What causes BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of spinning dizziness, which is related to the ear. This kind of spinning dizziness is called vertigo. In BPPV, the organ of balance in the inner ear malfunctions. The ear normally uses small crystals called “otoconia” to determine the direction of gravity. In a disease state these crystals come loose and float around inside the inner ear. These crystal particles cause the sensation of vertigo (spinning) every time they are disturbed by head motion.
BPPV has characteristic features such as:
- Intense vertigo (room spinning)
- Nausea, but rarely vomiting
- Can be brought on by certain positions
- Short duration (minutes)
- Characteristic eye movements called Nystagmus
People with BPPV typically have symptoms when looking up, rolling over in bed, or bending under things. In some cases it is possible for people to identify the ear causing the symptoms. This condition affects roughly 10% of the population over 60. BPPV is likely under diagnosed and often treated with medications instead of the more effective particle-repositioning maneuver.
What is Vertigo?
There are many diseases that can cause vertigo and many types of dizziness, which are not vertigo. Different terms can be applied to these other symptoms. The term dizziness is a very general term for a collection of sensations such as being off balance (disequilibrium), spinning (vertigo) or being light headed (pre-syncope). Each of these sensations can, in turn, have a number of causes. Common culprits include heart disease, certain type of drugs and medications, and brain disorders.
In general terms the causes of vertigo can be thought of as either central, related to the brain, or peripheral, related to the organ of hearing.
There are a number of other relatively common peripheral causes of vertigo, which include; Meniere’s Disease, Recurrent Vestibulopathy and Vestibular Neuronitis, and BPPV. In each of these peripheral causes of vertigo something has gone wrong with the balance organ in the ear called the vestibular apparatus.
Central causes can be related to a problem with the brain itself such a tumor or stroke or are related to outside conditions which affect the brain indirectly like drugs such as alcohol. Other disorders that affect the brain indirectly include heart disease and rhythm abnormalities, which interrupt the supply of oxygen to the brain and can cause dizziness. This is similar to the common experience of feeling lightheaded when standing too quickly.
Epley Maneuvers and other BPPV Treatments
Often the first line treatment for dizziness is pharmaceuticals. However, medications have been shown to be largely ineffective with BPPV.
Particle repositioning maneuver (Epley Maneuver)
In 1992 Epley published his first report on the “canalith repositioning procedure” (CRP). This Epley Maneuver has since been modified and is commonly referred to as the Particle Repositioning maneuver. This maneuver is the standard of practice in the offices of many Otolaryngologists. Its success has been reported at around 82% with a single maneuver.
The DizzyFIX device is designed specifically to enable anybody to perform a correct particle-repositioning maneuver. The visual feedback from the device guides patients through the most effective treatment for BPPV. Since the maneuver can be conducted at home it can be repeated as often as necessary.
Anti-Nausea drugs cover up the symptoms associated with BPPV but do not have any effect on the prognosis or duration of BPPV. Gravol, Maxeran, Ondansetron, Antivert, Dramamine, are examples of commonly used anti-nausea medications.
Sedatives (Anxiolytics) can also be used to mask the disabling symptoms associated with BPPV. These medications may still have a role to play in the management of BPPV but do not effect the course of the disease. Ativan and Lorazepam are commonly used as well as mild sedatives such as Benadryl.
Other medications called Beta-Histones are available in some countries, which may have an effect on the dizziness caused by the ear. Serc is commonly prescribed for conditions such as Meniere’s Disease. Its role in BPPV is still unclear.
Surgery for BPPV is reserved for the most severe cases which are intractable and which are not associated with other pathology. All surgical interventions carry with them the risk of anesthesia and the risk of injury to the nerve that moves the face and may also cause permanent and total deafness in the affected ear.
Posterior semi-circular canal occlusion is the simplest procedure, which addresses the cause of the dizziness at its source. The posterior semi-circular canal is surgically plugged. This prevents any loose particles from causing vertigo.
Singular Neurectomy involves the surgical cutting of the nerve that goes to part of the balance organ. It carries with the same risks as brain surgery as well as the possibility of injury to the hearing apparatus and the nerve to the face.
Vestibular Neurectomy involves the surgical cutting of all the nerves to the entire balance organ on the affected side. It is not the recommended procedure for BPPV. As above it has significant risks and will permanently remove the balance function on the affected side.
Labyrinthectomy involves the removal of the entire balance organ. In some cases this can be done with chemicals but is more commonly performed surgically. Surgical removal causes deafness on the affected side. This procedure is reserved for surgical approaches to tumors of the brain and for the treatment of refractory Meniere’s disease. It is not the recommended treatment of BPPV.
Brant-Daroff exercises have been used in the past to treat BPPV. Since the development of the Particle repositioning maneuver they are uncommonly recommended. The main downside is that they require patients to intentionally make themselves dizzy on a regular basis for a period of weeks. Their efficacy has been shown to be no greater than other treatments.
Vestibular Physiotherapy is reserved for patients with a permanent or transient loss of balance function. These exercises, including Cawthorne-Cooksey exercises, help the brain to relearn how to use the injured balance organ. The mechanism of disease in BPPV does not suggest that their use would be effective.
Frequently Asked Questions about BPPV
What Causes BPPV?
The ear normally uses small crystals called “otoconia” to determine the direction of gravity. In a disease state these crystals come loose and float around inside the inner ear. These crystal particles cause the sensation of vertigo (spinning) every time they are disturbed by head motion.
How did I get BPPV?
There are three main reasons for BPPV:
- Increasing age predisposes you to get loose particles in the inner ear.
- Infections of the ear often cause these particles to come loose.
- Head trauma and car accidents are the main cause of BPPV in young people.
How long will an episode of BPPV last?
The episodes themselves can last up to several minutes each over a period of several months. Most people get better spontaneously after months or years. However, people who have a single episode of BPPV will likely have further episodes in their lifetime.
Is this very common?
Yes. BPPV is the most common cause of dizziness related to the ear. Approximately 3 million new people are diagnosed with BPPV per year in the United States.
Will it come back?
Unfortunately this is very likely. The recurrence rate is somewhere between 20% and 60%. Fortunately a good treatment exists.
Why does it recur?
The maneuvers to treat BPPV do not permanently remove the particles which cause dizziness. These maneuvers simply relocate the particles to an area of the inner ear which does not cause vertigo. However, after several months or years these particles can find their way back into areas of the inner ear which are problematic.
How can I reduce the chance of having it again?
There is very little which effects the recurrence rate of BPPV.
Will flying or swimming worsen my BPPV?
No. Flying can affect certain ear conditions which are pressure related. BPPV is not one of them.
Is there anything which makes BPPV worse or better?
Yes. Stress, and lack of sleep both make the symptoms worse. Some people think a poor diet and alcohol intake also make the symptoms worse.
What are the crystals made of?
The “otoconia” crystals are primarily made up of calcium. Although they are a normal part of the inner ear, they are not supposed to be free floating.
Is there a treatment for dizziness and vertigo caused by BPPV?
Yes. DizzyFIX is an effective and natural treatment for vertigo and dizziness due to BPPV. The DizzyFIX interactively guides you through a particle repositioning maneuver. This maneuver helps you treat the most common cause of vertigo called Benign Paroxysmal Positional Vertigo or “BPPV”. The maneuver cures vertigo and dizziness in 88% of patients with just 1 treatment.
What else can I do?
Medications like sedatives, antihistamines and anti-nauseants do help to a certain degree Visit your family doctor to rule out other causes of dizziness.
Time often helps patients cope with dizziness. BPPV resolves spontaneously in most people after a period of between 3 months to 2 years.
There is a surgical procedure for BPPV called ‘Posterior Semi-cirular Canal Occlusion’ but it involves drilling into the mastoid bone, which is the very thick bone behind the ear. It has certain risks associated with it and should be considered akin to brain surgery. Unless the symptoms are very severe this is not a reasonable option for most people.
Complementary therapy has been tried by many patients. Acupuncture, Chiropractic and Naturopathic treatments may have benefit but this has yet to be quantified scientifically.
Is it possible to have two types of dizziness at the same time? Both BPPV and Labyrinthitis?
Yes. One of the major causes of BPPV are viral inner ear infections or Labyrinthitis. This type of BPPV is often called “Post Viral BPPV”. Labyrinthitis is a viral infection of the vestibular nerve (the nerve of balance). Typically characterized by a week of spinning vertigo and nausea which goes away by itself. It can leave the person with little or no balance function and can cause BPPV. The virus causes the nerve to swell and stop functioning. It sometimes dies. Sometimes doctors will treat with either steroids or antiviral agents during the acute episode in hopes of lessening the effect. Typically the virus is just a normal cold virus.
How can you get Labrinthitis diagnosed?
Labyrinthitis is typically a clinical diagnosis made on history and physical exam. Some specific balance tests may help confirm the diagnosis. An ENG (Electro-nystagmo-gram) which can be done at any Neuro-otologists office (Subspeciality ENT) will tell you, in most cases, what the problem is, or at least if it is related to the ear.
Do I Have BPPV?
BPPV is the most common cause of vertigo related to the ear. About 1 in 5 people who have dizziness will have BPPV. This number increases in the elderly or in at risk populations.
While BPPV is common, it is not the cause of all types of dizziness. It is easy to differentiate BPPV from other causes by reviewing these statements.
- My dizziness lasts only seconds to minutes, never hours or days.
- I can bring on the symptoms by certain head positions.
- It feels like either the room or my body is spinning.
- My dizziness is not associated with a change in my hearing or a noise in my ears.
- If you agree with the above statements there is a strong likelihood that your dizziness is BPPV.
- Here is a tool to help diagnose BPPV
(M von Brevern, A Radtke, F Lezius, M Feldmann, T Ziese, T Lempert. Epidemiology of benign paroxysmal positional vertigo. A population-based study. J. Neurol. Neurosurg. Psychiatry)
“Vestibular Vertigo” is dizziness related to the ear (you must have at least one of following 3 symptoms):
- Spontaneous rotational vertigo (Spinning suddenly)
- Positional vertigo (Spinning when laying down)
- Recurrent dizziness with nausea (sick to the stomach) and either oscillopsia (difficulty reading due to vision problems when dizzy) or imbalance
- Benign paroxysmal positional vertigo (ALL 4 of the following must be true):
- Recurrent “Vestibular Vertigo” (as above)
- The duration of the attack must always be < 1 minute
- Symptoms invariably provoked by the following changes of head position:
- Lying down or
- Turning over in the supine (lying on your back) position
- or at least 2 of the following maneuvers:
o Reclining the head
o Rising up from supine (lying on your back) position
o Bending forward
o Not attributable to another disorder
If the above tests show that you have BPPV, then the DizzyFIX may be right for you!
People with BPPV experience rapid involuntary eye motion called Nystagmus when in a head hanging position. The Nystagmus associated with BPPV is rotatory. The top of the eye moves towards the ground. This is called Geotropic. The Nystagmus disappears after several seconds and the associated vertigo passes.
DISCLAIMER: While the information offered here is intended to be of help to the user, this information in no way establishes a doctor-patient relationship between the user and Clearwater Clinical Ltd. or any Clearwater Clinical Ltd. Employee/Representative.
Always consult a physician before pursuing any treatment.