Dizziness: BPPV

Dizziness: BPPV (part 3)
By Heather Meyer

Here at Midwest ENT Centre, we assess and diagnose patients with many inner ear and balance disorders. One of the most common causes of dizziness in patients is called Benign Paroxysmal Positional Vertigo, or BPPV. It is present in about 20% of all dizzy patients, but is more likely found in older individuals. This is a condition caused by small calcium crystals floating in the fluids of the inner ear. When a person turns their head, the movement of fluids in the semi-circular canals send a signal to the brain, indicating direction. Loose crystals in the fluid disrupts normal responses, and are interpreted by the brain as dizziness or vertigo.

In addition to these, signs of BPPV can include lightheadedness, imbalance or unsteadiness, difficulty concentrating, and nausea. Although abrupt and sometimes frightening, these sensations usually last for only brief periods of time (usually 30-60 seconds), although unsteadiness may continue for longer. Activities that bring on symptoms vary in each person, but are precipitated by changes in head position. Rolling over, getting out of bed, bending over, and tilting the head to look up are commonly associated movements with BPPV.

What can be done for BPPV?

During a visit to our clinic, the physician may order further testing of the inner ear balance system to determine the source of a person’s dizziness. As previously discussed, VNG testing may be used to determine whether a person has BPPV or another inner ear balance disorder. If signs and testing indicates BPPV, the physician may perform a simple head-rolling maneuver in the office, which often alleviates symptoms right away. The doctor may also recommend other specific exercises intended to reposition the floating crystals so that they are no longer interfering with normal inner ear functions. Physical therapy may also be necessary, to help in developing long-term strategies.

Symptoms usually decrease over time as the inner ear system recovers and crystals are reabsorbed or return to their original placement. However, those who develop BPPV once are very likely to experience it again in the future.

What if my symptoms have improved: should I still go ahead and take the VNG test?

Yes! The VNG test is designed to determine the underlying cause of your dizziness and other symptoms. Although these may have gotten better, the doctor still needs to find what the cause of your initial symptoms were and how the balance system is recovering. BPPV is often characterized as having intermittent symptoms that decrease after a while, only to return again at a later time. Importantly, the VNG results may be able to tell how likely you are to experience another episode in the future.

Source: Vestibular Disorders Association and American Speech-Language-Hearing Association