A brief overview of Benign paroxysmal positional vertigo – the root cause behind Vertigo

Author: Rahul Kumar

Benign paroxysmal positional vertigo or BPPV as it is more commonly known as, is one of the root causes of vertigo, a disease in which the patient experiences the sensation of the world spinning around while he is standing still. BPPV is said to be the most common cause of vertigo but generally has a very mild effect. Symptoms of BPPV are observed only when a person moves his head in a sudden motion such as moving head sideways very quickly or nodding in quick succession.

Causes

Before knowing the causes of BPPV, it is important to understand what exactly goes wrong in BPPV which results in dizzying sensations. BPPV is associated with the internal organs in an ear. The innermost part of the ear contains a labyrinth of nerves and small organs, most important of which are three semi-circular canals which are responsible for monitoring the rotation of the head. In BPPV, due to some reason, certain ear crystals get dislodged from their original position and accumulate in one of these canals, jamming it and affecting its functioning. As a result, it starts responding to head position changes which it normally does not do, causing dizziness.

The exact cause why the ear crystals get dislodged and move into the canal is not known. However, the following causes are broadly considered while diagnosing BPPV:

  • Head injuries
  • Ear infections or surgeries
  • Medications which may have side effects affecting the ear
  • Migraines
  • Prolonged bed rest such that the person’s head remains in the same position

Tests

To diagnose BPPV, the doctor will generally conduct a physical examination first to test the patient’s eye movements, head movements and their effect through a series of exercises. Thereafter, the following two tests may be performed:

  • Electronystagmography (ENG) – The test is basically performed to detect nystagmus, a condition associated with Vertigo in which eye movement coordination is affected. The test is performed using electrodes or through micro cameras in case of VNG.
  • Magnetic Resonance Imaging (MRI) – This test is not very commonly prescribed but can be useful in cases where a brain tumour is suspected. The test is basically an advanced form of X-ray and gives a cross-sectional image of the brain and surrounding organs including the ear labyrinth.

Treatment

The treatment for BPPV is fairly simple as it rarely involves any drugs or other strong medications. The most effective treatment is canalithic repositioning which indicates a set of exercises which can reposition the ear crystals which are blocking the sensitive canals and set them back in their original place.

In rare cases when canalithic repositioning does not work, surgery is done to plug the affected canal in order to make it stop responding to head movements.