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What Is BPPV?

BPPV

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Updated May 22, 2014

What Is BPPV?

Inner Ear Anatomy

Photo © A.D.A.M.

BPPV is a medical abbreviation for Benign Paroxysmal Positional Vertigo. It is a form of vertigo that is thought to be caused by calcium deposits within the inner ear. The medical term for these deposits is otoconia. Otoconia normally reside in two parts of the ear called the utricle and saccule but when they abnormally make their way into the portion of the inner ear called the semicircular canals they can cause vertigo. BPPV usually occurs in one ear at a time and not bilaterally.

What Causes BPPV?

Injury to the utricle can cause BPPV including head trauma, an infection such as vestibular neuritis, or a breakdown of the utricle over time. It can also be caused by congenital disorders of the inner ear. Occasionally BPPV has been associated with a history of small strokes or Meneire's disease.

Symptoms of BPPV

Symptoms of BPPV can sometimes lessen in severity or go away after about six months. Symptoms of BPPV appear with changes in your position such as standing up from lying down or turning in bed. They may vary slightly among individuals but common symptoms include:

  • dizziness
  • being light headed or passing out
  • imbalance which may make walking difficult
  • nausea
  • headache

How is BPPV Diagnosed?

BPPV is diagnosed using a combination of medical tests including a patient history and a physical examination. BPPV is usually accompanied by nystagmus, a subtle "jumping" of the eyes which can sometimes be seen by an observer or by using a test called Electronystagmography (ENG). An MRI may be done to rule out a stroke or tumor.

Treatment of BPPV

Anti-nausea medications such as ondansetron or medications used for motion sickness may be helpful in treating nausea associated with BPPV. Otherwise medications do not seem very beneficial in treating the disorder. BPPV can be treated using Brandt-Daroff exercises and two treatments called the Epley and Semont Manueuvers.

The Epley Maneuver

The Epley Maneuver must be preformed by a qualified physician in a doctor's office. It takes about 15 minutes to complete and is intended as a means to get the otoconia (calcium deposits) into a different part of the ear where they will be less likely to cause symptoms. The Epley Maneuver may also be called the particle repositioning, canalith repositioning procedure or the modified liberatory maneuver. The exercise consists of four different head positions which are maintained for 30 seconds each.

The Semont Maneuver

During the Semont maneuver the doctor will tilt your head in different directions while you are in a seated position. Finally he will tilt your head and gradually assist you until you are lying down on the unaffected ear with your nose pointed down. You will remain in this position for 3 minutes. Then the doctor will gradually help you back in to a seated position.

There is about an 80 percent chance of both the Epley and Semont maneuvers working and a chance that symptoms of BPPV will reoccur. Your doctor may give you instruction of exercises or positions you should avoid after having these maneuvers done.

Brandt-Daroff Exercises

Brandt-Daroff Exercises may be preformed at home after instruction by a medical professional. They are usually reserved for individuals in which the Epley or Semont Maneuvers have been ineffective. The exercises are more rigorous in that they must be preformed in 3 sets per day for 2 weeks. Brandt-Daroff Exercises are successful in about 95 percent of BPPV cases.

Surgical Treatment For BPPV

Surgical treatment for BPPV are generally recommended only after the above treatments have failed and symptoms have persisted for one year or more. The surgery involves unplugging the posterior canal. Risks of the surgery include hearing loss in addition to the risks of general anesthesia. Only 1 percent of patients with BPPV ever have this procedure.

While BPPV can be difficult to cope with and will certainly require you to modify your daily life most patients are treated successfully.

Source:

Zalewski, Chris MA, CCC-A. What is Benign Paroxysmal Positional Vertigo (BPPV)?. ASHA 2011

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