The distinguishing characteristic
of BPPV is the positional onset of
vertigo (spinning). BPPV is due to
misplaced debris that has collected
in the inner ear. This debris,
commonly called "ear rocks", is
composed of calcium-carbonate
crystals. Patients typically
associate their onset of vertigo
with lying down, rolling over in bed,
tilting their head back to look up
and/or bending over. BPPV is the most common cause of brief spells of vertigo.
These symptoms may occur over several days or weeks and disappear, then reoccur.
The causes of BPPV are often considered to be "idiopathic" - occurring for no
known reason. However, BPPV is more common following head trauma, an illness
(e.g. inner ear infection), and/or a sudden change in the fluid of the inner ear.
BPPV is also common in the older adult population simply due to degenerative
changes of the inner ear.
The diagnosis of BPPV is determined by the patient's complaints and/or positive
findings with specific positional testing, which is commonly known as the Dix-
Hallpike. Testing can be further confirmed with electronystagmography (ENG) or
with video goggles. Although BPPV can occur by itself, it is most commonly seen
with other inner ear disorders. Therefore, additional balance and hearing tests
provide comprehensive information about any underlying cause of BPPV.
A maneuver known as the Epley maneuver is the most effective treatment for
BPPV. This procedure includes a physical movement of the patient to
reposition the crystals back into an area of the inner ear that is less
sensative to head movement. The maneuver is specific to the right or left
ear, the canal(s) involved, and the type of BPPV that exists. For example,
BPPV may occur in one or both ears, one or more of the semicircular canals,
and may be "free floating" within the canal or adhering to a part of the canal.
When performed by a qualified health care provider,this maneuver has shown to
be 90% successful in 1-2 visits. An alternate treatment if the Epley maneuver
is not successful is Brandt-Daroff exercises. Surgery is rarely used to treat
BPPV but may be necessary.
When the maneuvers are used, the patient is asked to follow a specific set of
home instuctions. These instructions decrease the chance of the crystals
becoming disloged again. If imbalance and/or movement-related symptoms are
persistent after the BPPV is resolved, vestibular rehabilitation may be necessary.
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