Information From Your Health Care Provider

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

Basic information

description

Benign paroxysmal positional vertigo (BPPV) is a common, inner ear disorder that causes dizziness or vertigo with certain movements of the head.

Benign means "not very serious."
Paroxysmal means "sudden and variable in onset."
Positional, because it comes about with a change in head position.
Vertigo, causing a sense of the room spinning or whirling.

FREQUENT SIGNS & SYMPTOMS

A sensation of dizziness or vertigo (spinning). Vertigo begins 5 to 10 seconds after the head moves and lasts less than a minute. Feeling off balance may last longer.
Most often, only one ear is affected, so symptoms occur when the head is turned that way. Symptoms are brought on when getting out of bed, rolling over in bed, or when looking up for an object on a high shelf.
Falling, or a feeling of falling.
Feeling lightheaded or woozy.
Visual blurring.
Nausea and vomiting (sometimes).
Faintness, changes in heart rate and blood pressure, fear, anxiety, or (less often) panic.
It does not cause hearing loss or ear noises (tinnitus).

causes

It is thought to be caused by small crystals of calcium carbonate (also called "ear rocks," otoconia, or otoliths) in the inner ear. The crystals normally help tell the brain about your head position. Sometimes the crystals become dislodged from their location in the vestibule and move into a semicircular canal. This can disrupt the ear's balance centers and cause the symptoms.

risk increases with

Head injury.
Degeneration of the vestibular system of the inner ear (usually in older people).
Ear infection or disorder.
Surgery.
Central nervous system disease.

PREVENTIVE MEASURES

No specific preventive measures.

expected outcomes

The condition usually clears up on its own within several weeks. It may recur. Treatment can hasten healing.

possible complications

BPPV symptoms may come and go, recur after treatment, or become chronic.

diagnosis & treatment

general measures

Your health care provider will do an exam of the ears and ask questions about your symptoms and activities. When BPPV occurs, there is an involuntary movement of the eyes, which is called nystagmus. To make the diagnosis, the patient's head is put into certain positions and the eye movements are observed. Medical tests may be done to confirm the diagnosis.
Treatment may involve watchful waiting. No treatment is done at first to see if the problem resolves itself.
An office procedure (e.g., Epley maneuver) may be done for treatment. It is performed by placing a patient's head in various positions. This will cause the crystals to loosen and return to normal movement. This procedure takes about 5 to 10 minutes. Frequently, only one office procedure is needed. It is painless and has few side effects if any. There may be mild vertigo for a few days afterwards.
Self-treatment exercises may be recommended. These can be done if symptoms recur, or office procedure was not effective. Instructions will be given on proper techniques for the head maneuvers. They are then done at home several times a day, usually for 2 weeks.
Rarely, when other treatment is not effective, patients with severe symptoms may require surgery.
To learn more: Vestibular Disorders Association, PO Box 4467, Portland, OR 97208-4467; (800) 837-8428; website: www.vestibular.org.

medications

Usually not needed for this disorder. Drugs may be prescribed for specific symptoms, such as nausea.

activity

Activities may be limited for 24 to 48 hours after the procedure is done. Specific instructions will be given.