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What is Benign Paroxysmal Positional Vertigo (BPPV)?

What is Benign Paroxysmal Positional Vertigo (BPPV)?

by Dr Oystein Kasa 26/09/2018

Benign Paroxysmal Positional Vertigo (BPPV) is the most common condition leading to vertigo. BPPV is an accummulation of calcium crystals in the inner ear.

The inner ear is composed of the cochlea which is responsible for hearing, and the vestibular system which is responsible for sensing gravity and movement. The vestibular system has three “canals” on each side, sitting perpendicular to each other. The canals are filled with two layers of fluid and little sensors called “hair cells”. When the head is moved in certain directions, fluid moves around the canal and deflects the hair cells. This sends signals to the brain about direction of movement so that we can maintain equilibrium and balance.

If we dislodge material from nearby areas in the inner ear, they may get stuck inside or at the entry of the canal. This will disrupt the normal movement of fluid through the ear canal and may give a sense of rotation of yourself or the environment.

The canal that is oriented backwards is most often affected as it also sits lower and the particles are more prone to “fall” into it. The middle and front canal may also be affected, but this is less common.

When you look up, roll over in bed or move your head quickly, there is typically activity in the canals. If you have BPPV, this will often trigger symptoms of vertigo or dizziness. It may also give you problems with your balance or nausea.

Vertigo can be a very frightening experience. Luckily BPPV is easy to diagnose and treat for a trained clinician.

One of the test that are used is the Dix Hallpike test. the practitioner will put your head in certain positions to look for symptoms and also identify abnormal eye movements that are associated with BPPV. The characteristics of the associated eye movements will help aid in the diagnosis of the vertigo. If it is determined that there is a crystal deposit, the clinician may treat you right away with Eppleys maneuvre or similar. The procedure is non invasive, and it is simply turning the patient slowly around to guide the crystal back out of the involved canal.

Most often patients will get results very quickly with Eppley´s. Sometimes the procedure needs to be repeated a few times but rarely more than 2-4 times.

Many people suffer with attacks of vertigo from BPPV for years before the cause is detected. The Eppleys maneuvre is still effective, but it is recommended to follow up with some vestibular rehabilitation to get best possible result.