People with vertigo mistakenly perceive motion (often a spinning motion) in their environment. The sensations of vertigo occasionally include spinning or falling sensations and dizziness. When vertigo impacts balance, it can lead to falls and accidental injuries – chiefly among the elderly. More serious cases of vertigo may also trigger vomiting, nausea, migraine headaches, fainting spells and visual irregularities known as nystagmus.
There are various distinct forms of vertigo with varied underlying causes. Audiologists frequently encounter benign paroxysmal positional vertigo, or BPPV, because it’s related to hearing. It is due to naturally-forming calcium crystals in the inner ear known as otoconia or otoliths, and which in most people cause no problems. For people who have BPPV, however, these crystals travel from their normal position into one of the semicircular canals, which are crucial for our sense of balance. When somebody with BPPV reorients their head relative to gravity, these crystals displace endolymph fluid and cause vertigo.
BPPV is characterized by the brief (paroxysmal) nature of the episodes, and can be triggered by such commonplace motions as looking up or down, tilting the head, rolling over while laying down, or any other sudden head motion. These symptoms can be worsened by sleep disorders, stress, or changes in barometric pressure, such as occur before rain or snow. Although benign paroxysmal positional vertigo can begin at any age, it is more common in individuals over 60 years of age. The precise reason behind BPPV is hard to determine for any given individual, but occasionally it is brought on by a blow to the head.
Benign paroxysmal positional vertigo differs from other forms of vertigo or dizziness because the episodes are quite short (typically under a minute), and because it is always prompted by head movements. Doctors may diagnose it by having the individual lie on their back and then tip their head to one side or over the edge of the examination table. More comprehensive tests can be used in selected cases including videonystagmography (VNG), electronystagmography (ENG) and magnetic resonance imaging (MRI). ENG and VNG test for abnormal eye movements while MRI is used to eliminate other potential causes of vertigo such as brain abnormalities or tumors.
BPPV is typically treated using a technique called canalith repositioning which shifts the crystals to a position in the inner ear where there are less bothersome using a sequence of physical motions. Two forms of canalith repositioning that may be used are the Semont maneuver and the Epley maneuver. Surgical treatment is a possibility in the exceptional cases where these therapies are ineffective. Visit your doctor if you have felt symptoms that seem as if they could be associated with BPPV, especially if they last for more than a week.
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