Positional vertigo is a bothersome problem that can adversely affect the daily activities of patients
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo â€” the sudden of head movements casing momentary vertigo or giddiness
Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.
Although benign paroxysmal positional vertigo can be a bothersome problem, it’s rarely serious except when it increases the chance of falls.
The signs and symptoms:
Dizziness, a sense that you or your surroundings are spinning or moving .You may feel lightheaded and unsteady. Nausea and vomiting may also occur in severe cases.
The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of benign paroxysmal positional vertigo and other forms of vertigo can disappear for some time and then recur.
Get medical help
See your ENT specialist if you experience any unexplained dizziness or vertigo that recurs periodically for more than one week. Although it’s uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:
and A new, different or severe headache
and A fever of 101 F (38 C) or higher
and Double vision or loss of vision
and Hearing loss
and Trouble speaking
and Leg or arm weakness
and Loss of consciousness
and Falling or difficulty walking
and Numbness or tingling
and Chest pain, or rapid or slow heart rate
The signs and symptoms listed above may signal a more serious problem, such as stroke or a cardiac condition.
The inner ear and your balance
Inside your ear is a tiny organ called the vestibular labyrinth. It includes three semicircular canals that contain fluid and fine, hair-like sensors that monitor the rotation of your head. otolith organs in your ear monitor movements of your head â€” up and down, right and left, back and forth â€” and your head’s position related to gravity. These otolith organs â€” the utricle and saccule â€” contain crystals that make you sensitive to movement and gravity.
For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals â€” especially while you’re lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy.
How to make a diagnosis
The doctor may do a series of tests to determine the cause of your dizziness. During a physical examination, your doctor will likely look for:
and Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute
and Dizziness with specific eye movements that occur when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed
and Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo.
If the cause of your signs and symptoms is difficult to diagnose, your doctor may order additional testing, such as:
and Audiogram: Hearing Tests
and Magnetic resonance imaging (MRI). MRI may be performed to rule out acoustic neuroma or other lesions that may be the cause of vertigo.
and 3D CT of inner ear can be helpful
Medical treatment with anti-vertigo medications may be considered in acute, severe exacerbation of BPPV. The medical management of vestibular syndromes has become increasingly popular over the last decade, and numerous novel drug therapies have emerged for the treatment of vertigo/dizziness syndromes. These drug therapies offer symptomatic treatment, and do not affect the disease process or resolution rate. Medications may be used to suppress symptoms during the positioning manoeuvres if the patient’s symptoms are severe and intolerable.
Commonly prescribed medications for vertigo include the following:
and meclizine hydrochloride
and promethazine hydrochloride
These medications should be taken only as directed and under the supervision of a doctor.
Other Treatments for BPPV
NeckExcersise can be taught and tried by patient at home.
Other two treatments have been found effective for relieving symptoms of posterior canal BPPV: the canalith repositioning procedure (CRP) or Epley maneuver,
The canalith repositioning procedure consists of several simple and slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs (utricle) in your ear where these particles don’t cause trouble and are more easily reabsorbed. Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure is usually effective after one or two treatments.
After the procedure, you must avoid lying flat or placing the treated ear below shoulder level for the rest of that day. For the first night following the procedure, you should elevate your head on a few pillows when you sleep. This allows time for the particles floating in your labyrinth to settle into your vestibule and be reabsorbed by the fluids in your inner ear.
CRP Can be done at home: Your doctor likely will teach you how to perform the canalith repositioning procedure on yourself so that you can do it at home before returning to follow up.
BPPV may recur even after successful therapy. Fortunately, although there’s no cure, the condition can be managed with physical therapy and home treatments.