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Benign positional paroxysmal vertigo (BPPV)

Overview

Benign positional paroxysmal vertigo refers to brief intermittent attacks of rotatory vertigo, that is a sudden spinning sensation. It is precipitated by rapid change in head position. Posterior semicircular canal is affected the most followed by anterior semicircular canal in the ear.

It is caused by movements of canalith (calcium crystals in inner ear) in endolymph (fluid in inner ear)

  • Age: Most common in people aged >50 years but can occur at anytime
  • Gender: BPPV is common in women
  • Vitamin D deficiency
  • Head trauma
  • Other disorders including:
    • Labyrinthitis
    • Vestibular neuronitis
    • Meniere disease
    • Migraine
    • Inner ear surgery
  • Other conditions including:
    • Hypertension
    • Diabetes mellitus
    • Hyperlipidaemia
    • Osteoporosis
    • Non-apnoea sleep disorders

  • Vertigo (spinning sensation of head) on turning head, while sitting up or lying down, and looking up or bending down
  • May be associated with nausea or vomiting
  • Imbalance
  • Usually comes in episodes
  • Relieved by resting in one position

Neurologist

  • Clinical examination using head impulse test or Dix Hallpike manoeuvre
  • MRI brain to detect unusual features

  • Repositing manoeuvres - Epley’s, Semont’s, Brandt-Daroff exercises
  • Regular vestibular rehabilitation exercises
  • Medicines for symptomatic treatment
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