What is BPPV?
BPPV stands for benign paroxysmal positional vertigo. It is one of the most common causes of dizziness, typified by bouts of spinning brought on by changes in posture. Some actions that can bring on an attack include turning in bed or reaching up to a shelf. The resulting bouts of vertigo usually settle down within seconds or minutes. However, the vertigo attack can leave you with a feeling of imbalance (rather than spinning) which may persist for several hours.
What causes BPPV?
BPPV is due to a disorder of a part of the inner ear called the semi-circular canals. These are c-shaped, fluid-filled tubes containing tiny calcium crystals called otoconia. When we move our head, the corresponding movement of otoconia within the semi-circular canals tells us what our head position is. In BPPV, otoconia become dislodged from their usual position and float freely in the canal. When this happens, position changes cause the crystals to send an incorrect signal, which produces short periods of dizziness.
Otoconia can become dislodged due to head trauma and sometimes jolting actions, for example, vigorous aerobics, violent coughing, and even golf. Medical conditions such as migraine, osteoporosis, and vitamin D deficiency could make you more prone to BPPV.
How do we diagnose BPPV?
We usually suspect the diagnosis from the patient’s description of their symptoms. We subsequently confirm the diagnosis by performing the Dix-Hallpike maneuver and supine roll test. During the maneuvers a beating type of eye movement known as nystagmus occurs specific head positions. This allows us to identify the affected semi-circular canal.
How do you treat BPPV?
We treat BPPV using the canalith repositioning procedure. During the procedure we place the patient in different positions over several minutes. This is so that the displaced crystals float back to their proper position in the semi-circular canal system. There are different versions of canalith repositioning, such as the Epley, and Semont, and Gans manoeuvres. They are all safe maneuvers and effective about 80% of the time.
Most patients have improvement or resolution of symptoms with one treatment, although some patients require more than one or two canalith repositioning treatments.
If left untreated, the displaced crystals may eventually settle and symptoms resolve. Despite this, it is symptoms often recur if the condition is not properly treated.
Does the canalith repositioning manouver have risks?
Canalith repositioning is a safe treatment. However it can cause nausea up to 30% of the time, which can be severe. Furthermore some patients may not be able to tolerate the maneuvers because of cervical spine (neck) problems.
Will vertigo come back after canalith repositioning, and how can I prevent this?
There is a high recurrence rate of BPPV even after treatment (it can be over 30%). Although head position restrictions after the procedure have not been shown to reduce recurrence rates, it is sensible to avoid the following:
(a) actions that may provoke recurrent symptoms. These include bending over or looking up suddenly, and might include actions such as bending your head back suddenly to put in eye drops, bending forward to tie a shoe lace, or possibly even going to the dentist or hairdresser, when this involves bending the head back.
(b) situations that may create danger such as when walking downstairs, and driving in the immediate post-repositioning period.
Several risk factors make BPPV more likely to recur. For instance high blood pressure, diabetes, high cholesterol, osteoporosis, vitamin D deficiency, advanced age, and migraine. Following menopause, women may need to be checked for osteoporosis, vitamin D deficiency, and thyroid dysfunction. Treating these conditions can reduce the possibility of BPPV recurring.
It is common to experience some residual sensation of rocking, swaying or mild dizziness for several days after the repositioning procedure. Non-drowsy medications may be prescribed to help with this.
Can I do canalith repositioning on my own?
You can treat yourself if you make the correct diagnosis, and can perform the canalith repositioning maneuver properly.
The affected semi-circular canal is usually the posterior semi-circular canal on the same side as which the dizziness occurs.
However, if you perform the repositioning incorrectly or for the wrong semi-circular canal, the crystals can become sidetracked into another semi-circular canal, resulting in worsening vertigo.
If you’ve not been diagnosed previously, it is best to get diagnosed and treated professionally. In some cases of recurrent BPPV, it is possible to learn how to do the maneuver at home, when you become more confident with managing the condition.
References