Patients with vertigo incorrectly perceive motion (commonly a rotating motion) in their environment. The feelings of vertigo sometimes include dizziness, spinning or falling. When vertigo impacts balance, it can result in falls and accidental injuries – especially in the elderly. More serious cases may also cause vomiting, nausea, migraine headaches, fainting spells and visual irregularities known as nystagmus.
Vertigo has many underlying causes, but one of them is related to hearing – benign paroxysmal positional vertigo, or BPPV. It is caused by calcium crystals that form naturally in the inner ear called otoliths or otoconia, and which in most people cause no problems. In BPPV, the crystals migrate from their normal locations into the semicircular canals of the inner ear. When an individual with BPPV reorients their head relative to gravity, these crystals displace endolymph fluid and cause vertigo.
Benign paroxysmal positional vertigo is characterized by the brief (paroxysmal) nature of the vertigo, and can be triggered by such common movements as tilting the head, looking up or down, rolling over in bed, or any other sudden head motion. Changes in barometric pressure, sleep disorders and anxiety can make the symptoms worse. BPPV may appear at any age, but it is most commonly seen in people over 60 years of age. The precise reason behind benign paroxysmal positional vertigo is difficult to determine for any given person, but occasionally it can be brought on by a blow to the head.
BPPV is readily distinguished from other varieties of vertigo because it is nearly always brought on by movements of the head with symptoms decreasing in one minute or less. Doctors may diagnose it by having the individual rest on their back and then tilt their head to one side or over the edge of the exam table. There are many rigorous tests that can be used to diagnose BPPV, such as videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, or magnetic resonance imaging (MRI), which is used primarily to rule out other possible causes of the vertigo.
The most common treatment for BPPV is canalith repositioning, such as the Semont maneuver and the Epley maneuver, both of which are a sequence of physical motions used to shift the crystals to a position in the inner ear in which they no longer cause problems. Surgery is a possibility in the exceptional cases where these therapies are not effective. If you suspect benign paroxysmal positional vertigo or have been suffering from dizziness or vertigo for over a week, visit a specialist familiar with vertigo and balance disorders.