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Benign Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common cause of dizziness. BPPV is a benign disorder because it is not life-threatening, however it can be dangerous by causing a fall or car accident. The symptoms occur suddenly and are not constant, and are produced by a movement of the head. The patient usually complains of a sensation of spinning rocking or unsteadiness.

BPPV may cause a sudden and violent, dizziness after movement or a change in head position. This sensation usually lasts only seconds. This may occcur when trying to lie down, arise or turn over in bed. It may even awaken a person from sleep. BPPV can also occur when looking up, downward to the side, or, for instance, when lying back to have one's hair washed. It is especially dangerous when it occurs while driving.

BPPV does not usually cause hearing loss, ear fullness or head noise (tinnitus). If these symptoms are present, it is likely that a second inner ear problem exists.

CAUSE


BPPV is due to damage to the vestibular system. The damage may have occurred from trauma to the head, whiplash injury, infection, circulatory changes, degeneration of the inner ear due to aging, or from an unknown cause. In the majority of cases, the cause of BPPV is unknown. Specifically, BPPV occurs when calcium crystals become dislodged in the inner ear. These crystals interfere with the normal function of the semicircular canals.

Diagnosis

BPPV is diagnosed on the basis of a history of typical symptoms, findings on the physical exam, and the results of balance tests. Frequently, the doctor will try to see the patient during or around the time of the dizzy spell to confirm the diagnosis.

PROGNOSIS

Typically, BPPV will go into complete remission with appropriate treatment. Remission means that the dizziness will eventually go away but it may return several months or years later. Treatment may include specific exercises for BPPV, medication. Complete remission is achieved in over 98% of cases using nonsurgical treatment.

Physical Therapy

One of the most effective treatments for BPPV is the Epley Maneuver, and the Canalith Repositioning Procedure . These techniques help to move the dislodged calcium crystals to position in the inner ear where they will not cause dizzyness. This is performed in the doctor's office and takes approximately 15 minutes. Sometimes the treatment is repeated in one to two weeks if dizziness is still present. Other forms of physical therapy include exercises performed at home.


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