Spotlight on Benign Paroxysmal Positional Vertigo

Today I would like to provide you with information on Benign Paroxysmal Positional Vertigo (BPPV). I feel that learning about BPPV is important because it is the number one cause of vertigo in the United States, as well as the most common disorder of the vestibular system of the inner ear. First, let's break down the medical terminology. Benign means that the disorder is not life-threatening, which is a good thing. Paroxysm means a sudden attack, positional means a change in position, and remember that vertigo is a spinning sensation.  

Putting it all together, BPPV is a non life-threatening disorder in which sudden episodes of vertigo occur that are caused by changes in the position of the head.

To help you understand how vertigo occurs, let's go over the anatomy of the inner ear and how it relates to balance. The anatomical structures in the inner ear that play a role in vertigo are the utricle, saccule, and three semicircular canals. 

The semicircular canals detect rotational movement and contain balance receptors. The three canals are placed at right angles from each other and allow us to know if our head is moving up-and-down, side-to-side, or titling. All three semicircular canals are filled with a watery fluid called endolymph. When the head moves, the endolymph fluid within the semicircular canals also moves, stimulating receptors to send information to the brain about the movement of the head. The ends of the semicircular canals are connected to the utricle which is connected to the saccule. Both the utricle and the saccule provide the brain with information on the position of the head. They also both contain tiny crystals of calcium carbonate called otoconia. 

Now that you have a better understanding of what is going on inside your inner ear, I will explain how vertigo occurs in the case of BPPV. If the crystals become dislodged from the utricle, they can move into the semicircular canals. Once in a semicircular canal, the crystals may clump together and form a larger mass. When the head moves, the clump of crystals can disrupt endolymph fluid movement, stimulating the sensory cells which then send false signals to the brain that the head is moving. Hence, vertigo is induced and you feel like you or your surroundings are spinning. 

In addition to vertigo, other symptoms of BPPV include unsteadiness, a loss of balance, nausea, vomiting, difficulty concentrating, and blurred vision. BPPV can be difficult to diagnose because there are many causes of vertigo and symptoms tend to be similar. It is most common in people over 60 but can occur at any age. The most common treatment options for BPPV are head repositioning maneuvers. There are several maneuvers that have been created and the most common one is the Epley maneuver. The goal of any head repositioning maneuver is to move the displaced otoconia out of the affected semicircular canal. For more information on the most common head repositioning maneuvers, follow the link here to my previous blog post on managing and treating vertigo. In rare cases, surgery may be recommended by your doctor. 

In this post I wanted to provide you with a brief overview on BPPV and teach you what exactly goes on inside your inner ear that induces vertigo. For more in depth information on BPPV, check out the following links:

• http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
• http://www.mayoclinic.org/diseases-conditions/vertigo/basics/definition/con-20028216
• http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/vestibular/conditions/benign_paroxysmal_positional_vertigo.html

If you suspect you have experienced vertigo, make sure to see your doctor to receive a proper diagnosis. It is likely you might have Benign Paroxysmal Positional Vertigo since it is the most common cause of vertigo in the United States. If you are diagnosed with BPPV remember that it is not life-threatening and highly treatable.   

Handling a Vertigo Episode

In a previous blog post, titled How to Manage and Treat Vertigo, I discussed treatment options and ways to prevent another vertigo episode from happening. Although the goal of someone suffering from vertigo is to prevent the occurrence of episodes, it is important to know what to do if a vertigo episode strikes, whether it is you or someone you know experiencing symptoms. 

If you feel that a vertigo episode is beginning (you feel like you are spinning), the first thing you should do is try to stay still and sit down slowly. You will want to avoid any quick movements because you might fall and injure yourself or make symptoms worse. If you are with someone, you should let them know how you are feeling, but if you are alone, you should try your best to concentrate and move slowly to sit down. If you are in a public place, you could find a wall to lean against or find a place to sit down and rest until symptoms subside. 

During a vertigo episode, it is also best to avoid moving your head and looking up or down as this could cause further disorientation. You should try to keep your head level and parallel to the ground. If you are at home or you can find a bench, it is sometimes helpful to lay down. Sitting or laying down can also help if you feel nauseous. Another tip is to focus on a distant object, which can help you concentrate and reduce feelings of dizziness. 

If someone you know is experiencing vertigo, you can help them follow the tips above and alleviate their symptoms. If someone tells you they feel like they or their surroundings are spinning, you should help them find a place to sit or lie down. Guide them slowly to a place to sit and try to keep them steady. You can help them relax by reassuring them their symptoms will most likely subside shortly since most episodes only last a few minutes. 

Following these tips can help you or someone you know endure a vertigo episode with minimal stress and anxiety. In addition, they can help alleviate symptoms, thereby reducing the length of an episode. 

Questions to Ask Your Doctor About Vertigo

If you suspect you have vertigo, it is wise to schedule a visit with your doctor. During the visit, you should not hesitate to ask your doctor any questions regarding your health. Asking questions is essential to good communication with your doctor. Asking your doctor questions lets him or her know that you are interested in learning or may need clarification on a certain topic. If you do not ask questions, your doctor might assume you do not need or want to learn new information. Some people do not ask their doctors questions for several reasons, such as due to shyness or fear of seeming ignorant. Although you may not enjoy visiting with your doctor and the very idea of it makes you nervous, doctors provide a service and their purpose is to help patients with any health concerns they may have. Most doctors are more than happy to sit with patients, answer questions, and explain any health-related topic that concerns you. It is beneficial to go into a doctor's appointment with some background knowledge and a written list of questions you would like answered. Do not be afraid to speak up if you are confused or do not know a medical term.

In relation to vertigo, below are several questions you should ask your doctor. First, you should ask basic questions in order to gain a better understanding of the cause of your vertigo. You will want to know the steps that need to be taken to determine the cause and develop a treatment plan. The questions you should ask initially include: 

• What do you suppose is the cause of my vertigo and why? 
• What types of examinations or evaluations need to be done to determine the cause of my vertigo?
• Do I need to prepare for these examinations? 
• What kinds of treatment do you recommend? Why? 
• If your doctor recommends a physical therapy maneuver, feel free to ask for an explanation or demonstration. 
• If medication is diagnosed, make sure you know understand the instructions and ask about side effects. 
• If this treatment is unsuccessful, what other treatment options are available to me? 
• Do you recommend that I see a specialist for my condition?
• In some cases, your doctor may recommend that you see an Otolaryngologist who would have more experience with the causes and treatment of vertigo.

There are several other questions you can ask your doctor that are not imperative but could provide you with beneficial information that could help you feel more prepared to self-manage your vertigo. These include: 

• What can I do to self-manage my vertigo? 
• Are there any exercises I can do on my own that could reduce symptoms?
• What kinds of activities or movements may trigger or worsen my symptoms?
• What should I do if my symptoms get worse or new symptoms arise?
• What should I do if I experience negative side effects from treatment (for example, side effects from medication)?
• Is surgery an option if my symptoms do not improve? 

Hopefully the questions listed above provide you with a good idea of the information you should obtain from your doctor. Remember, do not hesitate to ask any of these questions. Your doctor is there to help you improve your health. Answering health-related questions is part of their job so do not be afraid to ask any questions you may have. 

How to Manage and Treat Vertigo

If you or someone you know suffers from vertigo, there are several ways to manage and treat the condition with professional help and at home. As I mentioned in my previous blog post, it is best to first consult your doctor if you suspect you have vertigo in order to receive an accurate diagnosis. There are several treatments for vertigo that vary depending on the cause and type. Therefore, it is important to see your doctor in order to find out the exact cause of your symptoms and the best treatment option. 


Remember that there are two types of vertigo, central and peripheral. Central vertigo is due to a problem with the brain or brainstem and is a symptom of this problem. Therefore, treatment is geared toward the problem in the brain and vertigo will subside once this is treated. Treatment for peripheral vertigo usually includes repositioning maneuvers, the most common of which is the Epley maneuver. This treatment option involves specific head movements that cause loose crystals within the inner ear to move, leading to less irritation and a decrease in or cessation of episodes. The Epley maneuver should be done by a physical therapist or health care professional in order to prevent a neck or head injury. However, there are modified versions that your doctor or physical therapist can teach you so you can perform it at home. Also, the Epley maneuver has a high success rate and can be beneficial in treating most cases of vertigo. 

The Semont maneuver is similar to the Epley maneuver but is less popular. While you are seated at the edge of a table, a health professional holds your head and quickly lowers your head to one side. This method is best if done by a doctor or health professional. 

In addition, there are other repositioning maneuvers that you can do by yourself at home. Dr. Carol Foster, an Associate Professor of otolaryngology at the University of Colorado Hospital, created her own method after suffering from vertigo. She calls it the Half Somersault (also known as the Foster Maneuver) and it involves kneeling on the floor, bending over, and placing the crown of your head on the floor. You can watch the video below to see a demonstration.

Some ways to self-manage vertigo at home or during your day include changing your head position slowly, focusing on distant objects when walking, and making sure eye glass and hearing aid prescriptions are to date. It is important to avoid moving your head quickly as it can trigger vertigo. Balancing exercises have been shown to help people who suffer from frequent vertigo episodes. Better balance means less risk of falling or hurting yourself during an episode. These exercises can range from balancing standing still, on one leg, or while swaying. 

In some cases of vertigo, medication is prescribed to reduce episodes or alleviate symptoms but is not recommended for long term use. In this case, the best way to self-manage vertigo is to follow directions and dosages for medications. You may also practice some of the self-management tips above in addition to taking your medication. 

Overall, vertigo is highly treatable and, in most cases, not hard to manage. If you or someone you know has experienced vertigo, I hope these tips on how to treat and manage vertigo are helpful. 

An Introduction to Vertigo

Have you ever spun around in circles really fast and felt like the world was spinning when you stopped? If so, you have experienced vertigo. Rather, you induced vertigo and luckily it only lasted a few seconds. Vertigo is the sensation that you or your environment is spinning or moving even though you are still. Unlike when you induce vertigo by spinning quickly, a spontaneous vertigo episode can last anywhere from a few minutes, a few hours, or in some cases even a few days or weeks. Someone experiencing vertigo will most likely say they feel dizzy. However, only about half of dizziness complaints are actually vertigo. It is important to note that dizziness is an umbrella term also used to explain lightheadedness and unsteadiness. Dizziness is also a common symptom for many health conditions which leads vertigo to be misdiagnosed. Therefore, if you feel that you have had a vertigo episode, it is important to provide your physician with a clear description of how you felt in order to receive an accurate diagnosis. 

There are two types of vertigo, peripheral and central. Peripheral vertigo is due to a problem in the inner ear. Causes of peripheral vertigo include benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, labyrinthitis, acoustic neuroma, pressure on the vestibular nerve, or certain medications.

Central vertigo is due to a problem with the brain or brainstem. This type of vertigo may be caused by multiple sclerosis, stroke, tumors, migraines, decreased blood flow to the brain, arteriosclerosis, head trauma or neck injury, or certain drugs. 

There are several symptoms for vertigo, the main one being a sense of spinning or moving which is not to be confused with lightheadedness. Nausea and/or vomiting is one of the most common symptoms associated with a vertigo episode. Other symptoms include abnormal eye movements, hearing loss, ringing in the ears (tinnitus), loss of balance, and/or sweating. Central vertigo has some additional symptoms that can occur, including weakness, facial paralysis, slurred speech, double vision, and/or decreased level of consciousness. It is important to tell your doctor about any of these symptoms that may have accompanied a vertigo episode. 

If you have experienced any symptoms of vertigo, a doctor's visit is recommended in order to receive a proper diagnosis. You will need to provide your doctor with a complete medical history, including medications (both RX and OTC), recent illnesses, and prior medical problems. Several tests and exams can be done to diagnose vertigo, including, but not limited too, a physical exam, blood tests, hearing tests, Electronystagmography (ENG), the Dix-Hallpike test, a "roll test", and an MRI or CT scan.  

Even though vertigo episodes may seem frightening, more often times than not it is related to a manageable or benign medical condition that can be treated. Physical therapy maneuvers, medications, and self-care remedies can all serve as treatments for vertigo. In particular, the Epley Maneuver, a physical therapy treatment involving a series of simple head adjustments, has proven effective in reducing symptoms and episodes of vertigo. 

If you or someone you know has experienced vertigo episodes, remember that most cases of vertigo do not last long and can be easily treated. 



Some great resources to learn more in-depth information about vertigo can be found here:

• http://www.ent.uci.edu/clinical-specialties/ear-surgery/vertigo
• http://www.emedicinehealth.com/vertigo/article_em.htm#vertigo_overview
• http://www.medicinenet.com/vertigo_overview/article.htm#what_is_vertigo