Types of Traumatic Brain Injuries: Benign Paroxysmal Positional Vertigo

What is benign paroxysmal positional vertigo (BPPV)?

Benign paroxysmal positional vertigo is an inner ear problem that causes a spinning or whirling sensation when you move your head. That sensation is called vertigo. This vertigo usually lasts for less than a minute. It may be mild, or it may be bad enough to cause nausea. About 20% of all dizziness is due to BPPV. The older you are, the more likely it is that your dizziness is due to BPPV, as about 50% of all dizziness in older people is due to BPPV. In a recent study, 9% of a group of urban dwelling elders were found to have undiagnosed BPPV.

In BPPV dizziness is thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as "ear rocks", although the formal name is "otoconia". Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the "utricle". While the saccule also contains otoconia, they are not able to migrate into the canal system. The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age. Normally otoconia appear to have a slow turnover. They are probably dissolved naturally as well as actively reabsorbed by the "dark cells" of the labyrinth, which are found adjacent to the utricle and the crista, although this idea is not accepted by all.

What causes BPPV?

Experts do not know for sure, but suspect that particles of calcium normally found in your ear break off and float into the ear's semicircular canal. Once there, they interfere with your balance and cause vertigo. Medicines, disease, aging, or a head injury are some of the things that may cause the particles to break off.

This is probably what happens:

• Tiny calcium particles, called canaliths, break off from their normal position in the inner ear and enter the semicircular canal.
• The particles build up in the canal.
• When you move your head a certain way, such as tipping it back to look up, the particles float around in the canal, brushing against tiny hairs that detect movement. The hairs mistakenly tell your brain that you are moving.
• Because your other balance systems do not detect the same movement, they send conflicting signals to your brain, and vertigo is the result.

Anyone can develop BPPV.

What are the symptoms of BPPV?

The main symptom is vertigo-a feeling of spinning, whirling, or tilting-that occurs when you move your head certain ways. Turning over in bed, turning your head quickly, bending over, or tipping your head back may cause it. Sometimes the vertigo then causes nausea and vomiting.

When you repeat that head movement 3 or 4 times, the vertigo may get better each time and then stop happening. This is called fatigability. Only after several hours will the same movement again give you vertigo.

It is important to understand the difference between vertigo and dizziness. People often use the terms interchangeably, but they are different symptoms and may indicate different problems. Vertigo happens when your body's balance sensory systems disagree about what kind of movement they sense. You may find it hard to walk or stand. You may even lose your balance and fall. If your vertigo is bad enough, you may also have nausea and vomiting.

To determine whether your vertigo is caused by BPPV, your health professional will want to find out what causes it, how bad it is and how long it lasts. With BPPV:

Tilting the head, looking up or down, rolling over in bed, or getting in and out of bed causes vertigo.

It begins a few seconds after you move your head.

It usually lasts less than a minute.

The spinning sensation may be mild, or it may be bad enough to cause nausea and vomiting.

Vertigo becomes less noticeable each time you repeat the same movement. After 3 to 4 repeats, the movement may no longer cause vertigo. Several hours may pass before the same movement again causes in vertigo.

BPPV often goes away without treatment. Until it does, or is successfully treated, it can repeatedly cause vertigo with a particular head movement. Sometimes it will stop for a period of months or years and then suddenly come back.

What can Increase Your Risk of Getting BPPC

Scientists think you're more likely to develop benign paroxysmal positional vertigo (BPPV) if you have one of these conditions:

• You are an older adult.
• You have a head injury.
• You have an inflammation of the nerve that connects the inner ear to the brain, a condition called vestibular neuronitis.
• You have ear surgery.
• If you've had one episode of vertigo caused by BPPV, you are likely to have more.

How is BPPV diagnosed?

Benign paroxysmal positional vertigo is diagnosed with a physical exam and from your medical history. However, diagnosing the cause of the spinning, whirling sensation of vertigo can be difficult. Several diseases, the side effects of medicines, and head injuries can also cause vertigo.

A Dix-Hallpike test may be done to help your health professional determine the cause of your vertigo. During this test, he or she will carefully observe any involuntary eye movements. This will help determine whether the cause of your vertigo is inside your brain, inner ear, or the nerve connected to your inner ear. The Dix-Hallpike test also can help determine which ear is affected.

Other tests may be done to help diagnose your condition:

• Electronystagmography, which attaches small wires to your face that measure eye movements. It looks for the special eye movements that happen when the inner ear is stimulated. The pattern of eye movements can point to the location of the cause of the vertigo, such as the inner ear or the central nervous system.
• Imaging tests, such as magnetic resonance imaging of the head (MRI) or computed tomography of the head (CT scan). These tests may be done if symptoms could be caused by a brain problem.
• Hearing testing to detect hearing loss. A special hearing test can determine whether the nerve from the inner ear to the brain is working correctly. Hearing loss with vertigo usually indicates a problem other than BPPV, such as Ménière's disease or labyrinthitis.

How is BPPV treated?

Benign paroxysmal positional vertigo (BPPV) may go away in a few weeks by itself. If treatment is needed, it usually consists of head exercises called liberatory maneuvers. These exercises will move the particles out of the semicircular canals of your inner ear to a place where they will not affect your balance.

Over time, your brain may react less and less to the confusing signals triggered by the particles in the inner ear. This is called compensation. Compensation occurs most quickly if you continue normal head movements, even though doing so causes the whirling sensation of vertigo. A Brandt-Daroff exercise may also be done to speed the compensation process. This exercise takes you from sitting to lying on the side that causes the worst vertigo. You'll remain in this position until either the vertigo goes away or until 30 seconds have passed. This movement is then repeated on the other side. These exercises are done twice a day for several weeks to months, or until the vertigo goes away.

Medicines called vestibular suppressants (such as antihistamines, sedatives, or scopolamine) reduce vertigo and may be tried if your symptoms are severe. However, using medications to control vertigo often extends the time needed for compensation to occur.

Antiemetic medications may also be used to reduce nausea and vomiting that can occur with vertigo.

In rare cases, surgery may be used to treat BPPV.

You can reduce the whirling or spinning sensation of vertigo when you have benign paroxysmal positional vertigo (BPPV) by taking these steps:

• Use two or more pillows at night.
• Avoid sleeping on your side with the ear causing the problem facing down.
• Get up slowly in the morning and sit on the edge of the bed for a moment before standing.
• Avoid leaning over to pick things up or tipping your head far back to look up.
• Be careful about reclining, such as when you are in the dentist's chair or having your hair washed at a hair salon.
• Be careful about participating in sports that require you to turn your head, lean over, or lie flat on your back.

• Benign Paroxysmal Positional Vertigo
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• Encephalitis

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