Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo, or BPPV, is probably the most common single cause of vertigo (a sense of spinning) in the United States. It has been estimated that at least 20% of all patients who complain of vertigo have BPPV. However, because it is frequently misdiagnosed, this figure is most likely an underestimation.

BPPV, which was first described by Barany in 1921, causes vertigo due to tissue debris collecting within a part of the inner ear. This debris, or "ear rocks," is comprised of small crystals of calcium carbonate. The debris is believed to derive from structures in the ear called "otoliths" that may have been damaged by head injury, infection, disorders of the inner ear, or degeneration because of advanced age. However, in about half of the people affected, the cause of BPPV remains unknown.

In the most common variety of BPPV, symptoms are usually triggered by movement of the head, such as when turning rapidly, rotating in bed, or sitting up or lying down. Symptoms may begin suddenly and can persist for quite some time or dissipate within 20-30 seconds. The major symptoms of BPPV are vertigo, lightheadedness, imbalance, and nausea. The offending position may sometimes lead to oscillation or rapid jerky movement of the eyes (nystagmus) which is also a common component of the vertigo.

A diagnosis of BPPV can be made through a comprehensive history, examination, and a review of vestibular and auditory test results. Other diagnostic studies such as an electronystagmyography (ENG) may be required. An MRI may be performed to rule out other causes of vertigo.

Various treatment options are available to address BPPV. Many experts argue that since BPPV is benign and can resolve on its own in weeks to months, simple observation is all that is needed. However, symptoms can be disabling and may necessitate intervention for many sufferers.

For some people, certain medications may be very helpful. However, they often provide only minimal relief, do not solve the underlying problem, and may lead to significant side effects including sleepiness.

Various kinds of physical maneuvers have been found to be effective in treating BPPV. The two most common repositioning techniques are the "Seamont method" and the canalith reposition procedure (CRP), or "Epley method." Both involve rotating the head to particular positions to rearrange and displace the "ear rocks." The Seamont maneuver involves rapid and vigorous side-to-side head and body movements.

The CRP or Epley maneuver is a simple, noninvasive, office treatment which is designed to actually cure BPPV in 1-2 sessions. This therapy, when performed by experienced professionals, is often quite successful for many patients with BPPV. However, surgery is sometimes required.

For many sufferers, especially those suffering from classic BPPV, certain modifications in daily activities may be necessary. Patients should avoid sleeping on their "bad" side and should rise slowly and sit on the edge of the bed for a minute when awakening in the morning. In addition, those who suffer this condition should avoid rapid bending down or turning of their head, such as when looking from side to side, when looking down to pick something up, when bending over, or when extending the neck as they look upward.  Several members of the MHNI staff can perform the Epley maneuver.