BPPV - BENIGN PAROXYSMAL POSITIONAL VERTIGO

 

BPPV can sometimes occur following a bout of viral Labyrinthitis, which is exactly what we experienced. 

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Signs and symptoms.

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Usually BPPV is characterised by short and very intense bursts of vertigo that are related to certain positions. Quite often people will experience vertigo when they lie down, turn over in bed, rise from bed, lean forward or look up. Generally the vertigo is brief - lasting under a minute and is often accompanied by nausea and a classic nystagmus (eye movements).

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What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular (inner ear) disorder in which patients typically report attacks of vertigo with position changes. The exact cause of BPPV is still not completely understood. Although some controversy exists, the most widely excepted theory is that BPPV is caused by otoconia (calcium particles) that are shed from the utricular macula (which responds to linear motion) migrating to the posterior semi-circular canal (which responds to rotational motion).

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When the otoconia particles have dislodged, they either may 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 alters the dynamic response of the posterior semi-circular canal to head movement, causing vertigo.

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This may occur for several reasons e.g. whiplash injury, falls, head injury, even high-impact exercises and sometimes as a consequence of viral Labyrinthitis. In certain cases people who have had prolonged periods of inactivity, such as confinement to a bed, may also develop BPPV because of the settling of the otoconia particles.

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Getting BPPV diagnosed

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The diagnosis of BPPV is determined by a clinical history. Most people have a typical complaint of vertigo whenever leaning forward, getting up form bed and rolling over in bed.  The diagnosis is confirmed by a positive response on the Dix-Hallpike maneouver.

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Treatment

 

BPPV can have a very intermittent pattern with full resolution of symptoms for many months, even years at a time. For some, no treatment is required whilst others have more persistent symptoms that require treatment.

 

BPPV is generally treated by a physical maneouver called the Epley. The Epley is designed to reposition the particles away from the cupula into a less sensitive area of the inner ear.

 

This procedure takes around ten minutes and is always carried out in either a doctor’s surgery or hospital by a qualified practitioner.

 

Some practitioners may advocate a gentler approach to the Epley and may prescribe a course of home exercises that replicate the Epley but usually take longer to be effective.

 

Very rarely surgery is advocated when other treatments have failed and the patient is still highly symptomatic.