Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder characterized by brief episodes of vertigo (a spinning sensation) that are triggered by changes in head position. BPPV occurs when small calcium carbonate crystals, called otoconia, become dislodged from their normal position within the inner ear and migrate into one of the semicircular canals, which are fluid-filled structures responsible for sensing rotational movement.

When the head is moved, these displaced crystals can cause abnormal fluid movement within the semicircular canal, leading to a sensation of spinning or dizziness. The vertigo experienced in BPPV is typically short-lived and triggered by specific head movements, such as rolling over in bed, tilting the head back, or looking up.

Common symptoms of BPPV include brief episodes of vertigo lasting less than one minute, typically triggered by changes in head position, as well as accompanying symptoms such as nausea, imbalance, and occasionally, nystagmus (involuntary eye movements).

Diagnosis of BPPV is typically based on a combination of clinical history and physical examination maneuvers, such as the Dix-Hallpike test or the supine roll test, which aim to provoke and reproduce characteristic vertigo and nystagmus associated with the condition. Additional tests, such as videonystagmography (VNG) or electronystagmography (ENG), may be performed to confirm the diagnosis and rule out other potential causes of vertigo.

Treatment for BPPV often involves a series of simple maneuvers known as canalith repositioning procedures or particle repositioning maneuvers, such as the Epley maneuver or the Half Somersault maneuver, which aim to reposition the displaced otoconia within the inner ear and alleviate symptoms. These maneuvers can often provide rapid relief from vertigo and may be performed by a healthcare provider or taught for self-administration at home. In some cases, additional treatments or follow-up maneuvers may be necessary to fully resolve symptoms.

Maneuver video tutorials:

Epley maneuver

Half Somersault Maneuver

Semont maneuver

Brandt-Daroff maneuver

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