Benign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear. It is also known as postural vertigo or positional vertigo. Benign paroxysmal positional vertigo is characterised by intense but brief periods of vertigo that happen when moving the head, such as when rising from the bed in the morning. It appears as dizziness, nausea and unsteadiness. It is estimated to affect 2.4%…
What is vertigo?
Vertigo is a term used to describe a feeling of spinning, unsteadiness or dizziness in the head, which usually occurs during movement. Some people with vertigo feel like they are moving while their surroundings are staying still, while others feel like their surroundings are spinning, but they are still. These sensations may last only a few moments, or several hours or days at a time.
Vertigo can affect anyone, but is most common in elderly people.
Many different conditions and diseases can cause vertigo. Cases can be grouped into two main types: peripheral vertigo or central vertigo.
Peripheral vertigo is caused by a problem with the inner ear, which is the part of the body that controls balance. The inner ear is made up of a series of semicircular canals, which are known as the labyrinth. These canals are filled with a fluid that moves around during the movement of the head. The fluid conducts a signal along the vestibular nerve to the brain, which is interpreted as information about the direction and speed of the head movement.
Some common inner ear problems that can lead to peripheral vertigo include:
Benign paroxysmal positional vertigo
Benign paroxysmal positional vertigo is a condition that occurs when small crystals form in the canals in the inner ear. These crystals can move around in the canals when the head changes position, interfering with the balance sensors in the inner ear and causing the sensation of spinning, rocking or unsteadiness.
Meniere's disease is a condition that may be caused by a build-up of fluid in the inner ear. This can interfere with the balance and hearing mechanisms. Vertigo is one of the main symptoms of Meniere's disease. Someone with this condition may also experience hearing loss, a feeling of pressure inside the ear and an abnormal ringing sound inside the ear, which is called tinnitus.
Inner ear infections
Inner ear infections, caused by bacteria and viruses, can cause inflammation of the vestibular nerve or the labyrinth, the parts of the inner ear that coordinate balance. This inflammation can interfere with the information that is sent to the balance sensors in the inner ear, which can cause the feeling of vertigo.
Central vertigo is caused by conditions that affect the area of the brain involved with balance. It can be caused by a severe headache (migraine), a stroke, a tumor or other brain disorders such as multiple sclerosis. It is common for central vertigo to be related to a problem with the cerebellum, which is the part of the brain that controls the coordination of balance and movement.
Some other causes of vertigo include:
- Head or neck injuries;
- Some medications;
- Travel sickness, and;
- Low blood pressure.
Anyone can get vertigo, but there are some factors that can increase a person's risk of developing it. A person is more likely to get vertigo if they:
Signs and symptoms
Someone with vertigo may feel as if they, or their surroundings, are spinning, moving up and down or side to side. In severe cases, this can make it very hard to maintain balance and carry out daily activities. A person with vertigo may also experience:
- Difficulty walking;
- Nausea and vomiting;
- Blurred vision;
- Difficulty speaking, and;
The length of these symptoms can vary from person to person, but they may last from a few minutes to a few hours or even days at a time.
Methods for diagnosis
To diagnose vertigo and identify its cause, a doctor will usually ask questions about a person's symptoms and medical history, including how often they experience vertigo and how long it lasts.
During a physical exam, a doctor may check the person's blood pressure and look for abnormal eye movements or vision problems. The doctor may also use simple hearing and balance tests and arrange for imaging scans, such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) to work out whether the vertigo is caused by abnormalities in the inner ear or brain. These scans may be ordered if a central cause such as a stroke, tumor or multiple sclerosis is suspected, tumor or multiple sclerosis is suspected, or if the diagnosis is not clear from medical history and physical examination.
Types of treatment
The treatment for vertigo usually depends on what is causing it and how bad it is.
Treatment for benign paroxysmal positional vertigo
Treatment of benign paroxysmal positional vertigo usually involves a procedure performed by a doctor, called the Epley maneuver. This involves adjusting the position of the patient's head in several slow steps to try and move the crystals in the inner ear that are causing the condition, away from the balance sensors in the inner ear. The patient may also be taught certain exercises to do at home. If symptoms are very severe and frequent and do not respond to the Epley maneuver, then surgery to block the part of the inner ear causing the vertigo symptoms may be recommended.
Treatment for Meniere's disease
Unfortunately there is no cure for Meniere's disease, but there are some treatment options available for the symptoms. Anti-nausea medication may help reduce nausea and vomiting during episodes of vertigo. In severe cases, surgical procedures can be performed to reduce symptoms.
Treatment for inner ear infections
In many cases, inner ear infections will improve on their own. If the infection is caused by bacteria, antibiotics may be prescribed. In the case of a viral infection, corticosteroid medication to reduce the inflammation may be prescribed.
Treatment for migraines
To treat vertigo associated with a migraine, a doctor will work with the patient to find the triggers that bring on a migraine so they can be avoided. Certain medications, such as aspirin and acetaminophen, may help to relieve some of the symptoms of a migraine. A doctor may also recommend some specific exercises to help make the person's balance system less sensitive to motion.
The prognosis for vertigo depends on what is causing it. In many cases, vertigo that is associated with problems of the inner ear will usually improve on its own. Medications and rehabilitation exercises may also be able to provide some relief during episodes of vertigo. If vertigo is caused by a problem within the brain (central vertigo), the outcome is dependent on the degree of damage done to the central nervous system.
If someone has a condition that causes vertigo, it is important that they take care to avoid losing their balance and falling, as this can lead to injury. The sensation of vertigo may be avoided or lessened by avoiding sudden movement, getting up slowly and sitting down when feeling dizzy.