Vertigo can usually clear up without treatment
Benign paroxysmal positional vertigo (BPPV) is a condition of the inner ear.
It is a common cause of intense dizziness (vertigo), especially in older people.
- Benign means that it is due neither to a cancerous nor a serious cause. (The symptoms of BPPV may be unpleasant but the underlying cause is not serious.)
- Paroxysmal means recurring sudden episodes of symptoms.
- Positional means that the symptoms are triggered by certain positions. In the case of BPPV, it is certain positions of the head that trigger symptoms.
- Vertigo is dizziness with a spinning sensation. If you have vertigo you feel as if the world is spinning around you, and you feel very unsteady. Often you will also feel sick (nauseated), and you may be sick (vomit).
It is thought that BPPV is caused by tiny solid fragments (otoconia) that develop and float about in the fluid of the labyrinth. These fragments are made up of calcium carbonate crystals which are thought to have broken off from the inside lining of the labyrinth.
It is not clear why these otoconia form or drop off from the inside lining of the labyrinth. Most cases of BPPV occur in people over the age of 40. Therefore, it may be an age-related thing.
BPPV is one of the most common causes of vertigo in older people. However, some younger people develop BPPV following an injury to the ear, or following a previous infection in the inner ear.
Sometimes it occurs in younger people for no apparent reason. Women are affected about twice as often as men.
The main symptom is intense dizziness (vertigo). The vertigo lasts just a short time - typically just for 10-20 seconds and usually no longer than a minute. It then goes away completely. The vertigo is usually triggered by a change in head position. For example, getting out of bed and rolling over in bed are two of the most common movements that trigger a short episode of vertigo. Sometimes just looking up triggers an episode of vertigo.
With each episode of vertigo you may feel sick (nauseated). The nausea may last an hour or so even though the vertigo lasts just seconds.
Between episodes of BPPV you feel well. Many people who develop BPPV realize which head movements trigger their symptoms and so instinctively avoid doing those movements.
In most cases, the symptoms clear away within several weeks or months. The solid fragments (otoconia) may dissolve or float out from the posterior semicircular. However, after the symptoms have gone, some people have recurrences of symptoms months or years later. In some cases, symptoms persist for years.
• The Epley manoeuvre
This simple cure may be tried by your doctor. It often works if you have fragments of debris (otoconia) at the bottom of your posterior semicircular canal (the most common situation). This is done by a series of four movements of the head. After each movement, the head is held in the same place for 30 seconds or so.
The movements of the head basically cause the posterior semicircular canal to rotate around in such a way that gravity moves the otoconia fragments out from the posterior canal and into the vestibule where they then settle and cause no symptoms.
If symptoms return at a later date, the manoeuvre can be repeated.
• Brandt-Daroff exercises
You may be recommended to do these if the Epley manoeuvre does not work. These exercises involve a different way of moving the head compared to the Epley manoeuvre. Your doctor will advise you on how to do these if they are recommended.
If the Epley manoeuvre or Brandt-Daroff exercises are not successful, or not done, you can still remain optimistic. BPPV is a condition that often goes away on its own after several weeks or months without any treatment.
The otoconia are thought either to dissolve or move to a place in the labyrinth where they cause no symptoms.
You should stop driving if you develop sudden, unexpected and disabling attacks of dizziness.
You should inform your employer if dizziness could pose a risk to yourself or to others in your job. For example, if you use ladders, operate heavy machinery, or drive.
To avoid falls around the home, get out of bed slowly and avoid jobs around the house that involve looking upwards.