What is BPPV?
Benign Paroxysmal Postural (or Positional) Vertigo is a type of vertigo (often called dizziness or a spinning sensation). BPPV specifically happens when you turn your head one direction, you look up, or when you are lying on one side. The spinning sensation and sometimes accompanying nausea typically lasts up to a minute, and it happens each time the head is turned in that direction or is in that position.
What causes BPPV?
In our inner ears we have these little crystals (otoliths or otoconia) that can become loose, and when they end up floating in one of the three semicircular canals, instead of in the utricle and saccule, they cause symptoms. Head injuries can loosen them, as can ear infections, ear surgeries, atherosclerosis (buildup of plaque in blood vessels), MS, and cumulative damage as we age.
Why such a crazy name for dizziness caused by loose ear crystals?
It’s a bunch of big words to describe its presentation. Here’s what each means.
- Benign: it is non-cancerous and does not usually progress.
- Paroxysmal: occurs suddenly.
- Positional: caused by putting the head in certain positions.
- Vertigo: feeling off-balance or spinning.
How do we diagnose BPPV?
We will take a history, looking for clues such as head injury, recent illness or ear infection as well as symptoms that match up with BPPV: spinning sensation when turning the head a certain direction, tilting the head back, or laying on a side.
We will want to differentiate it from cervicogenic vertigo, dizziness that is coming from your neck, and here we use the Rotating Stool Test. We have you sit on a stool and turn your head quickly to one side and check for symptoms, and then other. These symptoms could come from your inner ear or from your neck. If we hold your head still and swing your body to each side and you have no symptoms, it points to BPPV. However if swinging your body with your head still (causing no movement in the semicircular canals) does cause symptoms, it indicates cervicogenic vertigo, and we are going to be doing work on your neck instead of utilizing the Epley or Sermont Maneuver.
We use the Dix-Hallpike test, which is also the start of the Epley Maneuver. We have you seated and help you lie back quickly. If you get dizzy and we see nystagmus (shaking of your eyes), that is a good indication for BPPV affecting the posterior semicircular canal.
We can use the roll test. You would be lying on your back and we would quickly turn your head to the side. Symptoms elicited with this would indicate an issue in the horizontal semicircular canal.
What is the Epley Maneuver and who can perform it?
The Epley maneuver is a simple set of motions that many health professionals can perform, and there are also instructions for at-home Epley Maneuvers that you can try yourself. The goal of the Epley Maneuver is to move the crystals through the semicircular canals and back to their resting place in the utricle and saccule where they won’t cause this horrific vertigo. Once out of the semicircular canals, we try to keep the crystals there, so no headstands, hanging one’s head upside down for blow-drying or searching under the car seat when you drop your cell phone.
What else can cause similar symptoms to BPPV?
- Cervicogenic Vertigo: Vertigo resulting from abnormal proprioceptive input in the neck. Similar in presentation and often differentiated by the Rotating Stool test.
- Meniere’s: Vertigo caused by fluid accumulation in the inner ear with recurring episodes of severe vertigo that last from minutes to hours.
- Labyrinthitis: Inflammation of the inner ear or nerve between the inner ear and brain, usually triggered by an infection, often flu or a cold. Common symptoms include dizziness and spinning sensations and it usually resolves on its own.
- Orthostatic hypotension: A sudden drop in blood pressure when standing up that causes light-headedness.
What does a visit look like for BPPV?
As we mentioned above, we will start with a history. Then we move into an exam. In treatment, we often will work through your neck as well as perform the Epley/Sermont Maneuver if it is indicated. Sometimes the maneuver will need to be performed several times until symptoms subside. We will send you home with a set of instructions that include not laying flat for several hours afterwards and avoiding aggravating movements (sharp head turns and of course hanging upside down) that could send the crystals moving again. We also will give you instructions for at-home treatment, because it’s not always a one visit does the trick permanently type of thing. Still, one visit often can make a huge difference, and that is why people come see us for BPPV.
