Vertigo is experienced after a change in head position such as lying down, turning in bed, looking up, or stooping. It lasts about 30 seconds and ceases when the head is still. It is due to a dislodged otololith crystal entering one of the semicircular balance canals. It can last for days, weeks, or months. The Epley “repositioning” treatment by an otolaryngologist is usually curative. BPPV is the most common cause of dizziness after (even a mild) head injury.

BPPV

Benign Positional Vertigo (BPV), also known as Benign Paroxysmal Positional Vertigo (BPPV), or simply Positional Vertigo, is a type of dizziness caused by an abnormal reaction of the inner ear balance system to certain head movements. Placing the affected ear in a downward position usually initiates symptoms. In some instances, any head movement will aggravate the symptoms.

Causes

Within the inner ear, there are tiny crystals (known as “otoconia,” “otoliths,” or “canaliths”) which are normally attached to the nerve endings. These crystals help sense acceleration such as going forward in a car or rising in an elevator. When these crystals are displaced into the semicircular (balance) canals, they float in the fluid of the inner ear and can stimulate the balance nerve inappropriately. Putting the head in certain positions will lead to a severe spinning sensation. Although this spinning sensation typically lasts only a few seconds, it is often severe and can produce unsteadiness and nausea lasting several hours. The most common causes for the crystals dislodging are head injuries, decreased blood supply to the inner ear, degenerative diseases, and viral infections of the inner ear. In many cases a cause is not identified.

Diagnosis

Vertigo can be due to many causes and its origin can be difficult to determine. After a thorough history and physical examination, sometimes several tests need to be done to evaluate the different types of vertigo. When BPPV occurs, there is an involuntary movement of the eyes called nystagmus. To make the diagnosis, the patient’s head is put into certain positions and the eye movements are observed by the examiner. In some cases the eye movements are recorded with an electric monitor in a test called videonystagmography (VNG).

Treatment

We are able to offer a non-surgical office procedure, known as a Canalith Repositioning Procedure (CRP), whereby the offending crystals are repositioned to an area of the inner ear where they will not cause symptoms. The procedure is performed by placing the patient’s head in various positions which will cause the crystals to gravitate to an area away from the balance nerve receptors to an area where they can cause no ill effect. It is effective 90% of the time, often with immediate improvement of symptoms. Some patients may need to be treated more than once. This procedure is quick (approximately 20 minutes), painless, and has few—if any—side effects. Occasionally, there is mild dizziness lasting a few days.