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Benign Paroxysmal Positional Vertigo (BPPV)

 

Benign paroxysmal positional vertigo (BPPV) is a condition of the inner ear. It is a common cause of vertigo, especially in older people.

  • Benign means that it is due to a non-cancerous or serious cause.
  • Paroxysmal means 'recurring sudden episodes of symptoms'.
  • Positional means that the symptoms are triggered by certain positions. In the case of BPPV, it is certain positions of the head that trigger symptoms.
  • Vertigo is dizziness with a spinning sensation. If you have vertigo you feel as if the world is spinning around you, and you feel very unsteady. Often you will also feel sick, and may vomit.

Causes

  • Age
  • Ear injury
  • Ear infection
  • Octonia (calcium carbonate crystals )

It is thought that BPPV is caused by one or more tiny fragments called octonia that float about in the fluid of the labyrinth. The fragments are thought to have broken off from the inside lining of the vestibule (larger fluid filled chamber) part of the labyrinth. Problems occur if a fragment gets into one of the semicircular canals which sense movement of your head.

The posterior canal is the usual one affected. In this situation, when your head is still, the fragment 'sits' at the bottom of the posterior canal. But when the head moves in certain directions the fragment gets carried along with the flow of fluid.

The fragment brushes along the delicate hairs that line the semicircular canal and this bombards messages down the vestibular nerve.

The extra messages from the affected ear conflict with the normal messages from the other ear. The brain becomes very confused and 'reacts' to cause vertigo.
It is not clear why these solid fragments (octonia) form or drop off from the inner lining of the labyrinth.

Symptoms

  • Vertigo which may last for 10-20 seconds
  • Nausea which may last for an hour or so

In most cases, the symptoms clear away within several weeks or months. However, after the symptoms have gone, some people have recurrences of symptoms months or years later. In some cases, symptoms persist for years.

Treatment

  • The Epley manoeuvre: This often works if you have octonia at the bottom of your posterior semicircular canal (the common situation). This is done by a series of four movements of the head, and after each movement the head is held in the same place for 30 seconds or so.

The movements of the head basically cause the posterior semicircular canal to rotate around in such a way that gravity moves the octonia fragments out from the posterior canal and into the vestibule where they settle and cause no symptoms.
Following a successful Epley manoeuvre, allowing the octonia to settle in the vestibule, and to reduce the risk of them falling back into the posterior semicircular canal, the following are commonly advised:

  1. Do not lie flat for 48 hours. During this time sleep sitting in a chair.
  2. Do not lie on the affected side for one week.
  3. Ideally, try to avoid bending over (to tie shoelaces or such activities) for a week.
  • No treatment
    BPPV is a condition that often goes away on its own after several weeks or months without any treatment. The octonia are thought to either 'dissolve' or move to a place in the labyrinth where they cause no symptoms.
  • Surgery
    Surgery is rarely needed as in most cases the condition either improves by itself or can be cured by the Epley manoeuvre. Occasionally, symptoms persist for months or years and cannot be eased. An operation of the inner ear to take out the function of the posterior semicircular canal may then be an option.

Prevention
There is no known way of preventing BPPV.