Benign paroxysmal positional vertigo

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Positional vertigo: diagnosis and maneuvers to treat it

If you have vertigo or suddenly feel dizzy, it can be very uncomfortable. Dizziness is more common among older people. Women are affected much more often than men.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign paroxysmal positional vertigo is a condition that is not considered serious, but at the same time can be very annoying. Vertigo is a sensation that is usually accompanied by nausea, loss of balance (dizziness) and a feeling of impending fainting.

The person in question suddenly becomes dizzy, which can be very uncomfortable. Even rolling over in bed can cause dizziness, which can be treated with different treatments.

Symptoms of BPPV

The main symptom is dizziness. This dizziness persists only for a few seconds, at the most after a minute it disappears again. In addition to dizziness, we must consider other symptoms:

  • Rapid and uncontrolled twitching of the eyelids (nystagmus).
  • Nausea and vomiting
  • Sweating
  • Balance problems that can lead to falls

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Causes of BPPV

Benign positional vertigo can have several causes. The typical cause of dizziness occurs when calcareous ear structures (otoliths) become dislodged from the inner ear. These then enter the semicircular canals of the ear. The organ of balance, which is influenced by the otoliths, is located near the inner ear.

If the person in question turns his head in a certain direction, the detached particles flow around the semicircular canals and cause suction in the sensory cells. The result is severe dizziness. There are several reasons why otoliths may become dislodged. These include the following:

  • Head injury.
  • Inflammation in the inner ear, where the balance organ is located.
  • Mild traumatic brain injuries.
  • Prolonged bed rest
  • Old age

Diagnosis of BPPV

To diagnose positional vertigo, the otolaryngologist first asks the patient about the exact symptoms, duration and frequency. Then, the doctor performs a test, if there is a suspicion of benign vertigo, a positional test called Dix-Hallpike will determine the vertigo. This method provokes and induces dizziness. In addition, the physician will pay attention to the tremor of the affected person's eyes, which usually occurs a few seconds after the test.

Further tests may be necessary to identify the cause of the vertigo. It is important to know that there may also be another form of vertigo with a different cause.

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Maneuvers for positional vertigo and treatments

There is the possibility of alleviating various symptoms with medication. Even dizziness in general can be reduced at first with medication. The negative here is that the brain is deprived of the opportunity to adapt to the new situation. The symptoms of vertigo are postponed and last longer. If the symptoms are very severe, only an operation on the inner ear can be effective. Benign positional vertigo is easily treatable. In many cases, however, it usually reappears within 2 years.

There are two known therapies or maneuvers that aim to counteract the attacks of dizziness. The aim of the therapies is to use gravity to move the detached otoliths out of the balance organ and into the non-sensitive parts of the ear. Special exercises are available for this, which should allow the symptoms to disappear in a short time. Ask a physical therapist or physician to show you the exact movements. It is important that the exercises are not a substitute for a visit to the doctor and are merely informative.

Epley maneuver

The Epley maneuver consists of five different steps. During positioning training, it is important to ensure that all head movements are carried out quickly.

  1. The patient sits on a couch with legs extended; when lying down, the head should protrude from the couch. First, the head is tilted 45 degrees in the affected direction. 
  2. Next, the patient quickly lies down on his back. In this case, the head should now hang over the couch, diagonally downward. In this position he should feel dizzy. The patient remains in this position for at least one minute until the dizziness has completely subsided. 
  3. Then, the patient turns the head 90 degrees to the sound side of the ear and remains in this position for at least 60 seconds more until the dizziness disappears. Then follows the rest of the body. The head does not change during this movement, the body only turns to the side of the healthy ear. 
  4. The patient waits again for at least 60 seconds. Finally, he straightens up from the side position to sit on the side of the bed and his legs can hang freely. 
  5. To counteract symptoms of nausea during the maneuver, it is helpful to keep the eyes closed during positioning training. For many people, the use of the maneuver leads to the disappearance of symptoms. The five movements can be repeated several times a day.

Sémont maneuver

A second possible movement therapy is the Sémont maneuver. Here, the patient sits on the couch, facing the physician, so that his legs hang off the seat. 

The head is turned 45 degrees to the healthy side, the affected ear points in the direction of the treating physician.

Then the patient is placed on the affected side without changing the head posture, so that the affected person is looking at the ceiling. The patient remains in this position until the vertigo subsides. This should take about 2 to 3 minutes. 

This is followed by an abrupt change of the patient to the other healthy side. The position of the head does not change, the person concerned looks in the direction of the bed. After waiting 2 to 3 minutes, the patient slowly sits down again and then sits in the initial position for another 3 minutes.

This therapy exercise can also be repeated several times a day. If the therapies show an effect on the person affected by dizziness, the exercises can be stopped. Generally, doing the exercises for 5 to 10 days is sufficient to avoid dizziness.

Home remedies

Benign positional vertigo is often harmless, but it can be very uncomfortable and frightening for those affected. The dizziness is usually triggered by rapid, jerky movements, such as bending over, getting up quickly or rolling over in bed. To counteract the dizziness itself, simple exercises can help. Here are some simple exercises you can do at home every day:

  • Fix a point: while lying down, fix a point on the ceiling. You can maintain eye contact and alternately move your head to the left and then to the right.ù
  • Moving an object: you can do this exercise sitting or standing. Take an everyday object, such as a book, and place it in front of you. Then pick it up again and place it in its previous position. Then, place the book in a different place on the floor, alternating left, right and front.
  • Getting up: rise several times from sitting to standing. First with your eyes open, then a second time with your eyes closed. You can do the exercise several times a day.
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