Have you ever experienced dizziness or vertigo?
If so, you might have a condition called BPPV, which stands for benign paroxysmal positional vertigo.
Although BPPV can be unsettling, the good news is that it's treatable without medications or surgeries.
While the word benign is in BPPV, really the only one it’s benign for is for people who have never experienced the rush of room spinning sensation, subsequent fear and anxiety, and potential nausea and vomiting.
Benign does however mean that it is non life threatening, which is good to know since these violent vertigo attacks can make it feel like your word is rolling over on its axis.
BPPV is the most common cause of vertigo. It is estimated that around 2.4% of the population experiences BPPV at some point in their lives, and it is most common in adults.
What is BPPV?
BPPV is a condition that affects the inner ear, or the vestibular system, which is responsible for balance and spatial orientation.
Specifically, BPPV occurs when tiny calcium crystals in the ear become dislodged and float into one of the semicircular canals, which are the fluid-filled structures that help detect movement and position.
When this happens, the brain receives conflicting signals from the affected ear, which can result in feelings of dizziness, vertigo, or spinning.
I know it sounds crazy to say you have crystals in your head, but you do and they are actually called otoconia.
What are the symptoms of BPPV?
The most common symptoms of BPPV include:
How is BPPV diagnosed?
To diagnose BPPV, a healthcare provider will typically perform a physical exam and ask about your symptoms.
Your healthcare provider should be performing tests that assess all of your systems of balance to help rule in/out other conditions that may be influencing your symptoms.
They may conduct tests such as the Dix-Hallpike maneuver, which involves moving the head into different positions to see if it triggers symptoms of vertigo and nystagmus (eye reflex response).
However, the Dix-Hallpike not a stand alone test for assessing for BPPV.
Dix-Hallpike will only assess part of your inner ear, specifically the posterior canal.
Posterior canal BPPV is the most common type of BPPV, accounting for approximately 80% of all cases. The other types of BPPV are less common, with the horizontal canal accounting for 10-15% of cases and the anterior canal accounting for less than 5% of cases.
If the crystals have fallen into another area of the inner ear, then the Dix-Hallpike won’t be effective since different types of maneuvers are required for assessment and treatment of the other canals.
It is also possible to have more than one canal involved, and/or more than one inner ear.
Additionally, it's possible that your vertigo may not be BPPV at all. 🤦🏻♀️
So it’s complicated, and this is why seeing a specialist who is experienced in all forms of evaluation and treatment of vertigo is recommended.
How is BPPV treated?
The good news is that BPPV is very treatable in most cases and symptoms typically resolve within a few sessions of canal repositioning maneuvers.
One common treatment is a procedure called the Epley maneuver, which involves moving the head in a series of specific positions to help the calcium crystals return to their proper place in the ear.
The Epley maneuver is used to treat the calcium crystals that have fallen into the posterior canal.
There are other treatment maneuvers such as the Gufoni, and Appiani which can address the calcium crystals that have fallen into other canals.
Other treatments may include medications to manage symptoms, such as anti-nausea drugs.
Just remember that “vertigo” is not a diagnosis, it’s a symptom.
There is always an underlying cause to vertigo and treatment by medication alone is not enough to address a weak or injured balance or vestibular system.