Benign Positional Paroxysmal Vertigo (BPPV)
“I get a sudden attack of dizziness everytime I tilt my head back to look up at the ceiling or turn my head to one side. After 10-30 seconds it subsides. It’s also difficult to roll onto my side in bed or to bend forwards. I am fine so long as I avoid these positions, but it interferes with my life and I’m frightened about getting an attack in public.”
BPPV is the most common form of vestibular dizziness. It results in severe dizziness caused by head movements, particularly tilting your head back or rolling over in bed. It is often highly disruptive to a person’s life. It is due to debris accumulating within 1 or more of the canals in your inner ear. The debris is made up of displaced calcium carbonate crystals from the otolith balance organ. With head movements, the debris shifts, sending false signals to the brain.
The most common cause of BPPV in people under the age of 50 is trauma, for example after whiplash or head injury. BPPV becomes more common as we get older. About 50% of dizziness in the elderly is due to BPPV. BPPV often develops after vestibular neuritis or Meniere’s disease.
Treatment of BPPV is usually simple and effective. It involves physical manouevres, based upon repositioning the particles of debris. Medication has no role to play.
Treatment is quick (10 minutes) and takes place in the clinic. Success rate is very high, normally 95% of patients experience a ‘cure’ within 1-3 treatments. The commonest treatment manoeuvre is called the ‘Epley Manoeuvre’, but there are other treatments depending upon which of the inner ear’s canals is affected.
The reccurrence of BPPV after successful treatment is low, however it may re-occur in about one-third of patients after 1 year, and in about one-half of all patients after 5 years. Further treatments are then necessary, with equally high sucess rates.
Following particle repositioning manoeuvres, some patients may require vestibular rehabilitation exercises. The success rate of home exercises is equally effective but is more arduous and takes longer.