Imagine waking up one morning and feeling dizzy as soon as you get out of bed. This was the experience of a well-known American football player during a crucial season. He described it as “a bad bout of vertigo” and was unsure if he could continue playing. After consulting with a doctor, he was diagnosed with Benign Paroxysmal Positional Vertigo (BPPV) and treated with the Epley maneuver. Remarkably, he went on to play one of the best games of his career.
What is BPPV?
BPPV is a prevalent cause of dizziness and vertigo, accounting for up to 20% of all cases. The condition is characterized by brief episodes of spinning sensations triggered by changes in head position. These episodes usually last less than a minute and are often worse in the morning. BPPV can cause unsteadiness while walking and can affect people of all ages, though it is more common as people age. The condition can occur due to injuries, certain positions, surgery, prolonged bed rest, or vitamin D deficiency. In many cases, however, no specific cause can be identified.
BPPV is caused by the displacement of tiny calcium carbonate crystals, known as otoconia, within the inner ear. Normally, these crystals are embedded in a gel-like membrane. BPPV occurs when these crystals become dislodged and move into one of the semi-circular canals in the inner ear. When the head moves, these displaced crystals shift, leading to sensations of dizziness or vertigo.
Diagnosing BPPV
The diagnosis of BPPV is based on symptoms, physical examination, and positional tests. These tests involve quickly moving the patient’s head into different positions to see if it triggers dizziness or vertigo. The Dix-Hallpike maneuver is used to test for BPPV in the posterior canal, while the Supine Roll test is used for horizontal canal BPPV. These tests often provoke a type of jerky eye movement called nystagmus, which can be recorded with videonystagmography (VNG) for a more accurate diagnosis.
Treating BPPV
Treatment for BPPV involves specific maneuvers to reposition the displaced crystals back to their proper location in the inner ear. The Epley or Semont maneuvers are used for posterior canal BPPV, while the Roll or Zuma maneuvers are used for horizontal canal BPPV. Most patients do not require medication. However, some may experience residual dizziness after the maneuvers, for which vestibular rehabilitation can be beneficial.
Conclusion
BPPV is a common inner ear disorder that causes episodes of dizziness and vertigo. It is caused by the displacement of crystals within the inner ear and can be diagnosed through positional tests like the Dix-Hallpike and Supine Roll tests. Treatment typically involves repositioning maneuvers. Proper diagnosis and treatment are crucial to reduce the likelihood of recurrence and improve quality of life.
Understanding and addressing BPPV can lead to remarkable recoveries, just as it did for the football player, allowing individuals to return to their daily activities with confidence.
By Rob Adelson
Chief Executive Officer, Founder