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BPV symptoms, causes, and treatment – Benign Paroxysmal Positional Vertigo

BPV or BPPV stands for Benign Paroxysmal Positional Vertigo. It is a condition that affects the inner ear and produces bothering symptoms.

Benign Paroxysmal Positional Vertigo is the most common cause of vertigo. The majority of the world’s population will suffer from at least one episode of vertigo during their lifetime. BPPV is part of a group of diseases that cause what doctors know as peripheral vertigo.

In this article, you will find the answers to the most frequent questions about this condition. A doctor (me) writes these answers, but with simple terms so anyone can understand.

We’ll review the causes of BPPV, its symptoms, and complications. Also, the way doctors diagnose BPPV and treat it. By the end of this reading, you’ll have the necessary knowledge of this condition.

What is benign paroxysmal positional vertigo or BPV?

Benign paroxysmal positional vertigo (BPV or BPPV) is a condition that affects the inner ear, specifically the semicircular canals. The semicircular canals are the structures that help you keep your balance.

There are three of them: the horizontal, the superior, and the posterior canal. They provide your brain with information about rotary movements. Each canal has a fluid on the inside called endolymph. 

When you shift your head, this fluid moves too. The movement of the endolymph sends signals to your brain of the position of your head. There are also little hair-like structures, the cilia cells that inform your brain when acceleration is taking place.

Additionally, inside the inner ear exist little “stones” or collections of calcium crystals. These have the name of otoliths. In patients with BPPV, these otoliths migrate into one of the semicircular canals.

The most common is the posterior semicircular canal because of its position. Once inside the canal, these otoliths cause abnormal movement of the endolymph. This abnormal movement of the endolymph results in vertigo. 

What are the BPPV symptoms? 

The symptoms of BPPV are pretty easy to figure out by the name of the condition. The most important symptom is, of course, vertigo.

Vertigo is a feeling or sensation that you are spinning when you are not. You can also feel that the inside of your head is spinning.

In the case of BPPV, vertigo appears suddenly (paroxysmal) and lasts only seconds up to a few minutes. The majority of the BPPV episodes last less than a minute. Also, in BPPV, the attacks of vertigo are triggered by changes in position (positional).

Movements like lying down, tilting your head, or spinning in bed can trigger vertigo. Vertigo is usually mild, but it can be more severe and cause nausea and vomiting. Some patients claim that they experience headaches and feelings of pressure after the episode.

Another significant symptom of BPV is nystagmus. Nystagmus is an abnormal eye movement. This involuntary movement of the eye always goes towards the affected ear. Due to this characteristic, nystagmus can be a diagnostic symptom too. This movement is a beating or twitching movement. It can last from 30 seconds to a minute. 

In benign paroxysmal vertigo, people do not experience other neurological symptoms. Symptoms like numbness, weakness, and loss of movement indicate that there can be another, more serious cause. 

What are the causes of BPV?

We already explained the leading cause of BPPV. However, as in any other disease, some factors predispose patients to benign paroxysmal vertigo.

Some of them include alcoholism, CNS (Central Nervous System) diseases. Older age is also a significant risk factor for developing BPPV. Most patients who have BPPV also have other pathologies or medical inner ear conditions.

These pathologies include head traumas, ear diseases like otitis media, and inner ear diseases like vestibular neuritis and Meniére disease. Other pathologies include cervical conditions and hearing loss, but this is much less common. 

Does BPV come on suddenly?

Yes. Like we mentioned before, one of the more important characteristics of BPV is paroxysmal. This means that the episodes happen suddenly. You can be fine at one moment, and the next, you can have this sudden spinning sensation or instability.

Remember that one important detail of this type of vertigo is the brief episodes. They can last a few seconds, but typically they won’t last more than a minute. Although it comes on suddenly, BVP has its triggers. A variation in the position of your body or your head can trigger vertigo. The most common triggers that patients claim are rolling in bed and lifting your head quickly. 

Can BPV last for months?

As we said before, the episodes of BPPV only last for a few seconds or minutes. However, you can have periods in which these episodes become more frequent or more severe.

Some modifiers make patients feel increased symptoms. Factors like changes in pressure due to weather or altitude can make your vertigo worse. Other circumstances like lack of sleep, stress, and dehydration can accentuate your vertigo symptoms. These periods of exacerbation can last from a few days up to 6 months.

Another thing that can happen is that you have very bad symptoms for a few days. Then the symptoms can become milder as time passes. Fortunately, BPPV is considered “self-limiting” because symptoms often disappear independently, even without treatment. 

Does BPV go away gradually?

Yes, without treatment, BPPV can go away gradually.

Usually, patients can experience many episodes of vertigo in a short period of time. As time goes by, these symptoms can be milder every time, or the episodes can occur further from each other. Since it is a self-limiting condition, after a few months, symptoms can disappear completely. This, until a new episode of BPPV, appears. 

Can stress cause BPV?

Not really. Remember that the main reason for Benign paroxysmal positional vertigo is the otoliths. These otoliths cause abnormal movement in the fluids inside your ear, sending wrong signals of movement to your brain. However, stress can be a risk factor for developing more intense and frequent episodes of BPPV. 

Why does BPPV keep coming back?

Keep in mind that you always have otoliths in your inner ear. What happens in BPPV is that these otoliths or crystals move inside your inner ear.

When they go inside the semicircular canals, they cause abnormal endolymph movement. And this movement sends signals to your brain that you are moving, even if you are not. This results in vertigo.

There is really no way to predict whether or not vertigo will come back. But it is very common for it to recur, so don’t worry if this happens. Also, some people have a predisposition to BPPV.

Older patients, patients with previous head traumas, and previous CNS diseases are prone to developing BPPV. In these patients, it is more common for vertigo episodes to come back every once in a while.

How is BPPV different from other types of vertigo?

As we mentioned before, BPPV is a form of peripheral vertigo. Other conditions that cause this type of vertigo are Menieres disease and Labyrinthitis. If You notice, all of these diseases affect the inner ear. They don’t affect any part of the central nervous system (CNS). The symptoms are usually milder and don’t represent a threat to the patient. Also, they don’t have as many complications.

On the other side, there is another type of vertigo, central vertigo. With central vertigo, the condition that causes it directly affects the CNS. The causes of central vertigo include head injuries, brain tumors, and strokes. This makes central vertigo an alarm sign for more serious conditions. Similarly, the symptoms of central vertigo are more severe.

Some patients can’t even get up or walk on their own. The episodes can last for weeks or even months and don’t respond to treatment. In the case of nystagmus, it appears in both types of vertigo. However, it lasts longer with central vertigo and won’t stop even when vertigo has stopped.

Does BPPV cause complications?

In the vast majority of cases, BPPV doesn’t cause any complications. Some of the difficulties or consequences of BPPV are fainting and, therefore, falling.

Episodes of vertigo are usually very short and disappear completely. Even though they can make a patient faint if they are very intense, these fainting episodes are also concise and resolve almost immediately.

The episodes of fainting may lead to falling. In the event of a fall, the patient may suffer severe trauma, depending on the location. 

Can vertigo be a sign of something more serious?

It could be. But, if your vertigo episodes are mild and last only for a few seconds, you don’t have anything to worry about.

So, if you experience mild symptoms, you probably have peripheral vertigo. This means that the inner ear is the one causing the problem. This is the type of vertigo that BPPV causes.

However, if you experience really severe vertigo, that you feel so bad that you need help in order to get up. This because it can be a central vertigo. Central vertigo occurs when the CNS is the problem.

In this case, vertigo can be a symptom of a serious disease. Diseases like brain tumors, strokes, and CNS infections may cause central vertigo. Consult with your doctor if vertigo symptoms are severe or long-lasting.

How is BPPV diagnosed? 

Your doctor will ask about the patient’s medical history and symptoms. The diagnosis of BPPV often doesn’t need further laboratory or imaging tests. However, there are two maneuvers or tests that doctors can perform on the patient.

Positional testing is the most effective way to diagnose BPPV. The first is the Dix–Hallpike test.

The Dix-Hallpike test can determine if the posterior semicircular canal is the one causing vertigo. During this test, your doctor will lower you quickly with your neck extended.

Doctors do this to replicate vertigo and the nystagmus characteristic of Benign Paroxysmal Positional Vertigo. A modification of this test can be done sideways by telling the patient to go from a seated position to a sideways lying down the head’s position and rotation. This also replicates vertigo and the nystagmus. 

To know if the horizontal semicircular canal is affected, doctors do the roll test. In this test, the patient is lying down with the head flexed at 30 degrees. Then, the doctor quickly rotates the head 90 degrees to the left side.

At that moment, the doctor checks for vertigo and nystagmus, returning your head to the initial position. Finally, the doctor will quickly rotate the head 90 degrees to the right. Vertigo may appear in turning to both sides, but it will be more intense while rotating to the affected side. Also, when rotating to the side with the affectation, nystagmus will beat towards the ground. 

It is uncommon that BPPV is a symptom of another severe or neurological disease. However, if your doctor suspects this is your case, it will indicate some other imaging tests. This includes CT scans, and MRIs are pretty useful to make sure you don’t have another, more serious condition. 

What is the best treatment for BPPV?

Many treatments are effective in treating BPPV. 

Repositioning maneuvers: 

The repositioning maneuvers are the easiest and preferred treatment. This will help the otoliths or crystals that cause vertigo out of the semicircular canals. These include the Epley maneuver and the Semont maneuver. 

The Epley maneuver follows these steps: 

  1. The patient starts by sitting with straight legs and head with 45 degrees rotation (towards the affected ear).
  2. Then the patient lowers themselves quickly, with the head at 30 degrees extension of the neck. The patient’s head is still rotated to the side. At this point, the doctor is doing the maneuver and checking for nystagmus. 
  3. The patient will remain in this position for about 2 minutes. Then, the doctor will rotate the patient’s head 90 degrees, maintaining the neck extension. The patient will stay in this position for 2 minutes too.
  4. Then, keeping the head still, the patient will roll on their shoulder. After that, the head will rotate 90 degrees towards the side they are facing. At this point, the doctor will check for nystagmus again. The patient will remain in this position for about 2 minutes.
  5. Finally, the patient is brought up to a sitting position. This, while keeping the rotation of the head of 45 degrees. The patient should keep this position for 30 seconds, at least.

The doctor will repeat this procedure two more times. It is normal for patients to experience vertigo during every step of this procedure. 

The Semont maneuver is also pretty useful at treating Benign paroxysmal positional vertigo.

1- The patient will sit on the table, legs hanging off the side. Then, the doctor turns the patient’s head 45 degrees to the healthy side. 

2- Then, the doctor will quickly tilt the patient so they lie on their affected side. The patient’s head is still rotated upwards. The patient will maintain this position for 3 minutes.

3- Later, the patient moves quickly to be lying on the healthy side, with the head in the same position. Now, facing 45 degrees downwards. The patient will maintain this position for another 3 minutes.

4- Finally, the patient will slowly return to an upright seated position. After this, vertigo will decrease or stop completely. 

Medications 

Some drugs can help with vertigo. These are often saved for acute exacerbations and are not considered a chronic treatment of BPPV. These drugs belong to the group of antihistaminics (yes, like the ones for allergies) and anticholinergics like scopolamine. Other diseases of the inner ear that cause vertigo can also be treated with drugs. 

Surgery

There is also surgical treatment for BPPV. It is pretty rare, and like other neurosurgical treatments, it has several risks. This is why it is only indicated in severe cases.

In the procedure, doctors fix the occlusion in the semicircular canals and relocate the otoliths that cause vertigo.

BPPV devices

There are new devices on the market for patients with severe BPPV. It is a device that goes in your head and has the shape of semicircular canals. The device is filled with liquid and has a particle to represent the otoliths.

This device works as instructions and a guide for the patient through maneuvers to correct the BPPV. We could say it helps the patient to perform a self-repositioning maneuver. This device’s name is DizzyFix; it has FDA approval, and both neurologists and otolaryngologists designed it. 

Do you have symptoms of BPV?

This tool is a Benign Paroxysmal Positional Vertigo Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this disease. Therefore, this tool will help anybody who uses it to determine their symptoms because of BPV. Also, it is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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