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Benign paroxysmal positional vertigo (BPPV) is a disease of the vestibular system of your inner ear. When you change your head position, it causes vertigo. Vertigo is a feeling that the room is spinning around you.
Your vestibular system helps sense motion and changes in space. It contributes to your sense of balance. The vestibular organs are inside the innermost part of your ear. They include the utricle, saccule, and three semicircular canals. When your head moves, these small organs send this information to the brain.
The utricle contains small calcium crystals. These aid in the perception of motion. Sometimes, these crystals detach from the utricle and land in one of the semicircular canals. When this happens, the canals may send the wrong signals to the brain, especially when the crystals move. This confuses the brain and leads to the symptoms of BPPV.
The condition is called “benign” because it is not life-threatening. It does not get worse with time. “Paroxysmal” refers to the fact that the vertigo comes and goes. “Positional” just means that symptoms come from a change in head position.
BPPV is fairly common, especially in women. Older adults have it more often. However, people of any age can get it. It is one of the most common disorders of the vestibular system.
Anything that dislodges the crystals from the utricle can cause BPPV. Prior head injury is a major cause. Other times, BPPV may result from other problems with the vestibular system. These can include Meniere disease or vestibular neuritis. Ear surgery is a less common cause. Most of the time, no one knows exactly what causes BPPV.
People with certain health conditions may have a higher risk for BPPV but many times the cause is unknown. You may have a higher risk of developing BPPV if you have any of these:
It’s not clear whether treating these conditions might lessen your risk for BPPV.
The most common symptoms of BPPV include:
Specific types of movement can bring on symptoms. Symptoms then usually last a minute or less. Common triggers are rolling over in bed, or looking up while standing. These symptoms can vary in how often they happen and how severe they are. In some people, these symptoms are so severe that they disrupt personal and work life.
Very commonly, the symptoms go away and then come back weeks or months later. Without treatment, symptoms might continue for a few weeks before going away. In a small number of people, the symptoms never come back after the first episode.
Unlike some other causes of vertigo, BPPV does not cause neurological symptoms. These include severe headache, speech difficulties, or loss of limb movement. It also does not cause hearing problems.
The symptoms of BPPV may seem like those of other health conditions. Always see your doctor for a diagnosis.
BPPV may be diagnosed and treated by your primary healthcare provider or an ear, nose, and throat doctor (otolaryngologist). Or it may be diagnosed and treated by a neurologist. The healthcare provider will ask about your medical history. You may also have a physical exam. This may include hearing and balance tests. It will also include an exam of the nervous and cardiovascular systems. Problems with these systems can also cause vertigo.
As part of the exam, your healthcare provider may have you do certain movements. These will include moving your head and body in certain ways. If you have BPPV, this test can bring on vertigo. It can also bring on quick, involuntary eye movements (nystagmus). Your healthcare provider can also use this test to find which semicircular canal is most likely affected.
If your healthcare provider is still not sure about the diagnosis, you may need other tests. A test called an electronystagmograph might help. This test shows if your vertigo is due to another sort of problem with your vestibular system. An imaging test, such as an MRI, can help rule out nervous system problems as a cause.
Your provider will figure out the best treatment based on:
First, your healthcare provider may attempt to move the calcium crystals out of your semicircular canals. This may be done with a series of certain head and neck movements. This usually takes around 15 minutes. Your healthcare provider may tell you to do certain movements at home. This treatment is often successful. Some people may still have vertigo with head movement for a few weeks.
Medicines are not usually given for BPPV. This is because most of them do not help. In some cases, short-term use of motion sickness medicines may help to ease nausea.
If these other treatments fail, in rare cases your healthcare provider may advise surgery. One option is called posterior canal plugging. It blocks the movement of calcium crystals in the posterior semicircular canal. The surgery can work well. But in rare cases, it can cause some hearing loss.
Your healthcare provider may also advise a watch-and-wait approach to your BPPV before trying surgery. BPPV does often go away on its own over time. In many cases, however, it does come back. If you are still having symptoms from BPPV, your healthcare provider may tell you how to avoid symptoms. For example:
Even if you stop having symptoms, your healthcare provider may suggest that you follow similar instructions, at least for a few weeks. This may help prevent your symptoms from coming back.
BPPV is a disease that affects the vestibular system of the inner ear. With changes of head position, it causes sudden vertigo and related symptoms.
Tips to help you get the most from a visit to your healthcare provider:
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