Benign Positional Vertigo and how to handle it

Are you feeling sudden dizziness on waking up from your sleep? You may be a victim of benign paroxysmal positional vertigo (BPPV). This is one of the most common forms of vertigo where you feel your head is spinning from the inside. This can occur when the positioning of the head varies according to different postures, such as lying flat on the bed and quickly sitting or standing up. Although it is rarely serious, it can be bothersome and a reason for falls when you lose focus.

An ENT doctor can accurately diagnose if you have this condition as generally it may be due to fragmentation of inner ear crystals. For an effective remedy for this condition, it is important to seek medical advice as it is a high risk factor for falls which the elderly should worry about. If you are in Singapore, the ENT Clinic, offers comprehensive, patient-friendly care for the elderly with a broad range of treatment options to choose from, for all your ear, nose and throat maladies.

It is important to have an ENT specialist for diagnosis and treatment of BPPV. Vertigo can reduce your quality of life and hinder daily activities. To understand this condition in more detail, it is important to know the symptoms and the causes.

What are the signs and symptoms of BPPV?

The below symptoms are triggered by positional changes of the head with respect to gravity.

  • Mild to severe dizziness
  • Spinning sensation of the surrounding
  • Unsteadiness and loss of balance
  • Nausea and vomiting

Severe episodes can hinder daily functioning. Minor symptoms lasting for a few seconds can come and go. In some individuals there could be abnormal rhythmic eye movements. It is important to seek medical advice as dizziness may be a sign of some other serious underlying condition. If vertigo is coupled with blackouts, double vision, fever, headache, or loss of hearing, then you need immediate attention by a doctor. Dizziness with limb weakness, loss of consciousness, numbness and sense of falling should be seen at the emergency care.

What are the causes of BPPV?

Most cases of BPPV are idiopathic in nature and may probably be due to degeneration of the macula, or the central area of the retina.  It could also be due to secondary causes like head injury or inner ear damage or long periods of lying on your back.

The ear has a role to play in BPPV. The ears help in maintaining body balance and have semicircular canals and hairlike sensors which monitor the head’s rotation. Apart from this the ear has otolith organs which have bio crystals called otoconia, that are sensitive to gravity, helping to monitor the movement of the head. These crystals can dislodge for various reasons. Mechanical force exerted on the inner ear is one reason. When the crystals dislodge they could move into semi-circular canals causing the head to become sensitive to positional changes. Inner ear disorders like vestibular neuritis and Meniere’s disease can cause the degradation and dissociation of otoconia.

How is BPPV diagnosed?

Your otolaryngologist will take a detailed clinical history. This is important as it helps to differentiate the main complaint from other forms of vertigo like pre-syncope and disequilibrium. Conditions like Meniere’s disease and migraine should also be ruled out.

Your ENT doctor will perform a Dix-Hallpike manoeuvre where the doctor will position your head at a certain angle and rapidly move you to the supine position with the neck in extension. During this test the ENT doctor will check for any abnormal eye movements and inquire from you if you feel a spinning sensation.

Some of the other diagnostic methods include:

  • Caloric stimulation of the ear where the inner ear is cooled or warmed to observe eye movements.
  • CT scan of head
  • MRI of the head
  • Magnetic resonance angiography
  • ENG to detect eye movement
  • EEG of brain
  • Hearing evaluation

How is BPPV treated?

There is a range of conservative treatment options to treat BPV. Epley’s maneuver is a simple, yet effective treatment for this condition where the head is tilted helping the otolith crystals to move from the dislodged semicircular canals. Most patients find an immediate relief following the manoeuvring process.

Steps to consider at home when having BPPV

As BPPV is associated with dizziness, it is important to keep yourself safe and prevent yourself from falling over. Losing balance can lead to falls which can cause serious injuries. Being aware of your surroundings is important. Whenever you have vertigo, remember to be seated to prevent yourself from falling over. It is important to have your home well-lit and keep sharp objects away from walking areas. A walking stick might come in handy.

One needs to be aware of what triggers the BPPV episodes. It could be simply avoiding certain positions which might trigger BPPV.

Are there medications for BPPV?

After a close review, your ENT doctor will prescribe medications to relieve the sensation of spinning. This can include antihistamines, sedative hypnotics and anticholinergics which block acetylcholine a neurotransmitter.

Is surgery needed for BPPV?

BPPV is mostly managed conservatively by ENT physicians as it is a benign disease. However, in less than 1 % of the cases, surgical intervention may be done if there is recurrent BPPV condition disturbing the quality of life in patients with intractable posterior canal BPPV. Your ENT doctor will rule out that BPPV is not due to any other secondary causes and perform audiometry, since hearing loss from inner ear surgery is a possibility. CT and MRI is done prior to surgical planning.

Can BPPV cause complications?

This condition is generally benign, but if there is double vision, weakness and slurred speech then medical attention is needed.

BPPV can be challenging to live with. One may have to undergo BPPV episodes without any warning. An experienced doctor will be able to manage the condition and improve your quality of life with tips and a treatment plan to overcome this condition. The ENT Clinic with its experienced physicians and modern diagnostic methods is an  ideal place to visit if you are going through any of the above mentioned symptoms.

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Christophe Rude

Christophe Rude

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