By Monquen Huang, MD
Benign paroxysmal positional vertigo (BPPV) is the most common cause of
dizziness. Cases are rarely serious but may increase the risk of falls,
which is a cause for concern. Avoid injury by staying informed about BPPV.
Below are some frequently asked questions about this condition, along with
their accompanying answers.
What are the symptoms of BPPV?
The most common symptoms are sensations of spinning triggered by certain
movements, such as turning in bed while lying down or straightening up
after bending over. Spinning sensations are usually intense but brief,
usually lasting seconds to minutes. After the spinning subsides, you may
still have a lingering sensation of dizziness.
Note that BPPV
does not cause hearing changes or loss of consciousness.
What causes BPPV?
There are crystals (otoliths) in specific parts of the inner ear that are
normally responsible for detecting linear movement. For reasons unclear
to us, these crystals become loose and move into the wrong part of the
inner ear (semicircular canal), which is responsible for detecting rotary
movement. It is these loose crystals that are responsible for a false
sense of spinning.
This occurrence can potentially be associated with head trauma or dental
or surgical procedures that involve lying in bed for long duration of time.
How is BPPV diagnosed?
BPPV is diagnosed in-clinic by an examiner who has the patient move his
or her head in a certain way to induce the sensation of spinning. The
most common test is called the Dix-Hallpike test or supine roll test.
The examiner looks for certain eye movement to confirm the diagnosis of BPPV.
Imaging studies such as CT or MRI cannot confirm BPPV because the crystals
are too small to see. Blood tests are not helpful either.
How is BPPV Treated?
Patients can perform the Epley maneuver to reposition the crystals so that
they return to their original location. The maneuver may have to be repeated
a few times for the repositioning to be successful. It is normal for the
maneuver to trigger dizziness and it may take a few days for the symptoms
to resolve. The success rate of the Epley maneuver is about 90 percent
if done properly.
Generally, anti-vertiginous medication is not necessary.
Can BPPV return?
Yes, it can return and there is no known way of preventing BPPV from coming
back. The recurrence rate at four years is about 30 percent, and most
recurrences occur within first six months of the symptoms’ onset.
However, most patients are treated successfully with an Epley maneuver
that effectively repositions the crystals.