Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo (BPPV), the most common cause of vertigo, is a condition in which the person feels intense spinning of the head usually during movement. ^[1]

Epidemiology

Older population is more affected with mean age of 51-57.2 years old. People less than 35 years of age rarely experience BPPV. The condition seems to have predilection for females accounting for about 64 % of the cases. ^[2]

Causes

BPPV is brought about by disturbance within the inner ear. Within the inner ear are fluid-filled tubes termed semicircular canals. These canals sense movements as the body changes position. The movement of fluid within the canals allows the brain to interpret the position of the body hence to maintain balance.

When a bone-like calcium becomes dislodged and floats within the inner ear, BPPV results. The brain gets confused as it receives difficult messages regarding the body's position. ^[1]

BPPV is usually linked to head injury. Other causes associated with the condition are ear infection, ear surgery and prolonged positioning on the back. ^{[1] [3]} BPPV may also occur following a dental work and viral infection such as vestibular neuritis and Meniere's disease. It is also common in patients treated with ototoxic medications like gentamicin.  ^[4]

Symptoms

People with BPPV experience symptoms like nausea, vomiting, loss of hearing and balance and problems with vision. The feeling of spinning begins abruptly and lasts for a few seconds to minutes. Moving the head usually triggers it. ^[1]

Other symptoms are light-headedness and unsteadiness. ^[3] Usual dilemma are getting out of bed or rolling over in bed. Use of shampoo bowls in beauty parlors and 'down dog' Yoga posture may trigger BPPV. Symptoms typically occur intermittently. ^[4]

Diagnosis

Diagnosis is usually made by obtaining history and physical examination. ^[4] Laboratory tests that may be done are EEG, electronystagmography (ENG), MRI, CT scan, and hearing test. ^[1]

Treatment

BPPV is usually self-limiting often disappearing within 2 months of onset. ^[4] Epley's maneuver is a usual treatment procedure. Medications may be indicated to relieve sensations of spinning such as antihistamines, anticholinergics and sedative-hypnotics. ^[1] Other treatment options are vestibular rehabilitation, canalith repositioning, and surgery. ^[2]

References:

1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002393/

2. http://emedicine.medscape.com/article/884261-overview#a0199

3. http://www.mayoclinic.com/health/vertigo/DS00534/DSECTION=causes

4. http://www.dizziness-and-balance.com/disorders/bppv/bppv.html

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