Vertigo is a feeling of dizziness that comes on quickly which may feel like a loss of balance or like that the room is spinning. Benign paroxysmal positional vertigo (BPPV) is a type of vertigo that happens suddenly and unexpectedly, especially with turning of the head to one side or change in position of the head including rising from lying down. The ear is a very complex organ that deals with both hearing and balance. With regard to balance, the ear has several structures including the semicircular canals (looped structures filled with fluid and tiny hairs to sense balance) and otoliths (small crystals that normally sit in a separate compartment called the utricle). Benign paroxysmal positional vertigo happens when the otoliths get knocked into the fluid of the semicircular canals. These crystals brush against the tiny sensory hairs, amplifying the movement signal to the brain with every slight change in position which causes the sensation of dizziness. Risk factors for having BPPV include being older than 60, having a blow to the head, and having damage to the ear. Generally, having BPPV does not cause any harm but can cause imbalance that can lead to falls and injury and vomiting that can lead to dehydration.
Dizziness, lightheadedness, loss of balance, feeling that the room or surroundings are spinning, nausea, vomiting, dizziness with turning the head or change in the position of the head
Your doctor will begin by discussing the symptoms of your dizziness and the situations that cause symptoms to be the worst. Your doctor will also do a physical exam to check the nerves in your head and make sure that the visible parts of your ears are normal. Your doctor may want to see you walk and check your balance. Your doctor will likely do a test for loose crystals (otoliths) in the semicircular canals called the Dix-Hallpike maneuver. This maneuver involves lying down while your doctor moves your head to the side to see if you feel dizzy and if your eyes tick rhythmically (nystagmus) briefly afterward. If your doctor suspects another cause of your dizziness, he or she may wanted to do testing called electronystagmography (ENG) or videonystagmography (VNG) which are two methods to check for involuntary movements of the eyes with electrodes and video, respectively. Your doctor may also want to take a picture of your brain with magnetic resonance imaging (MRI).
For the symptoms of nausea, your doctor may recommend medications for nausea like promethazine or metoclopramide. If the cause of your dizziness is benign paroxysmal positional vertigo (BPPV), the curative treatment is called the canalith repositioning procedure. The canalith repositioning procedure involves performing series of movements in order to move the otoliths (crystals) from the semi-circular canals back into the utricle where they are supposed to be. The movements are done slowly with the final position held for thirty seconds or more. Generally, these movements take one or two series of maneuvers to be effective. To maintain the changes, you will be asked to sleep with your head elevated and not move your head below the level of your shoulders. Your doctor will likely teach you’re the maneuvers and ask you to perform the movements a few more times while at home. If the canalith repositioning procedure is not effective to stop your dizziness, your doctor may recommend seeing an ear, nose and throat doctor (ENT doctor or otolaryngologist). The ENT doctor can put a bone plug into the area of the ear causing the dizziness so that your body does not sense the dizziness anymore and relieves your symptoms. This procedure is generally very successful but carries a small risk of hearing loss on the affected side. While you have symptoms of dizziness, you should be careful walking around and make sure that you have balance before moving quickly. If you feel dizzy, make sure to sit down. You should also make sure that areas you are walking in are well-lit. You should discuss all of your treatment options with your doctor.
