Most common vestibular disorder: Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (or BPPV) is general cause of vertigo. It is a false sensation of spinning complain by patient. Usually, it causes a sudden sensation of spinning, but it can also make you feel like your head is spinning from the inside. Benign paroxysmal positional vertigo causes brief episodes of mild to intense dizziness. Benign paroxysmal positional vertigo is usually prompted by explicit changes in the position of patient’s head. This might occur when he tip his head up or down, when he lies down, or when he turns over or sit up in bed. Benign Paroxysmal Positional Vertigo can be an irritating problem. Rarely, it is life threatening problem. Patients may get proper treatment to get rid of this disease.

Figure: Anatomy of right inner ear

Benign Paroxysmal Positional Vertigo is a mechanical problem in the inner ear. It happens when some of the calcium carbonate crystals (otoconia) that are normally surrounded in gel in the utricle become removed and migrate into one or more of the 3 fluid-filled semicircular canals, where they are not supposed to be. When plentiful of these particles collect in one of the canals they obstruct with the normal fluid movement that these canals use to sense head motion.

As a result, the inner ear send false signals to the brain. Fluid in the semi-circular canals does not usually react to seriousness. Though, the crystals do move with gravity, thereby moving the fluid when it normally would be still. When the fluid moves, nerve endings in the canal are excited and send a message to the brain that the head is poignant, but actually it is not moving. This false information does not match with what the other ear is sensing, with what the eyes are seeing, or with what the muscles and joints are doing, and this incompatible information is perceived by the brain as a spinning sensation, or vertigo, which usually lasts less than one minute. Between vertigo influences some people feel symptom-free, while others feel a mild sense of imbalance.

It is vital to discern that Benign Paroxysmal Positional Vertigo will cause constant dizziness that is unaffected by movement or a change in position. It will also not affect patient’s hearing or produce fainting, headache or neurological symptoms such as numbness, “pins and needles,” trouble speaking or trouble harmonisinghis movements. If patients complaint for additional symptoms, they must seek medical attention immediately.It is also possible that patient is misdiagnosed with disorders. It is therefore important that patients must be alert when explaining his symptoms to healthcare provider in addition to vertigo. Practitioners also needs to re-evaluate condition and consider whether he may have other disorder.

Major causes:

It is stated by medical researchers that there is no known cause for BPPV. When a cause can be firm, BPPV is often related with a minor to severe blow to person’s head. Sometimes, common causes of BPPV include disorders that damage inner ear of person or, infrequently, damage that occurs during ear surgery or during continued positioning on person’s back. Another cause of BPPV is migraines.

Benign Paroxysmal Positional Vertigo is caused by a trouble originating inside the inner ear. The fluid-filled tubes in your ear, called semicircular canals, are very sensitive to the movement of fluid that occurs when your position changes. Benign Paroxysmal Positional Vertigo develops when small pieces of calcium break free and find their way to the tube in the inner ear. This causes human brain to receive confusing messages about his body’s position.

Benign Paroxysmal Positional Vertigo Symptoms:

Patients suffering from BPV complain following symptoms:

• - Vomiting
• - Vertigo
• - Blurred vision
• - Nausea
• - Dizziness
• - Light-headedness
• - Loss of balance
• - Unsteadiness

Symptoms of BPV can be intermittent. They commonly last for less than one minute. Activities that bring on BPV can differ from person to person. However, most symptoms are brought on by a change in person’s head’s positioning. Abnormal eye movements, also called nystagmus, frequently accompany BPV symptoms. In rare case, patients can have BPV in both ears. In some extreme cases of BPV, sufferers can develop dehydration due to vomiting. Abnormal rhythmic eye movements (nystagmus) frequently accompany the symptoms of benign paroxysmal positional vertigo.

Risk Factors of Benign Paroxysmal Positional Vertigo: Although there are no major risk factors for Benign Paroxysmal Positional Vertigo, there is some sign that it could be hereditary condition. Many diagnosed individuals have showed that multiple relatives have also suffered from the condition. Moreover, head injuries occurred previously or an inner ear condition can make some people more prone in developing Benign Paroxysmal Positional Vertigo. Benign paroxysmal positional vertigo happens mostly in people having 50 years of age and older, but can occur at any age. Benign paroxysmal positional vertigo is also more common in women as compared to men. A head injury or any other disorder of the balance organs of person’s ear may be susceptible to Benign paroxysmal positional vertigo.

When to seek medical care:

Normally, patients must visit to doctor if they experience any unexplained dizziness or vertigo that recurs periodically for more than one week.

In following conditions, patients must seek emergency care:

1. A fever
2. Double vision or loss of vision
3. Hearing loss
4. Trouble speaking
5. Leg or arm weakness
6. Loss of consciousness
7. Falling or difficulty walking
8. Numbness or tingling

The signs and symptoms mentioned above may indicate a more serious problem.

Diagnosis:

Doctors diagnose Benign Paroxysmal Positional Vertigo through conducting series of tests to determine the cause of patients’ dizziness. During a physical examination, doctor will likely to investigate:

1. Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute.
2. Dizziness with specific eye movements that occur when person lie on his back with his head turned to one side and tipped slightly over the edge of the examination bed.
3. Involuntary movements of eyes from side to side (nystagmus).
4. Inability to control eye movements.

The doctor may ask if patientis experiencing a spinning sensation. Doctor will also conduct a general physical exam. He or she will obtain a complete medical history and also perform a neurological exam to rule out any other disorders or diseases.

If the cause of signs and symptoms is problematic to determine, doctor may conduct additional testing that are mentioned below.

Additional tests might include:

1. Caloric stimulation (warming and cooling the inner ear with water or air to observe eye movements).
2. Magnetic resonance angiography of the headhearing evaluation.
3. Magnetic resonance imaging (MRI) of the head: This test uses a magnetic field and radio waves to create cross-sectional images of patients’ head and body. Radiologists can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other probable causes of vertigo.
4. Computed tomography (CT) scan of the head:
5. Electronystagmography (ENG), which records eye movement: The aim of these tests is to identify abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while patient’s head is placed in different positions or his balance organs are stimulated with water or air.
6. Electroencephalogram (EEG), which measures brain activity:

Canalith repositioning:

It is performed in doctor's chamber. The canalith repositioning procedure consists of several simple and slow manoeuvres for positioning person’s head. The main objective of this is to move particles from the fluid-filled semicircular canals of patient’s inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs in ear where these particles donot cause trouble and are more easily resorbed. Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure is usually effective after one or two treatments.

To conduct this technique, doctors will likely train patients how to do the canalith repositioning procedure so that they can do it at home if needed.

Surgical Options: This is done in very rare situations in which the canalith repositioning procedure is not effective. Then doctor may recommend a surgical procedure in which a bone plug is used to block the portion of inner ear that is the cause of dizziness. The plug prevents the semi-circular canal in ear from being able to respond to particle movements or head movements in general. The success rate for canal plugging surgery is approximately 90 percent.

Although Benign Paroxysmal Positional Vertigo is temporary, it is important to seek medical advice and get thorough examination by doctor especially when symptoms persist because in some conditions, Vertigo may be serious. Following symptoms may be the sign of stroke.

1. A change in consciousness
2. Difficulty speaking or walking
3. Double vision
4. Weakness

Treating BPV:

Epley’sManeuver

Some doctors consider this to be the most effective BPV treatment. It involves moving the offending piece of calcium to a different part of your inner ear where it will no longer cause problems.

Home remedies:

Person can work to manage the dizziness related with Benign Paroxysmal Positional Vertigo with the following instructions:

1. Be Watchful. Losing balance is always a possibility. Be aware of surroundings and avoid placing yourself at risk. Falls can cause serious injuries.
2. Sit Down. Whenever person feel dizzy, take a seat. Sitting down during a dizzy spell can help him avoid falling.
3. Be Safety Conscious. Take precautions such as using good lighting around the home and using a cane for stability.
4. Know Causes. Preventing symptoms of vertigo from becoming worse during episodes of Benign Paroxysmal Positional Vertigo can be as simple as avoiding the positions that trigger it.

Precautions:

When patient is having Benign Paroxysmal Positional Vertigo, he must take some precautions to avoid any seriousness of disease:

1. It is recommended to use two or more pillows at night.
2. Person should avoid sleeping on side with the ear that's causing the problem facing down.
3. Patient must get up slowly in the morning and sit on the edge of the bed for a moment before standing.
4. Patients must avoid leaning over to pick things up or tipping their head far back to look up.
5. Patients must be careful about reclining, such as when they are in the dentist's chair or having hair washed at a hair salon.
6. They should be careful about playing sports that require to turn your head, lean over, or lie flat on their back.

It is advisable to do balance exercises and taking safety precautions.

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