Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo, characterized by brief episodes of dizziness or a spinning sensation triggered by specific changes in head position. It occurs when tiny calcium carbonate crystals, called otoconia, become dislodged from their usual location in the utricle of the inner ear and move into the semicircular canals. These misplaced crystals interfere with the normal movement of fluid within the canals, sending false signals to the brain about the body’s position and balance. This leads to a sensation of spinning or imbalance, especially when turning over in bed, looking up, or bending down. Although BPPV can be alarming, it is typically not serious and can often be effectively treated with simple repositioning maneuvers. BPPV treatment usually focuses on these repositioning exercises to guide the crystals back to their correct location.
In many patients, the spinning starts suddenly without any apparent cause. This is called Primary BPPV. However, some conditions can increase the risk of BPPV like:
The incidence of BPPV increases with advancing age. A deficiency of Vitamin D also increases the risk of getting BPPV.
Though the episodes of spinning usually last for less than a minute, patients may feel unsteady or heavy headed.
Certain positional tests like the Dix-Hallpike and Supine Roll tests are performed, preferably under the guidance of VNG, to diagnose BPPV and identify the position of the displaced crystal. BPPV treatment typically follows the confirmation of diagnosis through these positional tests. BPPV may co-exist with other vestibular problems which cause dizziness like Vestibular neuritis, Meniere’s disease, Vestibular migraine, etc. Hence, a thorough vestibular evaluation is advised to ensure appropriate BPPV treatment is provided and to rule out other possible causes.
Repositioning Maneuvers:
BPPV is a mechanical disorder of the inner ear caused by displacement of calcium carbonate crystals. The BPPV treatment involves a repositioning of these crystals back to their original position in the utricle. Various repositioning maneuvers have been described for BPPV treatment. A few common maneuvers are highly effective in managing BPPV:
A correctly done maneuver can provide relief to most patients of BPPV.
After the repositioning maneuver, the patient is asked to come for a follow-up visit to make sure that all displaced crystals have been repositioned. Some patients may require additional maneuvers. Some patients experience dizziness after the treatment of BPPV which can be treated with Vestibular Rehabilitation.
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While BPPV cannot always be fully prevented, certain lifestyle changes and precautions may help reduce the risk of recurrence and improve overall balance health.
Tips to Prevent Recurrence:
Manage Underlying Health Conditions:
Certain conditions like osteoporosis, migraine disorders, or chronic ear infections have been associated with an increased risk of BPPV. Addressing and managing these underlying factors can potentially reduce the chances of recurrence.
Canalith repositioning maneuvers can be safely performed by many individuals with benign paroxysmal positional vertigo (BPPV), so long as they are educated on the procedure before proceeding to perform it at home. When used appropriately, these exercises are simple, carry relatively low risk, and may hasten the resolution of symptoms.
With that said, home treatment cannot substitute professional examination in some instances. When vertigo is disproportionately acute, recurrent, or features with neurological manifestations, such as imbalance, speech impairment, or visual impairment, then it is necessary to consult a doctor. A physician is able to diagnose whether the dizziness is caused by BPPV or some other disease.
One of the most widely recommended exercises to perform on BPPV, more particularly when the right ear is involved, is the Epley maneuver. It is aimed at repositioning loose calcium crystals present in the semicircular canals to a more stable area inside the inner ear that no longer causes vertigo.
Steps:
This maneuver can be done two to three times a day until the symptoms disappear or as instructed by your healthcare provider.
In many cases, relief of vertigo may be achieved only in one or two sessions of repositioning. Others might need repetitive exercises in a number of days or weeks, before they can feel better. Your doctor may prescribe follow-up exercises, vestibular rehabilitation therapy, or periodic check-ups to lower the chances of recurrence even after the symptoms have improved.
Older adults are more likely to be affected by BPPV; repositioning maneuvers are generally safe and effective in patients. Caution is however required when used with pre-existing conditions of severe arthritis, spine problems or vascular disease as some movements of the head and neck may not be well received by patients. In this instance, adjustments to the maneuvers or controlled therapy within a clinical facility can be more suitable. Do not try to treat other illnesses at home without first consulting with a medical practitioner.
BPPV may reoccur despite successful treatment, but some lifestyle interventions and exercises can be used to reduce the rate of episodes:
BPPV is not life threatening in itself but it is important to differentiate between it and other conditions which may exhibit dizziness. Attend to the doctor as soon as possible when vertigo is accompanied by any of the following:
These signs could be evidence of a neurological crisis like stroke and need immediate assessment.
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