Benign Paroxysmal Positional Vertigo - BPPV The Most Common Cause of Vertigo...and the most Easily Treated What is BPPV? Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. It is best characterized by true vertigo and geotropic rotary nystagmus that occurs for a few seconds after specific head movements, such as rolling over in bed, bending over, or looking up. The vertigo sometimes lasts no more than a minute, but can become longer lasting and even constant. Both the vertigo and nystagmus tend to lessen in severity with repetitions of the evoking movement. The symptoms are most often experienced when patients lie down, which distinguishes BPPV from orthostatic hypotension. Many people suffer with this type of vertigo for years (sometimes on and off, sometimes constant). This is needless suffering, as there exists a treatment that is 100% successful and the results are dramatic- usually only one treatment is necessary! Many people suffer needlessly for months, years and even decades. This is completely unnecessary, as this treatment takes less than 5 minutes to complete, and does not require any medication or surgery.
What is the cause of BPPV? Technically speaking, the cause of BPPV is the dislodging of otoconia (calcium particles) that are shed from the utricular macula (which responds to linear motion) and migrate to the posterior semi-circular canal (which responds to rotational motion). These loose otoconia stimulate the nerve endings in the balance canals and send a message to your brain that you are moving in a direction you really are not. Thus, when the otoconia particles have dislodged, they either settle into the sensory organ cupula of the posterior semi-circular canal (cupulolithiasis) or they may continue to free float within the endolymph of the posterior canal itself (canalithiasis). In either case, their presence sends misinformation about your position with respects to head movement, causing vertigo. Whiplash injury, falls, a severe cold or even high-impact exercises may accelerate this process. Individuals with prolonged inactivity, such as confinement to a bed, may also develop BPPV because of the settling of the otoconia particles Essentially, the semicircular canals located in the inner ear are like a ‘bubble level’, which contains fluid which measures location and angle relative to gravity. Your inner ear has a similar device, but becomes dysfunctional as the sensitive hairs that measure fluid level relative to gravity become dislodged and send aberrant signals (your body thinks it is on an uneven surface).
How is BPPV diagnosed? The diagnosis of BPPV is determined by a Chiropractor or other Physician through a clinical history. It is suspected in patients with a typical complaint of vertigo whenever the patient leans forward, sits up, or rolls over in bed. The diagnosis is confirmed by a positive response on the Dix-Hallpike maneuver, performed in office.
BPPV is not associated with any particular pattern of hearing loss.
How is BPPV treated? The Canalith Repositioning Procedure (CRP) (Epley Repositioning Maneuver) is the treatment of choice for patients with the classic signs of BPPV. Also known as the Epley maneuver, the patient is moved through several positions to slowly move the otoconia particles from the posterior semicircular canal back into the utricle. The entire CRP maneuver takes approximately 5 minutes. The patient is instructed to not bend down, look up or lay flat for 48 hours after the procedure. Two weeks after the CRP, the Dix-Hallpike test is repeated. Most patients are not symptomatic and the DixHallpike maneuver elicits neither nystagmus nor vertigo. If the patient does experience vertigo and nystagmus, then the CRP is repeated.
Safe, Easy and Effective Other than this post-procedure inconvenience (avoiding certain movements, sleeping upright at no less than 45 degrees for 48 hrs), there is minimal stress to the patient. For patients who fail to improve with CRP, the possibility of positional vertigo has been eliminated and the diagnosis of a concomitant vestibular problem must be considered. Because long-term follow up is not required, there is no medication, and perhaps only two restless nights from sitting upright, CRP offers the most effective and tolerable treatment for BPPV.
What are the results of the CRP technique? Following the first CRP procedure, more than 80% of patients no longer experience vertigo or nystagmus. Patients who do not respond to the first CRP and undergo a second or third procedure have an overall success rate of greater than 90%. Patients who fail after three attempts with CRP undergo further diagnostic evaluation with ENG in order to determine the cause of their vertigo.
Significance In addition to the direct suffering caused by this type of vertigo, it’s secondary affects can be equally devastating...if not more. Many people can experience loss of balance and subsequent falls, leading to what can be serious injuries, especially in the elderly.
Why hasn’t my Family Physician heard of this treatment, or this type of Vertigo? General Medical Practitioners typically do not receive sufficient training in the neuroanatomy of the vestibular apparatus. Furthermore, their approach is usually directed at the ‘symptoms’ of the vertigo, which is dizziness. Thus, in this model, there is no need to accurately diagnose the cause.