Feeling Dizzy? Understanding what could be the cause of your Vertigo

I was sitting here trying to write a blog on Benign Paroxysmal Positional Vertigo (BPPV), breaking it down making it easy for everyone to understand what it is, how this could be the cause of their dizziness and vertigo and how they could treat it. I tried many time and just kept deleting what I wrote. Then I came along a beautifully written journal article that broke down this very complicated system. I decided to take this article and share it with all of you and give credit to the wonderful authors that took their time to explain what BPPV is.

The following information was taken from Plain Language Summary: Benign Paroxysmal

Positional Vertigo written by Neil Bhattacharyya et al. Published March 1, 2017.

What Is BPPV?

Benign paroxysmal positional vertigo, abbreviated BPPV, is the most common inner ear problem and cause of vertigo (vertigo is a false sense of spinning). It is more common in older people. Many of us will experience BPPV at some time in our lives.

BPPV is a specific diagnosis, and each word describes the condition:

• Benign (pronounce bi-NYN)—it is not life-threatening, even though the symptoms can be very intense and upsetting.

• Paroxysmal (pronounced par-ek-SIZZ-muhl)—it comes in sudden, short spells.

• Positional (pronounced puh-ZI-shun-uhl—certain head positions or movements can trigger a spell.

• Vertigo (pronounced VER-ti-goh)—feeling like you are spinning or the world around you is spinning.

What Causes BPPV?

Most cases of BPPV happen for no reason. Anyone can have episodes of BPPV, but it happens more often in seniors. It can sometimes be associated with trauma, migraine, other inner ear problems, diabetes, osteoporosis, and lying in bed for long periods of time (preferred sleep side, surgical procedures, illness). We have crystals of calcium carbonate in our inner ear that help us with our balance and body motion. These tiny rocklike crystals, or “otoconia” (oh-toe-CONE-ee-uh), are settled in the center “pouch” of our inner ear. BPPV is caused by the crystals becoming “unglued” from their normal place. As they float around, they can get stuck on sensors in the wrong part or wrong canal of the inner ear. BPPV symptoms are caused by the crystals being out of position. The most intense part of BPPV symptoms relate to how long it takes the crystals or sensors to settle down after you move or change your head or body position. As the crystals move and settle in your inner ear, your brain is getting these powerful (false) messages telling you that you are violently spinning when all you may have done is lie down or roll over in bed.

What Are the Common Symptoms of BPPV?

Everyone will experience BPPV differently, but there are common symptoms:

• Distinct triggered spells of vertigo or spinning sensations

• Nausea (sometimes vomiting)

• Severe feeling of disorientation in space or instability

These symptoms will be intense for seconds to minutes. You can have lasting feelings of dizziness and instability but at a lesser level, once the episode has passed. In some people, especially seniors, BPPV can seem more like an isolated feeling of instability that happens when changing body or head position. Sitting up, looking up, bending over, and reaching can trigger this feeling. BPPV does not cause constant severe dizziness and is usually triggered by movement. BPPV does not affect your hearing or cause you to faint. The dizziness episodes related to BPPV can increase your risk of falling.

How Is BPPV Diagnosed?

Health care providers diagnose BPPV through a physical examination and review of your medical history. Normal medical imaging, such as scans and x-rays, or medical laboratory testing cannot confirm BPPV. Your health care provider or examiner will complete simple bedside testing to help to confirm your diagnosis. The bedside testing requires the examiner to move your head into a position that makes the crystals move, and it will make you dizzy. The testing may include hanging your head a little off the edge of the bed or rolling your head left and right while lying in bed. The examiner will be watching you for a certain eye movement to confirm your diagnosis. The most common tests are called the Dix-Hallpike test and supine roll test.

What Treatments Are Available? Medications may be used for the relief of immediate distress, such as nausea, but not for BPPV itself. Most BPPV cases can be corrected with repositioning procedures that will be performed bedside by your provider. These treatments usually take only a few minutes to complete. They have high success rates (around 80%), although sometimes the treatment needs to be repeated a few times. Examples of these treatments are the Epley maneuver (Figure 1) and the Lempert 360° roll maneuver.

Figure 1. Depiction of the canalith repositioning maneuver (Epley maneuver) for right ear posterior semicircular canal benign paroxysmal positional vertigo. Adapted and reproduced with permission from Fife et al. © 2008 Barrow Neurological Institute, Phoenix, Arizona. These repositioning treatments (referred to as “maneuvers”) are designed to guide the crystals back to their original location in your inner ear. You may be treated during the same office visit when the diagnosis testing is performed. If you think you are suffering from BPPV book in today for an appointment or send me a message and we can discuss your symptoms and if I would be able to help you.