What Is It?
Benign Paroxysmal Positional Vertigo (BPPV), also known as Benign Positional Vertigo (BPV), or simply Positional Vertigo, is a type of dizziness caused by an abnormal reaction of the inner ear balance system to certain head movements. Placing the affected ear in a downward position usually brings on symptoms. In some instances, any head movement will aggravate the symptoms.
What Causes It?
Within the inner ear ear, there are tiny crystals, which are normally attached to the nerve endings. When these crystals (otoconia) are displaced into the semicircular balance canals, they can stimulate the balance nerve inappropriately. Putting the head in certain positions will lead to a severe spinning sensation. Although this spinning sensation lasts only approximately 20 seconds, it is often severe and can produced unsteadiness and nausea, which may last several hours.
How Is It Diagnosed?
Vertigo is due to many causes and can be difficult to diagnose. After a thorough history and physical, sometimes many tests need to be done to evaluate the different types of vertigo. 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 both observed by the examiner and recorded with an electric monitor (ENG).
How Is It Treated?
Although “watchful waiting” with medication has been utilized in the past, it is no longer necessary for the patient to endure the vertigo which can now be easily treated.
The Canalith Repositioning Procedure (CRP) is a non-surgical office procedure whereby the offending crystals (otoconia) are repositioned to an area of the inner ear where they will not cause symptoms. This non-surgical procedure is painless, has few side effects if any, and is effective in 95% of patients. Occasionally, there is mild transient vertigo for a few days afterwards.
The procedure is performed by placing the patient’s head in various positions which will cause the crystals to gravitate to an area away from the balance nerve receptors to an area where they can “do no harm.” The procedure takes approximately 10-20 minutes with an excellent cure rate.
On rare occasions, surgical intervention is necessary but, with the success rate of the Canalith Repositioning Procedure (CPR), surgery is now rarely performed.