What are the other Names for this Condition? (Also known as/Synonyms)

• Benign Paroxysmal Positional Nystagmus
• BPPV (Benign Paroxysmal Positional Vertigo) 

What is Benign Paroxysmal Positional Vertigo? (Definition/Background Information)

• Benign Paroxysmal Positional Vertigo (BPPV) is one of the common causes of vertigo
• Vertigo is a sudden sensation of spinning; one may feel that they are spinning or they may feel that the space around them is spinning. The episodes of vertigo are characteristically caused by changes in the position of the head
• BPPV is caused by a disorder of the inner ear vestibular system; the prime function of the vestibular system is to maintain balance. The semi-circular canals, in the vestibular system of the inner ear are fluid-filled canals that are responsible for detecting the body’s position and balance
• Other structures in the inner ear are the utricle and saccule (otolith organs), which monitor the movements of head in relation to gravity
• These otolith organs contain certain crystals, and these crystals for some unknown reason get dislodged and transported to one of the semicircular canals. This makes the semicircular canals sensitive to changes in the head position
• Benign Paroxysmal Positional Vertigo is usually experienced by individuals at the age of 60 years or older. There are no long-term complications of BPPV
• The condition can be treated using the canalith repositioning procedure. Benign Paroxysmal Positional Vertigo may cause discomfort, but generally, treatment can help improve the symptoms over time
• Currently, there is no effective prevention of Benign Paroxysmal Positional Vertigo

Who gets Benign Paroxysmal Positional Vertigo? (Age and Sex Distribution)

• Benign Paroxysmal Positional Vertigo is usually experienced by adults over the age of 60 years
• However, the condition may develop at any age
• There are no geographical, racial, or gender predilection observed

What are the Risk Factors for Benign Paroxysmal Positional Vertigo? (Predisposing Factors)

• There are no other known risk factors besides an advancing age, which increases one’s risk of Benign Paroxysmal Positional Vertigo

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Benign Paroxysmal Positional Vertigo? (Etiology)

With Benign Paroxysmal Positional Vertigo, the inner ear crystal deposits (otoconia, present in the utricle and saccule) are displaced from their usual position and transported to the semi-circular canals, which causes them to become sensitive to changes in the head position. The exact cause of dislodgment of otoconia is not known, but some possible causes include:

• Minor to heavy blows to the head
• Damage during ear surgery
• Prolonged positioning on one’s back (such as while performing certain tasks)
• High-intensity aerobics
• Disorders that damage the inner ear
• Vestibular migraines

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

The signs and symptoms associated with Benign Paroxysmal Positional Vertigo are mostly due to the sensation of ‘head spins’ experienced by the affected individuals. These include the following signs and symptoms:

• Nystagmus (involuntary eye movement due to inner ear stimulation)
• Nausea and vomiting
• Hearing loss
• Blurred vision due to vertigo
• Loss of balance

The spinning sensation:

• Can last from a few seconds to a few minutes
• May start suddenly and occur recurrently (paroxysmal)
• Is triggered by head motion or movement

How is Benign Paroxysmal Positional Vertigo Diagnosed?

A diagnosis of Benign Paroxysmal Positional Vertigo may involve:

• A complete evaluation of one’s medical history and a thorough physical exam
• During physical exam, the physician may assess for the following:
  • Nystagmus: Involuntary movements of the eye from side to side
  • Inability to control eye movements
  • Risk of falls      

The following tests are generally performed:

• Dix-Hallpike test:
  • It is an inexpensive way for the healthcare provider to determine if the vertigo is located centrally (within the brain) or peripherally (within the ear)
  • The individual may sit with his/her legs extended, tilting the head between 30-45 degrees in a left or right position, as the physician helps the individual to lie on their back. This can help the physician check for nystagmus
  • If the test is confirmatory that the vertigo is located within the inner ear, then it is possible to determine the ear that is affected as well     
  • A normal or negative test means that the individual does not have vertigo. An abnormal or positive test would mean the individual has either central or peripheral vertigo
• Electronystagmography (ENG): Patches (electrodes) are used to detect abnormal eye movements
• Videonystagmography (VNG): Cameras are used to determine dizziness by measuring eye movement when the head is moving
• Magnetic resonance imaging (MRI) scan may be used to rule out any tumors in the brain such as an acoustic neuroma
• Electroencephalogram (EEG): It is used to measure the electrical activity of the brain. Any abnormal brain activity can be detected with an EEG
• Caloric stimulation: Warming and cooling the inner ear with water or air to test eye movements 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Benign Paroxysmal Positional Vertigo?

• Although experiencing Benign Paroxysmal Positional Vertigo is not comfortable, the only rare complication may be dehydration due to frequent bouts of vomiting
• Also, the individual is at higher risk of falling due to the feeling of dizziness

How is Benign Paroxysmal Positional Vertigo Treated?

Benign Paroxysmal Positional Vertigo can be treated using the canalith repositioning procedure.

• The canalith repositioning procedure relieves 80% or more individuals after 1-2 treatment sessions
• The aim of the treatment is to move crystals from the fluid-filled semicircular canals to the utricle, where they do not cause any problems

The following medications relieve the spinning sensations, but do not address the cause of vertigo in BPPV:

• Antihistamines
• Anticholinergics
• Hypnotics 

How can Benign Paroxysmal Positional Vertigo be Prevented?

Currently, there are no effective preventative methods available for Benign Paroxysmal Positional Vertigo. 

What is the Prognosis of Benign Paroxysmal Positional Vertigo? (Outcomes/Resolutions)

• Benign Paroxysmal Positional Vertigo can cause a measure of discomfort to the affected individual. However, appropriate treatment can improve the symptoms gradually over time
• Vertigo may still occur suddenly, even after suitable treatment 

Additional and Relevant Useful Information for Benign Paroxysmal Positional Vertigo:

Benign Paroxysmal Positional Vertigo is a balance disorder and one of the most common causes of vertigo.