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Benign Paroxysmal Positional Vertigo

(BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)

Pronounced: Ba-nine Par-ox-see-mal Positional Ver-ta-go

Definition

Vertigo is a feeling of movement or spinning when you are still. Benign paroxysmal positional vertigo (BPPV) happens when the vertigo is caused by changes in the position of the head. This might include standing after bending down, turning the head in bed, or extending the neck to look up. People with BPPV can often identify which moves cause the most problems.

Causes    TOP

The inner ear contains tiny crystals. These crystals can sense movement and help you keep your balance. BPPV occurs because of a shift in location of these crystals or the clumping of these crystals. When this happens, your brain gets signals that you are moving when you are really not moving. This causes the feeling of movement.

Inner Ear

Inner ear deposits
The clump of ear crystals can lead to BPPV.
Copyright © Nucleus Medical Media, Inc.

In some cases, the cause of BPPV is unknown. In others, it may be caused by:

  • Head injury
  • Viral infection
  • Disorders of the inner ear
  • Prolonged immobility of the head
  • Age-related changes to inner ear

Risk Factors    TOP

Increasing age increases your chances of getting BPPV.

Symptoms    TOP

Symptoms may include:

  • Sensation of spinning or rotation when you change head position that last less than one minute
  • Loss of balance
  • Nausea
  • Vomiting
  • Ringing or buzzing sounds in the ear
  • Vision or hearing problems

Diagnosis    TOP

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Part of the process will be to eliminate other disorders. Your doctor may recommend tests to help determine the cause of vertigo symptoms. Tests may include:

  • Blood pressure test, both lying down and standing up
  • Blood tests
  • Auditory tests
  • Vision tests
  • Dix-Hallpike maneuver—moving your head or body in certain ways to test response
  • MRI scan
  • Electronystagmography (ENG)

Treatment    TOP

Many times BPPV can resolve on its own, usually within months of onset. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Vestibular Rehabilitation

Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.

Canalith Repositioning

This procedure (also called the Epley maneuver) is done in your doctor’s office. Your doctor will move your head in different positions to try to resettle the tiny crystals. The procedure is sometimes repeated and you may be taught how to do it at home.

Surgery    TOP

Some people with BPPV undergo surgery. During surgery, a piece of wax may be used to plug one area of your ear. This will prevent fluid in your inner ear from moving. Another type of surgery that may be done involves cutting the nerve from the inner ear.

Prevention    TOP

There are no current guidelines to prevent BPPV.

RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org/content/patient-health
Family Doctor—American Academy of Family Physicians Family Doctor
http://familydoctor.org

CANADIAN RESOURCES:

Canadian Academy of Audiology
http://www.canadianaudiology.ca
Canadian Society of Otolaryngology
http://www.entcanada.org

References:

Benign paroxysmal positional vertigo (BPPV). American Academy of Family Physicians Family Doctor website. Available at:
...(Click grey area to select URL)
Updated July 2010. Accessed April 25, 2013.
Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated March 10, 2016. Accessed September 29, 2016.
Benign paroxysmal positional vertigo. The Merck Manual Professional Edition website. Available at:
...(Click grey area to select URL)
Updated November 2012. Accessed April 25, 2013.
Benign paroxysmal positional vertigo (BPPV). Vestibular Disorders Association website. Available at: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo. Accessed April 25, 2013.
Post RE, Dickerson LM. Dizziness: A diagnostic approach. Am Fam Physician. 2010;82(4):369.
9/10/2014 DynaMed's Systematic Literature Surveillance. http://www.dynamed...: University of Texas at Austin School of Nursing, Family Practitioner Program. Evaluation of vertigo in the adult patient. Austin (Tx): University of Texas at Austin, School of Nursing; 2014 May. 19 p. Available at:
...(Click grey area to select URL)
Accessed September 10, 2014.
Last reviewed March 2017 by EBSCO Medical Review BoardRimas Lukas, MD
Last Updated: 9/10/2014

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