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What BPPV can feel like.

What is BPPV or Benign Paroxysmal Positional Vertigo?

This is the most common form of vertigo. [1] It is a problem with your inner ear that is in charge of perceiving the position of your head. It sends the wrong signals to your brain. This will give you the feeling that the room is spinning when if fact there is no movement at all. The condition lasts about two weeks. [2]

It gets worse when you change position, or rotate your head. And it usually improves when you don’t move at all.

BPPV is an abbreviation for the following:

Benign: In first instance it is not necessarily caused by anything sinister nor would we suspect it would turn into anything sinister.

Paroxysmal: This means it comes and goes. Each episode usually lasts seconds to minutes. Though you may suffer these episodes over the period of many days or weeks. Rarely will these episodes last months.

Positional: it occurs when you change the position of your head. When you look down to tie your shoes, or move your head around to get out of bed.

Vertigo: this is the sensation that the room is spinning.

Let’s talk a bit about vertigo.

What is vertigo?

Vertigo is the symptom in which you feel that the room is spinning around you. Some people describe it as if the floor is moving, or the walls are moving. In BPPV this symptom lasts a few seconds and sometimes a few minutes.

Nausea and vomiting con often accompany the symptoms of vertigo, which make it more unpleasant. In BPPV specifically, it is uncommon to have earache, ear fullness or aural fullness, tinnitus or ringing in the ears, loss of hearing, or symptoms of infection.

If you would like to know more about how the inner ear works you can read about it here.

What causes BPPV?

BPPV is caused when crystals – that are usually well positioned in your inner ear – move to a place they don’t belong. These crystals will have an effect on other structures of the ear in charge of perceiving position of your head and balance, such as the semicircular canals.

These crystal particles are called otoconia or otoliths. For the purpose of this article we will call them otoconia.

It is not clear why these crystals change place, but it is well documented that it in the younger population it is usually after a head injury. On the other hand, in the middle aged and the elderly, these episodes can be spontaneous and it is thought they can be related to how our ears produce otoconia.

How does it feel to have BPPV?

People having a first episode of BPPV usually feel scared. They feel there is something wrong with their head and they are not sure what it is. Some of the younger patients that I have had usually present with these symptoms after suffering a head injury. They feel concerned that the injury may have caused brain damage to a degree.

Elderly patients are usually more concerned about having a stroke. They feel they can’t walk straight and need more support than usual.

Because of the mixed messages the ear is sending to the brain, it is not uncommon to feel a loss of balance, sickness and vomiting. These symptoms contribute to a feeling of frustration and low mood. The intensity may have a negative impact on your daily activities.

What are the symptoms of BPPV?

  • Vertigo: also described as room spinning. Episodes last seconds to minutes.
  • Nausea and/or Vomiting
  • Symptoms get worse when you tilt your head in any direction, and improve when sitting or laying still.

How do you diagnose BPPV?

Your doctor can diagnose this condition by taking the history of your symptoms and performing a series of balance and eye tests.

The Dix-Hallpike manoeuvre is commonly used to make the diagnosis. It was invented in the 1950s and to this date is used by most doctors. Your doctor will ask you to sit with your head turned in a certain direction and then swiftly lower your back to a laying position.

Unfortunately this manoeuvre can cause your symptoms to reappear because of the change in position of your head. But soon after it will improve.

The Dix-Hallpike manoeuvre is also important because it is the first step in also treating this condition. Once your doctor has lowered your back down to the bed, you will be directed to then turn onto your shoulder and then back to the sitting position.

There are a few manauvers to treat this condition like the Epley Manuver and Brandt-Daroff exercises .

How do you treat BPPV?

Medication is not the first line of treatment for BPPV. Other causes of vertigo respond well to medication. But for BPPV, the treatment is to get the otoconia, or particles in your ear, back to where they belong.

It is of key importance you are clear about how it is treated and you understand what to expect from your treatment. This is a conversation to have with your doctor or health professional [3]

The series of movements your doctor will guide you through are called particle repositioning manoeuvres. There are different types, some more effective than others. The best part is that you can continue to do these manoeuvres at home.

Some people find relief within the first few days. Others may take longer. [4]

Dix-Hallpike Manoeuvre

This is a diagnostic test, meant to be used to find out if you have BPPV in the first place. It is also the first step in treatment. Once you have the diagnosis your doctor will advise you on the following tests.

Epley Manoeuvre

This is done by the help of you doctor, but can often be carried out at home once you understand how it is done. It is a series of movements that last about 30 seconds to one minute in each position.

It starts with the patient sitting upright with their legs extended on the examination couch. Their head is rotated to one side, then the back is lowered with the head tilting back just over the edge. They are rolled on to one shoulder, and then back to the sitting position.

This manoeuvre can be repeated a few times each session, and may need to be performed over multiple sessions to be effective.

Brandt Daroff Exercises

For this exercise the patient sits on the edge of an examination couch or bed, with tier head at a 45 degree angle. Swiftly they will lay on their side with the head at the same angle. The patient will stay in this position for 30 to 60 seconds until the symptoms subside. The patient will then move back to the sitting position before completing the exercise on the opposite side.

Unlike the Epley Manoeuvre, the patient does not lay on their backs. This is easier to perform without the aid of a healthcare professional.

The exercise may repeated during several sets, with two or three repetitions of the same exercise. These sets can also be done over a few days.

Other Manoeuvres

There are other manoeuvres, but for the sake of simplicity let’s stick to the above which are safe and effective. [5]

Conclusion

BPPV is a the most common cause of vertigo. The condition is caused by particles in the inner ear that end up in the wrong place. When this happens they affect other structures in the ear and cause which causes them to send the wrong messages to the brain, causing the symptom of vertigo.

Treatment is usually done by manoeuvres that help reposition these particles. This is why mediation is not effective to treat this condition.

References

  1. Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2022 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
  2. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):710-5. doi: 10.1136/jnnp.2006.100420. Epub 2006 Nov 29. PMID: 17135456; PMCID: PMC2117684.
  3. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RW, Do BT, Voelker CC, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017 Mar;156(3_suppl):S1-S47. doi: 10.1177/0194599816689667. PMID: 28248609.
  4. Steenerson RL, Cronin GW. Comparison of the canalith repositioning procedure and vestibular habituation training in forty patients with benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1996 Jan;114(1):61-4. doi: 10.1016/S0194-59989670284-X. PMID: 8570252.
  5. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schuring LT, Steiner RW, Whitney SL, Haidari J; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008 Nov;139(5 Suppl 4):S47-81. doi: 10.1016/j.otohns.2008.08.022. PMID: 18973840.

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