BENIGN PAROXYSMAL POSITIONAL VERTIGO
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| Normal membranous labyrinth | Dilated membranous labyrinth in Meniere's disease. After a head injury, scarring of the drainage pathways may cause fluid to build up. |
WHAT CAUSES BPPV?
The most common cause of BPPV in people under age 50 is head injury . There is also an association with migraine (Ishiyama et al, 2000). In older people, the most common cause is degeneration of the vestibular system of the inner ear. BPPV becomes much more common with advancing age (Froeling et al, 1991). In half of all cases, BPPV is called "idiopathic," which means it occurs for no known reason. Viruses affecting the ear such as those causing vestibular neuritis , minor strokes such as those involving anterior inferior cerebellar artery (AICA) syndrome", andMeniere's disease are significant but unusual causes. Occasionally BPPV follows surgery, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear (Atacan et al 2001). Other causes of positional symptoms are discussed here.
What doesn't cause BPPV ?
Gacek has suggested that BPPV is due to recurrent neuritis of the inferior vestibular nerve (Gacek and Gacek, 2002). We think that this is highly unlikely as BPPV is very well explained by mechanical consequences of loose debris within the inner ear, and not at all consistent with the usual picture of vestibular neuritis. BPPV is also not caused by psychological distress, and it is not a side effect of medication.
HOW IS THE DIAGNOSIS OF BPPV MADE?
HOW MIGHT BPPV AFFECT MY LIFE?
HOW IS BPPV TREATED?
INSTRUCTIONS FOR PATIENTS AFTER OFFICE TREATMENTS (Epley or Semont maneuvers)
1. Wait for 10 minutes after the maneuver is performed before going home. This is to avoid "quick spins," or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don't drive yourself home.
2. Sleep semi-recumbent for the next two nights. This means sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see figure 3). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eyedrops are required, try to put them in without tilting the head back. Shampoo only under the shower.
3. For at least one week, avoid provoking head positions that might bring BPPV on again.
- Use two pillows when you sleep.
- Avoid sleeping on the "bad" side.
- Don't turn your head far up or far down.
Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means be cautious at the beauty parlor, dentist's office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No "sit-ups" should be done for at least one week and no "crawl" swimming. (Breast stroke is OK.) Also avoid far head-forward positions such as might occur in certain exercises (i.e. touching the toes). Do not start doing the Brandt-Daroff exercises immediately or 2 days after the Epley or Semont maneuver, unless specifically instructed otherwise by your health care provider.
4. At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions in which you can't fall or hurt yourself. Let your doctor know how you did.
Comment: Massoud and Ireland (1996) stated that post-treatment instructions were not necessary. While we respect these authors, at this writing (2002), we still feel it best to follow the procedure recommended by Epley.
HOME TREATMENT OF BPPV:
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SURGICAL TREATMENT OF BPPV
(POSTERIOR CANAL PLUGGING)
ATYPICAL BPPV
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