Benign Paroxysmal Positional Vertigo - Causes, Symptoms, Diagnosis, and Treatment Maneuvers

What Is Benign Paroxysmal Positional Vertigo?

Benign paroxysmal positional vertigo is a sensation of head spinning and a feeling of going off-balance, which an individual experiences every time they make sudden head movements. It is a benign condition which means it is not life-threatening. The word paroxysmal refers to something that only lasts for a few seconds. Positional means vertigo happens due to changes in one's head or body positions. Benign paroxysmal positional vertigo is primarily caused by foreign body deposits on the minute structures inside one’s ear. It is considered a symptom of other undetected diseases as well. Vertigo can have a significantly negative impact on an individual's quality of life. Hence it should be treated appropriately.

What Causes Benign Paroxysmal Positional Vertigo?

It occurs in all ages but is more common in individuals above the age of fifty years. Structures called semicircular canals inside one’s ear have a major role in maintaining the balance of the body. They are filled with a fluid that tends to move around when there are positional changes. Concerning the movements in the fluid, the semilunar canals detect the changes in head positions and maintain the equilibrium preventing falls. Sometimes, substances like calcium carbonate crystals get accumulated in this structure. This may disturb the ability of the semicircular canals to function normally.

As a result, the individual experiences an erroneous sense of spinning at every head movement they make. Other causes of benign paroxysmal positional vertigo can be:

• Head injury due to trauma.

• Rapid head movements.

• Viral infections of the ear (labyrinthitis).

• Inflammation of the nerve connected to the ear (neuritis).

• A tumor on the nerve.

• Meniere’s disease (a condition with abnormal fluid collection in the inner ears).

• Migraine.

• As a part of ear surgery complications.

• As an adverse reaction to certain medicines.

• As a part of the aging process.

• Those with a family history of benign paroxysmal positional vertigo are at a higher risk.

What Are the Signs and Symptoms of Benign Paroxysmal Positional Vertigo?

The following are the apparent symptoms experienced when one is under a vertigo spell:

1. There is a typical feeling of head-spinning on making any head movements. Some may describe it as ‘my head is spinning’ or ‘the world is spinning around me’.

2. The spinning starts suddenly triggered by the changes in head position.

3. Simply rolling over in bed, bending over to pick up something, or tilting the head to look at something may also trigger dizziness.

4. Losing the body balance, one tends to fall.

5. In most cases, the vertigo episode may last only less than a minute.

6. Periodical recurrence of vertigo episodes, meaning the condition lasts for several weeks to months, followed by a period of remission. Then it starts again.

7. One may suffer severe nausea and vomiting.

8. Unintentional rapid eye movements at the time of the vertigo spell (nystagmus). Eyes seem to jump or twitch in all directions.

9. Some may suffer hearing loss and blurred vision as well.

How Is Benign Paroxysmal Positional Vertigo Clinically Diagnosed?

This is usually an easy condition to diagnose. The doctor will ask about the medical history of the individual to identify the undetected disease conditions that may have triggered one’s vertigo attack. This is followed by a physical examination. The doctor may perform one or two confirmatory tests specifically to diagnose this condition. They are:

• Dix Hallpike test - Where the patient is made to sit upright, and the head is positioned in a forty-five-degree angulation. Then the patient is forced back into a lying-down position. This position is held for about thirty seconds. If this makes the patient perform uncontrollably rapid eye movements (nystagmus) and complain of dizziness, it is suggestive of benign paroxysmal positional vertigo. Additionally, this test helps differentiate if the vertigo is caused by a problem in the inner ear or the brain.

• A side-lying test is performed to check if sitting upright and lying down to one’s side with the head angulated causes the same symptoms mentioned above and to determine which ear is affected.

• Caloric stimulation test; where the inner ear is filled with warm and cold water simultaneously, and the eye movements are observed for involuntary reactions.

• Computed tomography (CT) scan or magnetic resonance imaging (MRI) of the head to look for any underlying cause of vertigo.

• An electroencephalogram (EEG) to detect the electrical activity inside the brain.

• An electronystagmography (ENG) to detect the rapid eye movement response (nystagmus) produced by electrical stimuli around the eyes.

What Is the Treatment for Benign Paroxysmal Positional Vertigo?

An individual with Benign paroxysmal positional vertigo may recover spontaneously without any treatment. But it may take as long as weeks, months, or years to recover from the symptoms. The following strategies are used routinely:

1. Epley’s Maneuver - It is a type of treatment performed in the physician's office for migrating the calcium deposits from inside the semilunar canals so that the symptoms are relieved. This procedure is considered the best way to resolve a benign paroxysmal positional vertigo. However, it may have to be repeated several times if the symptoms come back.

2. Modified Semont Maneuver - Is performed for people who cannot lie on their back. The affected individual is trained to do this on their own.

3. Vestibular Rehabilitation Therapy - Where one can perform balancing therapy exercises to improve the sense of losing balance.

4. Medications - Drugs like Antihistamines, Anticholinergics, and Sedative Hypnotics are also prescribed to relieve the spinning sensations. They include Meclizine, Diazepam, etc.

5. Symptom Control - For those who suffer significant nausea and vomiting along with vertigo, prescription medicines like Ondansetron, Metoclopramide or Promethazine can help control the symptoms.

Conclusion:

When the vertigo symptoms like dizziness do not resolve sooner, one is always at risk of falling. Activities such as driving or swimming also pose a level of risk to the affected individuals. Additionally, there is a risk of getting dehydrated due to repeated vomiting at the time of the attack. The best way to prevent benign paroxysmal positional vertigo from occurring is to avoid the positions that trigger it. For instance, one should not sleep on the affected side, do head rotations, bend over much, and make sure to rise from the bed slowly. A qualified medical professional will be the best guide to advise on how to resolve paroxysmal positional vertigo effectively.