Benign Paroxysmal Positional Vertigo

What is benign paroxysmal positional vertigo?

Benign paroxysmal positional vertigo (BPPV) is an inner ear condition. BPPV is also called positional vertigo or benign (not life-threatening) paroxysmal nystagmus. With BPPV you have paroxysmal (sudden) attacks of vertigo when you change your head position. Vertigo is the sudden feeling that you or the room is moving or spinning. With each attack of vertigo, you may have nystagmus. Nystagmus is a quick, shaky eye movement that you cannot control. The attacks of vertigo and nystagmus last from a few seconds up to 1 minute. Treating your BPPV may help resolve your vertigo attacks, and decrease your risk for injuries from falls.

What causes benign paroxysmal positional vertigo?

The exact cause of your BPPV may not be known. BPPV may be caused by otoconia that float into the semicircular canals in your inner ears. The otoconia are small pieces of calcium (a mineral) normally found in an area of your ear called the utricle. You have 3 loop-shaped, semicircular canals in each inner ear. The semicircular canals are called the posterior, lateral, and superior canals. With BPPV, the pieces commonly collect in your posterior semicircular canal. When the pieces enter a semicircular canal, you may have symptoms of BPPV.

What increases my risk for benign paroxysmal positional vertigo?

  • Age: As you age, your risk for BPPV increases.

  • Ear infections: Chronic (long-term) recurring ear infections increase your risk for BPPV.

  • Gender: Women are more likely to get BPPV than men.

  • Long-term bed rest: Staying in bed for long periods of time increases your risk for BPPV. Your risk is greater if you lie on the same side of your head most of the time.

  • Medical conditions: Certain medical conditions may increase your risk for BPPV. Medical conditions include diabetes, high blood pressure, migraine headaches, and Ménière disease.

  • Trauma: You may be at risk for BPPV after you have an injury or trauma to your head or neck.

What are the signs and symptoms of benign paroxysmal positional vertigo?

Head movements, such as looking up or down and bending over, may lead to an attack of vertigo. Vertigo may also occur when you first lie down or roll over in bed. The nystagmus will decrease with vertigo attacks that occur close together. When you have an attack of BPPV, you may also have the following symptoms:

  • Changes in your vision.

  • Nausea (upset stomach) or vomiting (throwing up).

  • Poor balance and feeling unsteady when you walk.

How is benign paroxysmal positional vertigo diagnosed?

Your caregiver will ask about your symptoms and any health problems you have. Tell your caregiver if you have had surgeries, ear infections, or head injuries. Your caregiver will look inside your ears. Your caregiver may also check your eyes. Tell your caregiver if you are taking any medicines, including herbs, supplements, and over-the-counter (OTC) medicines. Your caregiver may do the following tests:

  • Dix-Hallpike maneuver: The Dix-Hallpike maneuver helps diagnose posterior semicircular canal BPPV. During this test, you sit on a table with your legs out in front of you. Your caregiver then turns your head to one side and tips your neck back slightly. Your caregiver then lays you on your back. Your head will be supported as it hangs over the end of the table. Your caregiver watches your eyes for nystagmus and times how long the movements last. After the test, your caregiver may have you do it again with your head turned to the other side. You may get an upset stomach from the Dix-Hallpike maneuver.

  • Supine roll test: If your caregiver thinks you have lateral semicircular canal BPPV, you may need to do the supine roll test. During this test, you lie on your back on a table. Your caregiver quickly turns your head to one side and checks for nystagmus. Your head is turned back to the face-up position until the nystagmus stops. Your caregiver then quickly turns your head to the other side and watches for nystagmus. You may feel dizzy during the supine roll test.

What other tests may I need when I have benign paroxysmal vertigo?

Ask your caregiver about these and other tests you may need:

  • Audiometry testing: This test checks for hearing loss or helps caregivers learn how much hearing loss you have.

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • Electronystagmography: This test is also called an ENG. An ENG is done to test for problems you may have with balance or dizziness. Sticky pads with wires are placed on the skin around your eyes. The wires are connected to a special machine that records information during your ENG. Warm and cool air or water is put into your ears while your eye movements are recorded. Do not drink alcohol or eat a heavy meal before this test. You may feel dizzy or sick to your stomach after the test.

  • Magnetic resonance imaging: This test is called an MRI. During the MRI, pictures are taken of your head to look inside your ears and brain. You need to lie still during an MRI. Never enter the MRI room with any metal objects. This can cause serious injury.

  • Computed tomography scan: This test is also called a CAT or CT scan. A computer takes pictures of your brain and the inside of your ears. You may be given dye in an IV before the pictures are taken. The dye helps your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish.

How is benign paroxysmal positional vertigo treated?

Sometimes, your caregiver waits to see if your symptoms go away on their own. Untreated BPPV may go away within 6 to 8 weeks. Treatments for BPPV include head movements to move the otoconia pieces out of your semicircular canals. Your caregiver may give you medicine to prevent nausea during your treatment. You may need the following:

  • The Epley procedure: The Epley, or canalith repositioning procedure (CRP), is done to treat posterior canal BPPV. Sitting on a table, your caregiver turns your head to the side, toward the ear causing your symptoms. Your caregiver then quickly lays you back on the table with your head hanging over the edge. You stay in the position at least 20 to 30 seconds. Your caregiver then turns your head to the other side for another 20 to 30 seconds. You then turn your body onto the side you are facing, rolling over until you are almost facing down. After 20 to 30 seconds, you can sit up. During the procedure, your caregiver watches your eyes for nystagmus.

  • The Semont maneuver: During the Semont maneuver, you sit on a table. Your caregiver turns your head to one side and quickly lays your body on the side you are facing. You lie on your side for about 30 seconds. Without sitting up, your caregiver rolls your body to the other side. You stay there for another 30 seconds before slowly sitting up.

  • The Lempert maneuver: During the Lempert, or barbecue roll maneuver, your caregiver rolls you over completely in a series of steps. The Lempert maneuver is done for lateral canal BPPV.

  • The Vannucchi maneuver: During the Vannucchi maneuver, you lie on a bed. You turn your head or roll your entire body to the side of your healthy ear. You will need to stay in this position for up to 12 hours. Your caregiver may have you do this maneuver at home to treat your lateral canal BPPV.

  • Vestibular and balance rehabilitation therapy: During vestibular and balance rehabilitation therapy (VBRT), you learn exercises to improve your balance and strength. VBRT may help decrease your dizziness and prevent injuries if you are at risk for falls.

  • Surgery: You may need surgery to treat your BPPV if other treatments have failed. Ask your caregiver for more information about the following surgeries:

    • Posterior semicircular canal occlusion: During this surgery, your posterior semicircular canal is filled with bone chips or glue. The filled canal blocks otoconia from entering and causing BPPV.

    • Singular neurectomy: During this surgery, part of a nerve that connects to your posterior semicircular canal is cut. Cutting the nerve resolves your symptoms of BPPV.

What are the risks of benign paroxysmal positional vertigo?

  • Treatments for BPPV may cause dizziness, nausea, and vomiting. Treatment may also cause you to faint. Treatment may cause the otoconia pieces to leave one semicircular canal and enter another. Even after treatment to move the otoconia out of your semicircular canal, your symptoms may not improve. If your symptoms resolve, they may return. You may need treatment again. If you have surgery to treat your BPPV, you may have problems with your balance. After surgery, you may have temporary or permanent hearing loss.

  • If you do not get treatment for BPPV, your symptoms, such as vertigo and nausea, may get worse. You may be at higher risk for falling and getting hurt. You may not be able to drive if your vertigo gets worse. You may become depressed or anxious. You may worry so much about having an attack of vertigo that you will not leave your home. Your symptoms of BPPV may interfere with your ability to do your daily activities, such as work.

What can I do to prevent my symptoms from returning after treatment for benign paroxysmal positional vertigo?

  • Avoid sudden head movements.

  • Do not bend over at the waist for 2 full days.

  • Only lay on the side with your healthy ear for 2 full days.

  • When you lie down, keep your head raised up. Do not lie on your back for 2 full days.

How can I help decrease my risk for getting benign paroxysmal positional vertigo again?

  • Avoid long-term bed rest: Try not to stay in bed for long periods of time. If you are on bed rest, change your position often. Try not to lie with your head on the same side for long periods of time.

  • Manage your medical problems: Get proper treatment for medical problems, such as diabetes and high blood pressure.

  • Wear a helmet: Wear a helmet when you ride a bike or play sports. A helmet helps protect your head from injury.

Where can I find more information?

  • American Academy of Family Physicians
    11400 Tomahawk Creek Parkway
    Leawood , KS 66211-2680
    Phone: 1- 913 - 906-6000
    Phone: 1- 800 - 274-2237
    Web Address: http://www.aafp.org
  • American Hearing Research Foundation
    8 South Michigan Avenue, Suite 814
    Chicago , IL 60603-4539
    Phone: 1- 312 - 726-9670
    Web Address: http://www.american-hearing.org

When should I call my caregiver?

Call your caregiver if:

  • You feel anxious or depressed and do not want to leave your home.

  • You have problems with your balance, or you are falling often.

  • You have new or increased nausea or vomiting when you have vertigo.

  • You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You fall and hurt yourself.

  • You have a severe headache that does not go away.

  • You have new changes in your vision or feel weak or confused.

  • You have problems hearing, or you have ringing or buzzing in your ears.

  • Your BPPV symptoms last longer than 1 minute.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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