Vertigo – the sensation of motion where the person or the person’s surroundings seem to spin and move – is, typically an unpleasant event. Feelings of vertigo can disrupt balance and lead to falls that can be serious in the elderly; it might also be coupled with sensations of spinning in space, dizziness, and more infrequently, nausea, vomiting, headaches, visual irregularities including nystagmus, and fainting.
Vertigo can have many root causes, but one of them is connected to hearing – benign paroxysmal positional vertigo, or BPPV. It arises as the result of calcium crystals that form naturally known as otoliths or otoconia, which generally cause no problems. In benign paroxysmal positional vertigo, the crystals migrate from their normal locations into the semicircular canals of the inner ear. When this happens, and the individual with BPPV changes the orientation of their head relative to gravity, these crystals move about, resulting in an abnormal displacement of endolymph fluid, which results in vertigo.
Everyday movements such as tilting your head, looking up and down or rolling over in bed can bring about the benign paroxysmal positional vertigo. The vertigo sensation comes on very quickly and has a short duration. Changes in barometric pressure, sleep disorders and stress can worsen the symptoms. The disorder can present itself at any age, but it typically appears in people over age 60. It is difficult to pinpoint the specific cause of BPPV for any given individual, however it generally develops following accidents in which the individual receives a blow to the head.
BPPV is differentiated from other types of vertigo or dizziness in that it is nearly always prompted by head movements, and in that its symptoms usually subside in under a minute. Physicians may diagnose it by having the affected individual lie on their back and then tilt their head to one side or over the edge of the exam table. There are more exacting tests that can be used to diagnose BPPV, such as videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, or magnetic resonance imaging (MRI), which is used principally to rule out other potential causes of the vertigo.
Benign paroxysmal positional vertigo is typically treated using a technique called canalith repositioning which guides the crystals to a position in the inner ear where there are less bothersome using a sequence of physical movements. Two forms of canalith repositioning that may be used are the Epley maneuver and the Semont maneuver. In some cases (under 10%), if these therapies don’t provide relief, surgery can be recommended. If you have encountered unexplained dizziness or vertigo that lasts for more than a week, see your doctor.