Dear friends.
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Have you ever been affected by sudden short bursts of VERTIGO? Like the whole room starts to spin when you get up from bed? Sometimes, it can be triggered by sudden head/neck positional changes, e.g., during a hair shampoo at your hairdresser.
It may be due to BPPV or Benign Paroxysmal Positional Vertigo.
Q: WHAT IS BPPV?
Benign paroxysmal positional vertigo (BPPV) is characterised by paroxysms of vertigo triggered by head position changes in the direction of gravity. BPPV is explained by the migration of degenerated otoconia into the semicircular canals, rendering them sensitive to head motion.
BPPV is the most common cause of dizziness/vertigo worldwide with a lifetime prevalence of 2.4%, a 1-year prevalence of 1.6%, and a 1-year incidence of 0.6%. BPPV accounts for 24.1% of all hospital visits due to dizziness/vertigo. BPPV is most common in elderly women with a peak incidence in their sixties and a women-to-men ratio of 2.4:1. Recurrences of BPPV are frequent with an annual recurrence rate of 15–20%
or year
Q: WHAT ARE THE SYMPTOMS OF BPPV?
BPPV symptoms include any of the following:
Feeling like you are spinning or moving
Feeling like the world is spinning around you
Loss of balance
Nausea and vomiting
Hearing loss
Vision problems, such as a feeling that things are jumping or moving
The spinning sensation:
Is usually triggered by moving your head
Often starts suddenly
Lasts a few seconds to minutes
Certain positions can trigger the spinning feeling:
Rolling over in bed
Tilting your head up to look at something
Image of a patient feeling giddy
Q: WHAT CAUSES BPPV?
In many people, especially older adults, there is no specific event that causes BPPV to occur, but there are some things that may bring on an attack, such as:
Mild to severe head trauma
Keeping the head in the same position for a long time, such as in the dentist's chair, at the beauty salon or during strict bed rest
Bike riding on rough trails
High-intensity aerobics
Other inner ear disease (ischaemic, inflammatory, infectious)
Q. HOW IS BPPV DIAGNOSED?
Diagnosing BPPV involves taking a detailed history of a person’s health.
The doctor confirms the diagnosis by observing nystagmus — jerking of the person’s eyes that accompanies the vertigo caused by changing head position. This is accomplished through a diagnostic test called the Dix-Hallpike manoeuvre.
Image of Dr Euan examining a patient's ear
The Dix Hallpike manoeuvre targets the posterior semi-circular canal, the most commonly affected canal.
First, the person’s head is turned about 45 degrees to one side while sitting up. Next, the patient is quickly laid down backwards with the head just over the edge of the examining table. This move can often bring on vertigo and the doctor can observe if the person’s eyes show the jerking pattern of nystagmus. A positive response confirms the diagnosis of BPPV.
An MRI or CT scan of the brain is usually unnecessary unless there are other unexplained signs or symptoms.
A doctor’s diagnosis of BPPV can be reassuring, especially when the patient understands that help is available to relieve the symptoms. Even without treatment, the usual course of the illness is that of improvement of symptoms over a period of days to weeks, and sometimes there is spontaneous resolution of the condition.
Q: HOW IS BPPV TREATED?
Your Doctor / Vestibular Therapist may perform a procedure called the Epley manoeuvre. It is a series of head movements to reposition the canaliths of your inner ear. The procedure may need to be repeated if symptoms re-occur, but this treatment works best to cure BPPV.
The Epley Maneuver for BPPV:
BPPV with the most common variant (crystals in the posterior SCC) can be treated successfully — with no tests, pills, surgery or special equipment — by using the Epley manoeuvre.
This simple, effective approach to addressing BPPV involves sequentially turning the head in a way that helps remove the crystals and help them float out of the semicircular canal. Several repositioning manoeuvres performed in the same visit may be necessary.
The Epley manoeuvre and other bedside physical therapy manoeuvres and exercise programs can help reposition the crystals from the semicircular canals. Recurrences can occur, and repeat repositioning treatments are often necessary.
After the Epley manoeuvre treatment, the patient may begin walking with caution. He or she should avoid putting the head back or bending far forward (for example, to tie shoes) for the remainder of the day. Sleeping on the side of the affected ear should be avoided for several days.
If the crystals are in a location other than the posterior semicircular canal, slightly different manoeuvres may be used, but they are based on the same principle of moving the stones out of the offending semicircular canal. BPPV of the anterior canal is exceedingly rare since debris in this canal (located at the top of the inner ear) easily falls out on its own.
Image of Dix Hallpike Manoeuvre
Your Doctor or Vestibular Therapist may also teach you other repositioning exercises that you can do at home but may take longer than the Epley manoeuvre to work. Other exercises, such as balance therapy, may help some people.
Some medicines may help relieve spinning sensations:
Antihistamines
Anticholinergics
Sedative-hypnotics
However, these medicines do not correct the underlying mechanisms of the vertigo.
Vestibular Therapy is STILL the best remedy for BPPV.
Well, I hope this information has been helpful to you and your friends and family.
If you or a loved one are experiencing dizziness or symptoms of Benign Paroxysmal Positional Vertigo (BPPV), don't hesitate to reach out. Early diagnosis and treatment can significantly improve your quality of life and prevent further complications. Contact us today at Euan's ENT Surgery & Clinic or call 66944282 to schedule an appointment and take the first step towards regaining your balance and well-being.
If you would like to delve deeper into the topic of BPPV, here are some useful references for you!
Have a great weekend!
References:
1. Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med. 2014;370(12):1138–1147. doi: 10.1056/NEJMcp1309481. [PubMed] [CrossRef] [Google Scholar]
2. Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV) CMAJ. 2003;169(7):681–693. [PMC free article] [PubMed] [Google Scholar]
3. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710–715. doi: 10.1136/jnnp.2006.100420. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
4. Kim HJ, Lee JO, Choi JY, Kim JS. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol. 2020;267(8):2252–2259. doi: 10.1007/s00415-020-09831-2. [PubMed] [CrossRef] [Google Scholar]
5. Balatsouras DG, Koukoutsis G, Ganelis P, Economou NC, Moukos A, Aspris A, Katotomichelakis M. Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur Arch Otorhinolaryngol. 2014;271(5):919–924. doi: 10.1007/s00405-013-2484-2. [PubMed] [CrossRef] [Google Scholar]
6. Tanimoto H, Doi K, Nishikawa T, Nibu K. Risk factors for recurrence of benign paroxysmal positional vertigo. J Otolaryngol Head Neck Surg. 2008;37(6):832–835. [PubMed] [Google Scholar]
7. Brandt T, Huppert D, Hecht J, Karch C, Strupp M. Benign paroxysmal positioning vertigo: a long-term follow-up (6–17 years) of 125 patients. Acta Otolaryngol. 2006;126(2):160–163. doi: 10.1080/00016480500280140. [PubMed] [CrossRef] [Google Scholar]
8. Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122(5):647–652. doi: 10.1016/S0194-5998(00)70190-2. [PubMed] [CrossRef] [Google Scholar]
9. Kim HJ, Kim JS. The patterns of recurrences in idiopathic benign paroxysmal positional vertigo and self-treatment evaluation. Front Neurol. 2017;8:690. doi: 10.3389/fneur.2017.00690. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
10. Martens C, Goplen FK, Aasen T, Nordfalk KF, Nordahl SHG. Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV. Eur Arch Otorhinolaryngol. 2019;276(8):2181–2189. doi: 10.1007/s00405-019-05459-9. [PubMed] [CrossRef] [Google Scholar]
11. Pereira AB, Santos JN, Volpe FM. Effect of Epley's maneuver on the quality of life of paroxismal positional benign vertigo patients. Braz J Otorhinolaryngol. 2010;76(6):704–708. doi: 10.1590/S1808-86942010000600006. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
12. Li JC, Li CJ, Epley J, Weinberg L. Cost-effective management of benign positional vertigo using canalith repositioning. Otolaryngol Head Neck Surg. 2000;122(3):334–339. doi: 10.1067/mhn.2000.100752. [PubMed] [CrossRef] [Google Scholar]
13. Pérez P, Manrique C, Álvarez MJ, Aldama P, Álvarez JC, Luisa Fernández M, Méndez JC. Evaluation of benign paroxysmal positional vertigo in primary health-care and first level specialist care. Acta Otorrinolaringol (Engl Ed) 2008;59(6):277–282. doi: 10.1016/S2173-5735(08)70238-2. [PubMed] [CrossRef] [Google Scholar]
14. Wang YL, Wu MY, Cheng PL, Pei SF, Liu Y, Liu YM. Analysis of cost and effectiveness of treatment in benign paroxysmal positional vertigo. Chin Med J (Engl) 2019;132(3):342–345. doi: 10.1097/CM9.0000000000000063. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
15. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RW, Do BT, Voelker CC, Waguespack RW, Corrigan MD. Clinical practice guideline: benign paroxysmal positional vertigo (update) Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1–S47. doi: 10.1177/0194599816689667. [PubMed] [CrossRef] [Google Scholar]
16. Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology. 1987;37(3):371–378. doi: 10.1212/wnl.37.3.371. [PubMed] [CrossRef] [Google Scholar]
17. Byun H, Chung JH, Lee SH, Park CW, Kim EM, Kim I. Increased risk of benign paroxysmal positional vertigo in osteoporosis: a nationwide population-based cohort study. Sci Rep. 2019;9(1):3469. doi: 10.1038/s41598-019-39830-x. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
18. Shih CP, Wang CH, Chung CH, Lin HC, Chen HC, Lee JC, Chien WC. Increased risk of benign paroxysmal positional vertigo in patients with non-apnea sleep disorders: a nationwide, population-based cohort study. J Clin Sleep Med. 2018;14(12):2021–2029. doi: 10.5664/jcsm.7528. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
19. Chen J, Zhang S, Cui K, Liu C. Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol. 2020 doi: 10.1007/s00415-020-10175-0. [PubMed] [CrossRef] [Google Scholar]
20. Yang H, Gu H, Sun W, Li Y, Wu H, Burnee M, Zhuang J. Estradiol deficiency is a risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients. Laryngoscope. 2018;128(4):948–953. doi: 10.1002/lary.26628. [PubMed] [CrossRef] [Google Scholar]
21. Bazoni JA, Mendes WS, Meneses-Barriviera CL, Melo JJ, Costa Vde S, Teixeira Dde C, Marchiori LL. Physical activity in the prevention of benign paroxysmal positional vertigo: probable association. Int Arch Otorhinolaryngol. 2014;18(4):387–390. doi: 10.1055/s-0034-1384815. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
22. Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim Y. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260(3):832–838. doi: 10.1007/s00415-012-6712-2. [PubMed] [CrossRef] [Google Scholar]
23. Korres S, Balatsouras DG, Kaberos A, Economou C, Kandiloros D, Ferekidis E. Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo. Otol Neurotol. 2002;23(6):926–932. doi: 10.1097/00129492-200211000-00019. [PubMed] [CrossRef] [Google Scholar]
24. Soto-Varela A, Santos-Perez S, Rossi-Izquierdo M, Sanchez-Sellero I. Are the three canals equally susceptible to benign paroxysmal positional vertigo? Audiol Neurotol. 2013;18(5):327–334. doi: 10.1159/000354649. [PubMed] [CrossRef] [Google Scholar]
25. Moon SY, Kim JS, Kim BK, Kim JI, Lee H, Son SI, Kim KS, Rhee CK, Han GC, Lee WS. Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study. J Korean Med Sci. 2006;21(3):539–543. doi: 10.3346/jkms.2006.21.3.539. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
26. von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res. 2015;25(3–4):105–117. doi: 10.3233/VES-150553. [PubMed] [CrossRef] [Google Scholar]
27. Jeon EJ, Lee DH, Park JM, Oh JH, Seo JH. The efficacy of a modified Dix–Hallpike test with a pillow under shoulders. J Vestib Res. 2019;29(4):197–203. doi: 10.3233/VES-190666. [PubMed] [CrossRef] [Google Scholar]
28. Choi SY, Oh SW, Kim HJ, Kim JS. Determinants for bedside lateralization of benign paroxysmal positional vertigo involving the horizontal semicircular canal. J Neurol. 2020;267(6):1709–1714. doi: 10.1007/s00415-020-09763-x. [PubMed] [CrossRef] [Google Scholar]
29. Han BI, Oh HJ, Kim JS. Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo. Neurology. 2006;66(5):706–710. doi: 10.1212/01.wnl.0000201184.69134.23. [PubMed] [CrossRef] [Google Scholar]
30. Choung YH, Shin YR, Kahng H, Park K, Choi SJ. 'Bow and lean test' to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope. 2006;116(10):1776–1781. doi: 10.1097/01.mlg.0000231291.44818.be. [PubMed] [CrossRef] [Google Scholar]
31. Choo OS, Kim H, Jang JH, Park HY, Choung YH. Vertical nystagmus in the bow and lean test may indicate hidden posterior semicircular canal benign paroxysmal positional vertigo: hypothesis of the location of otoconia. Sci Rep. 2020;10(1):6514. doi: 10.1038/s41598-020-63630-3. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
32. Lee H, Kim HA. The association of head shaking nystagmus with head-bending and lying-down nystagmus in horizontal canal benign paroxysmal positional vertigo. J Vestib Res. 2020;30(2):95–100. doi: 10.3233/VES-200696. [PubMed] [CrossRef] [Google Scholar]
33. von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: diagnostic criteria consensus document of the Committee for the Classification of Vestibular Disorders of the Barany Society. Acta Otorrinolaringol Esp. 2017;68(6):349–360. doi: 10.1016/j.otorri.2017.02.007. [PubMed] [CrossRef] [Google Scholar]
34. Choi SY, Jang JY, Oh EH, Choi JH, Park JY, Lee SH, Choi KD. Persistent geotropic positional nystagmus in unilateral cerebellar lesions. Neurology. 2018;91(11):e1053–e1057. doi: 10.1212/WNL.0000000000006167. [PubMed] [CrossRef] [Google Scholar]
35. Kim CH, Kim MB, Ban JH. Persistent geotropic direction-changing positional nystagmus with a null plane: the light cupula. Laryngoscope. 2014;124(1):E15–19. doi: 10.1002/lary.24048. [PubMed] [CrossRef] [Google Scholar]
36. Choi JY, Lee ES, Kim HJ, Kim JS. Persistent geotropic positional nystagmus after meningitis: evidence for light cupula. J Neurol Sci. 2017;379:279–280. doi: 10.1016/j.jns.2017.06.036. [PubMed] [CrossRef] [Google Scholar]
37. Kim MB, Hong SM, Choi H, Choi S, Pham NC, Shin JE, Kim CH. The light cupula: an emerging new concept for positional vertigo. J Audiol Otol. 2018;22(1):1–5. doi: 10.7874/jao.2017.00234. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
38. Beh SC. Horizontal direction-changing positional nystagmus and vertigo: a case of vestibular migraine masquerading as horizontal canal BPPV. Headache. 2018;58(7):1113–1117. doi: 10.1111/head.13356. [PubMed] [CrossRef] [Google Scholar]
39. Lechner C, Taylor RL, Todd C, Macdougall H, Yavor R, Halmagyi GM, Welgampola MS. Causes and characteristics of horizontal positional nystagmus. J Neurol. 2014;261(5):1009–1017. doi: 10.1007/s00415-013-7223-5. [PubMed] [CrossRef] [Google Scholar]
40. Yun SY, Lee JY, Kwon EJ, Jung C, Yang X, Kim JS. Compression of both vertebral arteries during neck extension: a new type of vertebral artery compression syndrome. J Neurol. 2020;267(1):276–278. doi: 10.1007/s00415-019-09576-7. [PubMed] [CrossRef] [Google Scholar]
41. Choi JY, Glasauer S, Kim JH, Zee DS, Kim JS. Characteristics and mechanism of apogeotropic central positional nystagmus. Brain. 2018;141(3):762–775. doi: 10.1093/brain/awx381. [PubMed] [CrossRef] [Google Scholar]
42. Choi JY, Kim JH, Kim HJ, Glasauer S, Kim JS. Central paroxysmal positional nystagmus: characteristics and possible mechanisms. Neurology. 2015;84(22):2238–2246. doi: 10.1212/WNL.0000000000001640. [PubMed] [CrossRef] [Google Scholar]
43. Higashi-Shingai K, Imai T, Kitahara T, Uno A, Ohta Y, Horii A, Nishiike S, Kawashima T, Hasegawa T, Inohara H. Diagnosis of the subtype and affected ear of benign paroxysmal positional vertigo using a questionnaire. Acta Otolaryngol. 2011;131(12):1264–1269. doi: 10.3109/00016489.2011.611535. [PubMed] [CrossRef] [Google Scholar]
44. Li L, Liu JG, Wang ZW, Qi XK. Formulation and evaluation of diagnostic questionnaire for benign paroxysmal positional vertigo. Zhonghua Yi Xue Za Zhi. 2017;97(14):1061–1064. doi: 10.3760/cma.j.issn.0376-2491.2017.14.007. [PubMed] [CrossRef] [Google Scholar]
45. Kim HJ, Song JM, Zhong L, Yang X, Kim JS. Questionnaire-based diagnosis of benign paroxysmal positional vertigo. Neurology. 2020;94(9):e942–e949. doi: 10.1212/WNL.0000000000008876. [PubMed] [CrossRef] [Google Scholar]
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