Benign Paroxysmal Positional Vertigo (BPPV), also known as benign postural vertigo or positional vertigo, occurs when the balance-sensing mechanism of the inner ear malfunctions, producing an illusion of movement of the body or the surroundings. In BPPV, crystals from a part of the inner ear called the utricle mistakenly find their way to the semi-circular canals, where they trigger sensitive hair cells to misfire, producing a false sensation of spinning. Even without treatment, BPPV usually resolves within several weeks to several months, although recurrences are common.
Spinning Sensation
Vertigo refers to the sensation of spinning, wheeling, or tilting even when the body is perfectly still. In BPPV, simple head movements such as tilting back or rolling over in bed can produce mild to intense spinning sensations that last for a few seconds to a minute or so. Some people also describe feeling dizzy or light-headed during an episode. The Merck Manual states that symptoms tend to be worst in the morning and then taper off later in the day. Unlike other possible causes of vertigo, people with BPPV do not experience tinnitus (ringing in the ears) or loss of hearing.
Loss of Balance
Generally, BPPV is not a serious condition, but during an episode the sensation of spinning can cause the patient to lose his balance and stumble while walking, or even tilt-over while sitting down. The likelihood of BPPV increases with age, and the elderly are especially susceptible to falls during an episode of BPPV. Because of the risk of minor falls causing serious injury in the elderly, older people should seek treatment for BPPV rather than waiting for it to subside on its own.
Nausea
In some cases of intense spinning sensations, the patient might feel nauseated or even vomit. Motion sickness medications or other antiemetic drugs can sometimes help with nausea due to BPPV.
Nystagmus
During an episode of BPPV, a patient might demonstrate nystagmus, very rapid abnormal rhythmic movements of the eyes. The nystagmus associated with BPPV has specific characteristics that along with other symptoms can allow a doctor to diagnose BPPV with good certainty. If a doctor suspects BPPV, he might perform the Dix-Hallpike maneuver to bring on an episode, and watch any resulting nystagmus. Starting with the patient in a seated position on an examining table, the doctor rapidly leans the patient back to horizontal, with head tipped back off the end of the table at a 45-degree angle, and then turns the head to the side at 45 degrees. With BPPV, nystagmus will occur within 3 to 10 seconds of the position change, stopping if the patient focuses on a nearby object, or stopping on its own eventually, according to Merck Manual’s description of nystagmus and BPPV. In nystagmus due to BPPV, the eyes always move laterally, never up-and-down or in a circle.
