BENIGN PAROXYSMAL POSITIONAL VERTIGO

In Benign Paroxysmal Positional Vertigo (BPPV), dizziness is generally thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as, “ear rocks”, although the formal name is, “otoconia”. Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the utricle and the cupula. While the saccule also contains otoconia, they are not able to migrate into the canal system. The utricle or the cupula may have been damaged by head injury, infection, chemical changes, or other disorder of the inner ear, or may have degenerated because of advanced age. Normally otoconia appear to have a slow turnover. They are probably dissolved naturally as well as actively reabsorbed by the “dark cells” of the labyrinth, another portion of the complex inner ear, which is found adjacent to the utricle and the crista, although this idea is not final and accepted by all ear specialists.

BPPV is a common cause of dizziness. About 20% of all dizziness is due to BPPV. While BPPV can occur in children, the older you are, the more likely it is that your dizziness is due to BPPV. About 50% of all dizziness in older people is due to BPPV. In one study, 9% of a group of active elderly people were found to have undiagnosed BPPV.

The symptoms of BPPV include dizziness or vertigo, imbalance, and nausea. Activities which bring on symptoms will vary among persons, but symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common “problem” motions. Because people with BPPV often feel dizzy and unsteady when they tip their heads back to loop up, sometimes BPPV is called “top shelf vertigo”. Women with BPPV may find that the use of shampoo bowls in beauty parlors bring on symptoms. A Yoga posture called the “downward dog,” or Pilates are sometimes the trigger. An “on-again, off-again” patter is also common. BPPV may be present for a few weeks, then stop, then come back again weeks or months later.

WHAT CAUSES BPPV?

The most common cause of BPPV in people under the age of 50 is a head injury. The head injury doesn’t need to be that direct, even whiplash injuries have a substantial incidence of BPPV. There is also a strong association with migraines. In older people, the most common cause is degeneration of the vestibular system of the inner ear. BPPV becomes much more common with advancing age. Viruses affecting the ear such as those causing vestibular neuritis and Meniere’s Disease are significant causes. Occasionally BPPV follows surgery, including dental work where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear. While rarely encountered, BPPV is also common in persons who have been treated with medications which may be toxic to the ear, such as Gentamicin. In half of these cases, BPPV is called “idiopathic,” which means it occurs for no known reason.

HOW IS THE DIAGNOSIS OF BPPV MADE?

A Physician can make the diagnosis based on history, findings on physical examination, and the results of vestibular and auditory tests. Often, the diagnosis can be made with history and physical examination alone. The Dix-Hallpike test is done when a person is brought from sitting to a lying down position, with the head turned 45 degrees to one side and extended about 20 degrees backward. A positive Dix-Hallpike test consists of a burst of nystagmus (jumping of the eyes). The physician will look carefully for these eye movements as the direction of these movements tells him what part of which ear is involved. The eyes jump upward as well as twitch so that the top part of the eye jumps toward the down side. This also looks like the rotation of a doorknob as the eye repetitively snaps back to its starting position. The severity of the person’s dizziness often correlates to the severity of these eye movements.

With respect to history, the key observation is that dizziness is triggered by lying down, or upon rolling over in bed. Most other conditions that have positional dizziness get worse on standing rather than lying down(e.g., orthostatic hypotension). There are some rare conditions that have symptoms that resemble BPPV. Patients with certain types of central vertigo such as the  pinocerebellar ataxias may have “bed spins” and prefer to sleep propped up in bed. These conditions can generally be detected on a careful neurological examination and are generally accompanied by a familiar history of other persons with similar symptoms.

Electronystagmography (ENG) testing may be needed to look for the characteristic nystagmus (jumping of the eyes) induced by the Dix-Hallpike test. A magnetic resonance imaging (MRI) scan will be performed if a stroke or brain tumor is suspected. It is possible but uncommon (5%) to have BPPV in both ears (bilateral BPPV).

HELPFUL TIPS IN MANAGING BPPV

• Avoid bending and reaching up for the next 2 days
• Wear soft cervical collar for the next 2 days
• Sleep with head elevated or in recliner for the next two nights

WHEN SHOULD YOU CALL FOR HELP

Call 911 anytime you think you may need emergency care. For example, call if:

•  You have symptoms of a stroke. These may include:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only
    one side of your body.
  • Sudden vision changes
  • Sudden trouble speaking
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance
  • A sudden, severe headache that is different from past headaches.
• Call your doctor now or seek immediate medical care if:
  • You have new or worsening nausea and vomiting
  • You have new symptoms such as hearing loss or roaring in your ears.
• Watch closely for changes in your health, and be sure to contact your doctor if:
  • You are not getting better as expected
  • Your vertigo gets worse

 

How to Schedule an Appointment

Premier ENT is Minden Medical Center’s newest clinic. Call Dr. Watkins at 318.716.1111 to make an appointment. For more information about his clinic, visit Premier ENT.

 

Premier ENT

1000 Chinaberry Dr. Suite 1103
Bossier City, LA 71111
For Appointments, Call: 318.716.1111