Benign Paroxysmal Positional Vertigo

Are you suffering from dizziness, vertigo, or imbalance? BPPV (benign paroxysmal positional vertigo) is the most common cause of vertigo in adults.

BPPV is characterized by brief episodes of a spinning sensation when the head is moved into certain positions. Lying down, rolling over, looking up, or bending over can provoke spinning. This may occur with normal activities such as: washing hair, getting in and out of bed, and lying back in the dentist or hairdresser chair. In addition, you may experience nausea, vomiting, lightheadedness, or a feeling of floating.

Symptoms can vary from mild to very debilitating. In more severe cases you may be unable to drive or go to work. Commonly it can make you feel unsteady or fall.

The cause of BPPV is the displacement of calcium carbonate crystals in the inner ear. When those crystals move into the semicircular canals, they stimulate cells which transmit information to the brain, making you feel like you are moving. See the diagram below.

A test for BPPV, the Dix-hallpike, is very simple and quick. It involves turning your head to one side lying back with your head extended. If crystals are present on that side, symptoms will be provoked.

After the symptoms settle (usually within one minute) a therapist can proceed with the treatment called the Epley Maneuver (see diagram below). It involves a series of movements each followed by a 30 second pause, to allow gravity to move the crystals out of semicircular canal and back into their proper place. The entire process takes just minutes, it is non-invasive, safe and effective with one treatment - in over 95% of cases! It is important to treat quickly and avoid disruption of your normal activities. If this is left untreated it could lead to falls and immobility.

Key Points from the Clinical Practice Guideline Article on BPPV:

Benign Paroxysmal Positional Vertigo (BPPV) is the single most common form of vertigo. (10-64/100,000 population). Classically, patients have a room spin, brief in duration, and provoked by bending over, looking up, or getting in or out of bed.

Approximately $2,000 per dizzy patient is spent to diagnose of BPPV.

This spending is a burden on the healthcare system and on our patients. So much of this could be avoided by a simple quick clinical test known as the Dix- Hallpike. If this test was performed first on patients suspected of vertigo it would save money and precious time for our patients. Often, time and money is wasted on unnecessary diagnostic tests, and multiple specialist referrals.

Diagnostic imaging has not been shown to be useful for diagnosis of BPPV

Vestibular suppressants are not recommended for BPPV (Antihistamines or Benzodiazepines) Other than for the short-term management of nausea or vomiting. There are harmful side effects of these medications. (Drowsiness, falls, impaired cognition etc). Use cautiously.

Canalith repositioning maneuvers show good evidence as an initial therapy option for BPPV. They have been found to be 96% effective in one to three sessions.

BPPV can severely impact a patient’s quality of life. This can cause patients to miss work and not be able to do their normal activities.

Balance can be impaired with BPPV. It is important that these patients are screened for balance and fall risk by a vestibular specialist.

Article Reference: Bhattacharyya N, Baugh R, Orvidas L, et al. Clinical practice guideline: benign paroxysmal posi-tional vertigo. Otolaryngol Head Neck Surg. 2008:139: S47 – S81.

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