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BPPV (Benign Paroxysmal Positional Vertigo) background

WHAT IS BPPV?

BPPV or Benign Paroxysmal Positional Vertigo is one of the most common disorders of the inner ear that results in vertigo. It is due to particles that have collected in the fluid filled inner ear. These particles float in the fluid and will occasionally touch a sensitive area resulting in the sensation of vertigo. The name of this disorder is derived from the fact that BPPV is benign (not life threatening), paroxysmal (dizziness occurs suddenly and is generally brief) and it is positional (dizziness occurs with particular head positions).

What are the symptoms of BPPV?

The symptoms can vary in each person but are generally brought on by movement or position changes of the head. Laying back, tilting the head backwards or rolling over in bed are common "problem" motions. Although many people feel normal when not in a stimulating position, some do have a sensation of imbalance. The symptoms can last for days, months or occasionally forever. In some the dizziness can come back after it resolves completely.

What causes BPPV?

In most people BPPV occurs for no apparent reason (idiopathic). In a small group of people it occurs after a head injury.

How is the diagnosis made?

Your doctor will make the diagnosis based on your symptoms, physical examination and the results of your hearing and balance tests. Occasionally other tests may be required.

How is BPPV treated?

There are several treatment options.

In general, medications are rarely effective.

The particle repositioning maneuver can be performed in the office by your physician. In this maneuver, the particles are placed in an unimportant part of the inner ear. You will be asked to lie on your back with your head turned towards the "bad" side which will make you temporarily dizzy. Then your head (along with your body) is rotated around towards the "good" ear. To increase the success of the maneuver you will be asked to:

1. Sleep upright as best you can for 48 hours. Use of a recliner or pillows is beneficial.

2. For one week avoid the movements that have caused dizziness such as bending over, moving your head quickly or laying on the bad ear.

3. A soft cervical collar can be used as a reminder for you to avoid quick motions and particular positions.

The Brandt-Daroff exercises are simple exercises performed at home three times a day. They gradually allow compensation or correction of the problem. The maneuver below (four positions) is completed five times during each of the three daily sessions. One remains in each position until the dizziness passes or for 10 seconds if no dizziness occurs. No restriction of activities between sessions is necessary. The sessions need not be spaced evenly throughout the day but we ask that you do allow at least one hour between sessions.

A surgical procedure called "posterior semicircular canal occlusion" can be used to treat BPPV in the rare person where conservative treatments fail.

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