodes of a sensation of everything around you spinning which is called rotary vertigo. This happens when you put your head in certain positions. Typically this is when you lie down, turn over in bed, get out of bed, look up or down or under something. The spinning sensation usually lasts for only a few seconds and certainly less than a minute. Some people feel very sick (nauseated) during the spinning sensation and occasionally may vomit. Most people also feel unsteady on their feet as well.
BPPV rarely occurs in children and is most common in people over the age of forty. The incidence increases with age, eighty percent of the population get BPPV at least once in their lives.
What causes BPPV?
In the inner ear there are three semi-circular canals filled with a thick fluid. At the base of these canals there are some tiny calcium carbonate crystals. In people with BPPV some of these tiny crystals break off and float into one of the semi-circular canals. Movement of the head into certain positions causes the crystals and fluid to move.
This triggers an eye reflex movement called a nystagmus, which causes the spinning sensation (vertigo) and normally last a few seconds, though can seem longer. The spinning will stop but happens again when the head is moved into the positions mentioned earlier. BPPV occurs suddenly in many people but can follow a viral infection, a head injury or some other disorders of the inner ear. In some people the few floating crystals are soon absorbed by the body or return to their proper place and the condition therefore settles quickly without treatment. In others, the episodes of the spinning sensation are persistent causing disruption to their lifestyle.
What is the treatment for BPPV?
- Correct assessment and diagnosis
- Repositioning manoeuvre
- Self-management
The most common and very effective treatment for BPPV is a repositioning treatment (also known as an Epley manoeuvre). This moves the crystals out of the area in which they are causing symptoms. This involves putting you in the position that is causing the spinning sensation for up to thirty seconds, then turning your head, then rolling you onto your side and finally sitting up. There are other manoeuvres depending on the type and location of the BPPV. In about ninety percent of cases the condition is cleared up with just one manoeuvre but for some people it is necessary to repeat the manoeuvre or choose another form of treatment. After a repositioning treatment you will be given advice about what to do next.