Benign paroxysmal positional vertigo: BPPV

     Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, characterized by a spinning sensation. Statistics show it accounts for 20–30% of clinic-associated vertigo cases. It is more prevalent in women than men, with a reported ratio of 1:5 to 2:1.

Causes of BPPV

Possible causes include:

• History of head trauma (47%)
• Previous inner ear infections (26%)
• Vestibular neuritis, aging, or prolonged bed rest
• Stress and lack of physical activity, which affect the semicircular canals responsible for balance, especially the posterior canal (90%), followed by the horizontal (5–10%) and anterior canals (1%). These issues may be due to calcium debris or dislodged otoliths entering the semicircular canals.

Characteristics of Vertigo in BPPV

     Patients typically experience vertigo during head movements, especially vertical ones—e.g., lying down, getting up, bending over, looking up, or shampooing at a salon. These actions affect calcium particles in the inner ear, triggering vertigo accompanied by nausea or vomiting.

The vertigo is usually brief, occurring only during movement, and subsides on its own. However, it can recur with the same head movements. Some may experience dizziness lasting hours or days.

The Significant Symptoms

     Symptoms are often most intense initially and lessen over time. Episodes can occur multiple times daily and gradually resolve over weeks to months. In some cases, symptoms may recur after months or years. Notably, BPPV does not cause hearing loss, tinnitus, or other neurological symptoms. Patients remain conscious and alert during episodes.

Treatment of BPPV

1.  Lifestyle Adjustment and Medication

     Patients are advised to avoid triggering positions. Symptoms usually improve within a week to a month. Short-term medication may be prescribed. Caution is advised against activities that pose safety risks, such as climbing, diving, or driving.

2.  Physical Therapy

Widely accepted and effective, it includes:

• Method 1: Performed by specialists to reposition calcium debris out of the semicircular canals, eliminating the cause of vertigo.
• Method 2: Home-based exercises. Patients may initially feel dizzy, but symptoms improve as the body adapts over time.

3.  Surgery

     Reserved for patients who do not respond to physical therapy after 4–6 months or have frequent recurrences. Surgery is highly effective in resolving vertigo permanently.

For more information: Dizziness and Spinning Sensation: Causes and Treatments