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Individuals with vertigo mistakenly perceive motion (commonly a rotating motion) in their surroundings. The feelings of vertigo occasionally include dizziness, falling or spinning. Any time vertigo affects balance, it can result in falls and personal injuries – chiefly in older adults. More extreme cases can also cause vomiting, nausea, migraines, fainting spells and visual abnormalities called nystagmus.
Vertigo can have many underlying causes, but one of them relates to hearing – benign paroxysmal positional vertigo, abbreviated BPPV. BPPV occurs from naturally-forming calcium crystals known as otoconia or otoliths, that usually cause no issues. In BPPV, the crystals travel from their normal locations into the semicircular canals of the inner ear. Once inside the semicircular canals, the crystals cause an abnormal displacement of endolymph fluid every time a person changes the position of their head (relative to gravity). This is the underlying cause of the vertigo feelings in cases of BPPV.
Everyday actions such as looking up and down, tilting your head or rolling over in bed can trigger the BPPV. The vertigo sensation comes on very quickly and has a short duration. Changes in barometric pressure, sleep disorders and stress can make the symptoms worse. Benign paroxysmal positional vertigo can occur at any age, but it’s most commonly seen in people over the age of 60. The initial trigger for the BPPV is generally difficult to determine. A sudden blow to the head (for example in a car accident) is among the more common causes.
BPPV is easily distinguished from other kinds of vertigo because it is almost always brought on by movements of the head with symptoms decreasing in 60 seconds or less. Diagnosing BPPV commonly involves a straightforward test where the individual lies on an examination table and tilts their head to the side or over the edge. More extensive tests can be used in selected cases including electronystagmography (ENG), videonystagmography (VNG) and magnetic resonance imaging (MRI). ENG and VNG test for abnormal eye movements while MRI is used to eliminate other potential causes of vertigo such as brain abnormalities or tumors.
There is no full cure for BPPV, but it can be effectively treated using canalith repositioning (either the Epley maneuver or the Semont maneuver), both of which use bodily movements to guide the crystals to an area in which they no longer cause trouble.Surgical treatment is an option in the rare cases in which these therapies are not effective. If you’ve experienced unexplained vertigo or dizziness that persists for over a week, see your balance disorder specialist.
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