We’ve all experienced situations of vertigo (when the room spins around us) or dizziness when we change head positions or stand up too quickly. In most people they subside quickly and we don’t think about them again, however if they are repetitive and causing problems, it’s possible you may have Benign Paroxysmal Positional Vertigo (BPPV), a common disorder of the inner ear.
What is BPPV?
BPPV is caused by tiny crystals, called otoconia, that have incorrectly collected within a sensitive part of the inner ear. To get technical, otoconia are calcium carbonate crystals that are normally located inside the utricle of the inner ear. Vertigo/dizziness occurs when these crystals are displaced from the utricle into the semicircular canals of the inner ear, resulting in miscommunication along the vestibular system (our balance and orientation system). When you change the position of your head, the otoconia move with the semicircular canals and this causes the vertigo/dizziness. As the otoconia stop and settle into their new position, the symptoms normally subside.
What causes it?
BPPV is quite common and can be caused in the following:
- Head or ear injury
- Degeneration of the inner ear structures (as part of the normal aging process)
- Ear surgery or infection, such as otitis media
- Vestibular neuritis (viral infection of the inner ear)
- Meniere’s disease
- Some types of minor strokes
What are the symptoms?
Most commonly BPPV presents as vertigo, with a feeling of dizziness or lightheadedness following an episode, with more severe cases also leading to imbalance and nausea. These symptoms are usually brought on by a change in the position of the head from activities such as getting out of bed, rolling over in bed or tilting the head back to look up.
Symptoms are usually intermittent, so it may be present for weeks, stop and come back some time later.
What is the treatment?
The good news it that BPPV isn’t permanent and symptoms may actually go away within six months of onset by themselves. During this period, medication to prevent motion sickness or nausea is sometimes prescribed.
There are also manoeuvres able to be performed by a physiotherapist in the clinic that are specifically intended to move the otoconia out of the semicircular canals. Treatment will be selected by your clinician according to what symptoms you may present with. These treatments normally alleviate symptoms in the majority of patients immediately, however a second treatment may be necessary.
If symptoms don’t subside and manoeuvres don’t help, surgery maybe recommended. As with all surgery there is risk, however it has been found effective for individuals who have not responded to other treatments and when symptoms are sever and long-standing.