Vertigo, a sensation of movement where the person or the person’s surroundings seem to whirl dizzily, is generally regarded as a rather unpleasant experience. Vertigo feelings can disrupt balance and lead to falls that can be serious in the elderly; vertigo can also be combined with sensations of spinning in space, dizziness, and more rarely, nausea, vomiting, migraines, visual abnormalities including nystagmus, and fainting.

Vertigo can have several causes, but one of them relates to hearingbenign paroxysmal positional vertigo, abbreviated BPPV. Benign paroxysmal positional vertigo is due to calcium crystals that form naturally in the inner ear called otoconia or otoliths, and which typically cause no problems. For people who have BPPV, however, these crystals travel from their normal position into one of the semicircular canals of the inner ear, which are crucial for our sense of balance. When this occurs, and the person with BPPV reorients their head relative to gravity, these crystals move around, resulting in an abnormal displacement of endolymph fluid, which results in vertigo.

BPPV is characterized by the brief (paroxysmal) nature of the vertigo, and can be brought on by such common movements as tilting the head, looking up or down, rolling over in bed, or any other rapid head motion. These symptoms can be made worse by sleep disorders, stress, or changes in barometric pressure, such as before snow or rain. Although benign paroxysmal positional vertigo can begin at any age, it is more common in individuals over 60 years of age. The initial trigger for the benign paroxysmal positional vertigo is typically hard to pinpoint. An unexpected blow to the head (for example in a car accident) is among the more common causes.

BPPV is differentiated from other forms of dizziness or vertigo in that it is almost always brought on by head movements, and in that its effects usually subside less than a minute. Vertigo specialists may diagnose it by having the affected individual lie on their back and then tilt their head to one side or over the edge of the exam table. Additional tests that can be used to diagnose BPPV include videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, and magnetic resonance imaging (MRI), whose primary role is to rule out other potential causes, such as brain tumors or brain abnormalities.

There’s no full cure for BPPV, but it can be successfully treated using canalith repositioning (either the Epley maneuver or the Semont maneuver), both of which use physical movements to guide the crystals to a position in which they no longer cause trouble.Surgery is an option in the exceptional cases in which these therapies are not effective. If you have encountered unexplained dizziness or vertigo that persists for over a week, see your balance disorder specialist.

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