Benign paroxysmal positional vertigo, also known as BPPV, is an inner ear disease where small changes in the position of your head, like tilting the head back, cause sudden dizziness or a sense that the whole room is spinning. BPPV is usually not a severe problem, if it doesn’t disappear on its own over six weeks. There are two common types of this disease, which are classified according to where the imbalance is located in the inner ear. They are classified as primary and secondary.
The primary form of BPPV involves the movement of the cochlea toward the temple. This leads to the buildup of fluid behind the ear, which is what is called a calcium carbonate crystal. The condition causes the inner ear to vibrate, resulting in hearing loss and sometimes dizziness. This is a painful condition, but fortunately, most people clear up on their own with no serious medical treatment required. A number of studies show that BPPV may have a genetic link, though other studies have shown that it is not passed genetically.
The secondary form of positional vertigo has no discernible cause. Instead, small hair-like crystals begin to build up in the canal as a result of fluid movement. The crystals cause the sufferer to feel dizzy or to lose consciousness. Treatment includes surgical procedures to drain the fluid from behind the ear and to reduce the number of crystals.
Patients who wear eyeglasses or are using hearing aids may suffer from benign paroxysmal positional vertigo. They can wear such devices comfortably and be unaware of any symptoms. Treatment includes antihistamines to reduce the number of apps in the eye, a course of antibiotics to kill any infection, and repositioning of the eyes if necessary.
If there is no evidence of BPPV or other symptoms, the next step is to perform a biopsy. Special x-ray instruments are used to examine the inside of the ear. During this examination, the doctor will note the location and size of any bone or tissue obstructions. Biopsies of the inside of the ear will reveal information about the movements of fluid inside the ear, the location of nerves, and the extent of loss of sensation. There are two ways to perform a biopsy: through a tiny incision in the skin, and through a larger incision in the scalp. Miniature otoscopes are often used for this procedure, and an ophthalmologist should be consulted if the patient is having trouble seeing.
The third step in treating positional vertigo or detecting it in its early stages is a neurological examination. This involves testing the response of the brain to visual stimuli such as moving objects or sounds. Because the majority of cases of BPPV involve head positions that are mildly to moderately tilted, most patients will not have a normal response to light or sound. However, patients who experience severe symptoms can have abnormal responses to visual stimuli. This examination is done on a standard otoscope so that all of the cranial nerve patterns can be seen.
When the cause of BPPV cannot be identified through these exams, additional tests need to be performed. One of these is a blood test to check for levels of diphenylamine in the patient’s blood. Diphenylamine is a chemical in the brain that produces an illusion of movement in response to light or sound. If levels are high, then the patient may have minor BPPV, but it could also mean that there are some irreconcilable structural issues in the inner ear that need to be addressed.
Patients with severe symptoms of BPPV may eventually undergo surgery. However, it should always be considered that this option comes with a very high risk factor. First of all, surgery is used only as a last resort. If a secondary, more drastic treatment is needed, it will not be performed within six weeks of the surgery.