Dear Doctor Column, February 28, 2005
Benign Paroxysmal Positioning Vertigo: Common Cause of Dizziness is Treatable
Question:
What is benign paroxysmal vertigo? I was experiencing extreme dizziness and went to my doctor, who moved my head around and said I shouldn't have any more problems. This diagnosis was on my insurance form. Can you explain this to me?
Answer:
Benign paroxysmal repositioning vertigo (BPPV) is an inner ear problem resulting in short lasting, but severe, room-spinning vertigo. The recurrent attacks of vertigo last for less than a minute and are brought about by rapid head movement, such as looking up quickly, rolling over in bed, or bending over.
BPPV occurs when tiny particles of calcium carbonate crystals (canaliths), which help maintain your balance, break loose inside your inner ear and fall into the wrong part of your inner ear canals. When these particles shift, usually from head movements, they can stimulate sensors in your ear that produce episodes of vertigo.
There is no hearing loss or severe ringing associated with these attacks, which helps to distinguish BPPV from other inner ear conditions. Vertigo that is not triggered by head movements and persists for minutes, hours, or days is unlikely to be BPPV.
It is unclear what causes BPPV. However, the condition can occur after head trauma or a viral infection that affected the inner ear. But, because it becomes more common as people grow older, BPPV often is thought to be linked to aging.
Doctors can usually diagnose BPPV, based on your symptoms and a physical examination and medical history. BPPV is often diagnosed using the Dix-Hallpike Maneuver, which involves quickly laying a patient on his back with his neck extended and turning the patient's head to the left. The patient then sits up again and the procedure is repeated — this time turning the patient's head to the right. In both instances, the patient is evaluated for symptoms of vertigo or for nystagmus (involuntary cyclical movement of the eyeballs). Sometimes, additional tests may be ordered to rule out other, more serious conditions, such as stroke.
Fortunately, an effective treatment for BPPV now exists, consisting of a series of doctor-guided head exercises called the Epley Maneuver or canalith repositioning. The 5-minute treatment is easily performed in the doctor's office without medication. The basic maneuver requires placing the patient into the position that stimulates their vertigo; the doctor then gently rolls the patient in the opposite direction. The goal is to move loose particles in the ear to a place where they will not cause dizziness and can be reabsorbed into inner ear fluids. The procedure has been shown to be 90% successful. BPPV may recur after several months to years and the treatment can then be repeated.
BPPV is not a harmful condition, but can be a troubling problem. Thankfully, it usually can be treated or managed. Whenever experiencing dizziness or vertigo, see your doctor to determine the cause of your symptoms.