Benign Paroxysmal Positional Vertigo (BPPV), its Symptoms and Treatment

Overview

Most individuals have experienced dizziness at least once in their lives. It can be due to various reasons, including changes in blood pressure, exhaustion, and other underlying medical conditions. However, one of the common causes of dizziness is benign paroxysmal positional vertigo (BPPV). The disorder of the inner ear causes a sudden spinning sensation whenever a person moves their head. It is not a severe health condition. If it does not resolve on its own, a simple outpatient procedure can alleviate the symptoms.

The blog explains benign paroxysmal positional vertigo, its symptoms, causes, and various treatment options. 

What is benign paroxysmal positional vertigo?

As mentioned earlier, BPPV is a common disorder of the inner ear that results in the sudden onset of a spinning sensation. The condition develops when the crystals in the inner ear move to another part of the ear, disrupting transferring signals to the brain. In extremely rare cases, BPPV can develop in both ears. Changes in the position of the head, including tipping the crown forward or backwards or sitting up on the bed, may trigger brief episodes of dizziness. These episodes may vary from mild to intense.   

However, BPPV is not a sign of any severe issues. It may increase the risk of falling. BPPV typically disappears on its own, but doctors  provide effective treatment to eliminate the issue. It may take close to several weeks for BPPV to disappear. The condition is more common in women than in men.   

What are the symptoms of benign paroxysmal positional vertigo?

The symptoms can occur any time of the day, whenever a person changes the position of their head. Also, the symptoms may occur periodically and last for less than a minute. The most common symptom is dizziness which may lead to loss of balance and falls. The other symptoms may include the following:

• A sensation that the surrounding is spinning
• Nausea
• Vomiting
• Unsteadiness
• Light-headedness
• Vertigo
• Blurred vision
• Vomiting
• Dehydration, in severe cases
• Rapid and involuntary eye movement

When to seek medical help?

Dizziness is rarely a sign of a serious health condition. But if a person is experiencing recurrent, sudden, severe, prolonged, and unexplained vertigo and dizziness, a visit to a doctor is a must. People should also seek urgent medical attention if they experience any of the following:

• The onset of new, different, and severe headache
• Sudden fever
• Loss of vision or double vision
• Hearing loss
• Weakness in the leg
• Loss of consciousness
• Difficulty walking or frequent falls
• Numbness or tingling sensation
• Persistent fatigue
• Neck pain
• Prolonged episodes of vertigo or dizziness
• Sudden changes in mood 

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What are the causes of benign paroxysmal positional vertigo?

When calcium carbonate particles, known as otoconia, shift and get trapped in the semicircular canals, it leads to benign paroxysmal positional vertigo. Semicircular canals are inner ear structures that control balance. Typically, the otoconia are a crucial part of the utricle – a vestibular organ located near the semicircular canals. 

However, due to injury, age, or infection, the otoconia may loosen in the utricle. In such cases, with the change of head position, the otoconia roll around and push on the cilia – a tiny-like structure – present within the semicircular canals. The function of the cilia is to transmit information about balance to the brain. But when otoconia roll into the cilia, the transmission disrupts, causing vertigo.

What are the risk factors of benign paroxysmal positional vertigo?

Often, BBPV occurs in people aged 50 and above but can occur at any age. Older individuals develop this disorder as the parts of the inner ear show signs of wear and tear. It is more common in women than men. People with a head injury or other disorder of the balance organs in the ear are more susceptible to developing BPPV. Other risk factors include if a person:

• Lays their head in the same position for a prolonged time, for example, at a dentist or a hairdresser.
• Performs high-intensity aerobics
• Rides bike on rough terrains
• Meniere’s disease – a disorder of the inner ear
• Is hospitalised or on bed rest for an extended period
• Experiences a certain type of migraine. 

What are the complications of benign paroxysmal positional vertigo?

Fortunately, complications are rare in BBPV. The dizziness may make a person feel uncomfortable and unsteady, putting them at greater risk of falling. 

What are the treatment options for benign paroxysmal positional vertigo?

There are a variety of treatment options available to help patients with BPPV. They are as follows:

Epley’s Manoeuvre

Most doctors find Epley’s manoeuvre the most effective treatment for BPPV. It is a simple exercise that can be performed at home without any equipment. It involves tilting the head to dislodge the calcium carbonate crystal and moving these crystals to different parts of the inner ear. 

The following are the steps to relieve issues in the right ear:

• Begin by sitting on the edge of the bed
• Turn the head 45 degrees towards the right
• Lie back with the head turned, the shoulders should be on the pillow, and the head reclined. Wait for 30 seconds
• Next, turn the head 90 degrees to the left without lifting the head. Now, the head will be looking at 45 degrees to the left. Wait for 30 seconds
• Turn the head and body another 90 degrees to the left. Wait for 30 seconds
• Gradually, sit up on the left side

Brandt-Daroff Exercises

This is less effective than the Epley manoeuvre as it doesn’t remove the crystals but scatters any buildups. These exercises are known to reduce the symptoms of vertigo. An individual can perform these exercises as follows:

• Sit in an upright position on the edge of the bed
• Lie down on the left side of the bed. Slowly turn the head to the right, ensuring that the face is towards the ceiling
• Hold the position for 30 section
• Slowly sit and resume the starting position
• Repeat the exercise on the other side

Sometimes, a person may experience light-headedness or dizziness after completing one set of exercises. When this happens, waiting till the dizziness passes is crucial before standing up. People should not continue to perform this exercise if they experience any new symptoms.

• Home remedies: it is crucial to be aware of the surroundings and avoid being in a place where one may lose balance and fall. Falls may lead to severe injuries. Whenever a person experiences an episode of dizziness, immediately sit and wait for the dizziness to pass. It is also essential to learn the triggers of dizziness and avoid the same. 
• Medications:  The healthcare provider may prescribe medications to relieve the symptoms of BPPV. The medicines may include sedative-hypnotics or sleeping aids, anticholinergics – that block the neurotransmitter acetylcholine, and antihistamines. 
• Surgery: A patient may rarely need surgery. When the canalith procedure fails, in rare cases, the doctor may recommend a surgical procedure that uses a bone plug to block the portion of the inner ear, causing dizziness. The plug stops the semicircular canal from responding to a particular movement or head movement. The canal plugging surgery is successful nearly 90% of the time.

How can benign paroxysmal positional vertigo be prevented?

BPPV is not preventable. However, it is manageable with repositioning exercises. These exercises are mentioned above. People can prevent trauma-related BPPV by wearing protective headgear during biking, contact sports, or other activities.

Conclusion

BPPV does not mean a person is suffering from a severe health condition. It is uncomfortable, but with the proper treatment, it can be easily managed.