Benign paroxysmal vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common type of vestibular disorder associated with rotational head movements or changes in body position. BPPV is also known as cochlear stone disease or Benking-Hilman syndrome.

BPPV is usually caused by the movement or displacement of stones (otocytes) inside the semicircular canals of the inner ear. These stones, called otocytes, are normally found in structures called the cochlea. In BPPV, they can become lodged in the semicircular canals and cause motion abnormalities and dizziness.

Epidemiology

The incidence of benign paroxysmal positional vertigo varies and, according to some authors, is 3-50% of all patients with peripheral vestibular vertigo. Women suffer from this disease more often than men.

Classification

Benign paroxysmal positional vertigo is primarily classified by the cause of occurrence: idiopathic or other (post-traumatic, post-infectious, etc.). Depending on the location of the freely moving particles of the otolithic membrane in relation to the structures of the semicircular canal, the most common forms of benign paroxysmal positional vertigo are distinguished:

• cupulolithiasis - particles are attached to the cupula of one of the channels of the vestibular receptor;
• canalolithiasis - particles of the macula are located freely in the cavity of the canal.

The main characteristics of BPPV include:

1. Paroxysmal attacks of vertigo: Episodes of vertigo usually begin with changes in head position, such as turning over in bed, tilting the head back, or getting out of bed.
2. Short-term episodes: Episodes of dizziness usually last no more than one minute.
3. Position-dependent symptoms: BPPV symptoms usually occur with certain head positions and resolve when the head is returned to its normal position.
4. No other symptoms: During episodes of BPPV, there are usually no other symptoms, such as nausea, vomiting, or changes in consciousness.

BPPV can be diagnosed by a doctor based on clinical symptoms and specialized tests, such as positional vertigo tests. Treatment for BPPV usually involves procedures to restore the normal position of the otocytes within the semicircular canals, such as the Epley maneuvers and Barbeck maneuvers. These procedures are performed by a doctor or physical therapist and can help the patient manage symptoms.

Reasons

DPG is usually caused by stones (broken pieces of calcium carbonate crystals) in the semicircular canals of the inner ear. These stones can cause abnormal signals to the brain about the position and movement of the head, leading to dizziness.

Possible causes of DPG may include:

1. Age: As a person ages, he or she becomes more susceptible to various inner ear conditions that may contribute to the development of BPH.
2. Trauma: Trauma, such as blows to the head, can dislodge stones in the semicircular canals and trigger DPH.
3. Viral infections: Some viral infections, such as vestibular neuritis or viral labyrinthitis, can damage the inner ear and become precursors to BPH.
4. Idiopathic origin: In some cases, the cause of DPH remains unknown and this is called idiopathic DPH.

Pathogenesis

The pathogenesis of benign paroxysmal positional vertigo is associated with disruption of the normal functioning of the semicircular canals in the inner ear and the vestibular system.

This is how DPG happens:

1. Stones in the semicircular canals: Inside the semicircular canals are microscopic calcium crystals called otoliths or "stones." These stones are usually found in specialized saccules and utricles of the inner ear.
2. Stone migration: Normally, stones remain in special compartments of the ear and do not cause problems. However, sometimes they can move from the saccules and utricles into the semicircular canals.
3. Positional changes: When stones enter the semicircular canals, they can stimulate the vestibular receptors, causing abnormal signals to the brain when the head position changes. This can lead to a feeling of severe dizziness.
4. Episodes of dizziness: In DPG, episodes of dizziness usually occur with certain movements or head positions, such as getting out of bed, tilting the head back or to the side, turning the head, etc. These episodes can be very intense but short-lived.
5. Compensation: Usually the body compensates for the signals coming from the vestibular system, and over time, symptoms may improve or disappear.

Benign paroxysmal vertigo - Causes and pathogenesis

Symptoms of benign paroxysmal vertigo

It can occur when the head position changes, such as when turning or bending, and can cause a spinning or rocking sensation. Symptoms of DPH may include:

1. Paroxysmal Vertigo: The main symptom of PPV is a feeling of sudden and intense dizziness that can last from a few seconds to several minutes. This dizziness can be triggered by certain head movements or changes in body position.
2. Spinning or rocking sensation: Patients with DPG may feel like the world around them is spinning or that they are rocking.
3. Changes in head position: Symptoms of DPH usually occur when the position of the head changes, such as turning to the side in bed, bending over, or getting out of bed.
4. Tonsils: Patients may experience uncontrollable eye movement, called nystagmus, during attacks of vertigo.
5. Nausea and vomiting: Dizziness associated with DPG can sometimes cause nausea and vomiting, especially during prolonged attacks.
6. Symptoms after an attack: After the dizzy spell ends, patients usually feel better and can return to their normal activities.

DPH is usually not accompanied by auditory or other neurological symptoms. It is important to note that the symptoms of DPH can be very similar to those of other conditions, such as vertigo caused by vestibular disorders, migraines, or other inner ear disorders.

Benign Paroxysmal Vertigo - Symptoms

Complications

Benign paroxysmal positional vertigo (BPPV) is generally not a serious condition and usually does not have serious complications or long-term effects. However, it can be very annoying and interfere with a person's daily life. Below are some of the possible complications and effects of BPPV:

1. Impaired quality of life: Episodes of dizziness can be very distressing and interfere with daily activities such as walking, getting out of bed, and driving. This can lead to a decreased quality of life.
2. Injuries: Due to sudden episodes of dizziness, patients may lose their balance and fall, which may result in injuries such as bruises, abrasions, or fractures.
3. Fear and anxiety: After several episodes of BPPV, patients may develop fear or anxiety about the risk of further attacks.
4. Activity restrictions: Some people with BPPV may limit their activities and avoid certain head positions to prevent dizziness. This can limit their ability to lead normal lives.
5. Underlying condition: In most people, BPPV is a primary condition and is not associated with other serious medical problems. However, in some cases, BPPV may be associated with other conditions, such as vestibular disorders or ear infections.

Diagnosis of benign paroxysmal vertigo

Diagnosis of benign positional vertigo (BPV) is usually performed by a specialist doctor, such as a neurologist or otolaryngologist. Diagnosis involves the following steps:

1. Physical examination: The doctor performs a general physical examination and takes a medical history, including a description of the symptoms of dizziness, the frequency and duration of episodes.
2. Balance assessment tests: The doctor may perform specific tests to assess the patient's balance and coordination. This may include tests such as the Romberg test, the marking test, the double-support balance test, and others.
3. Semicircular Canal Maneuvers and Tests: A diagnosis of DPG can be confirmed with specific maneuvers and tests performed by a doctor. One of the most common of these tests is the Dix-Galpine (or Epley) maneuver.
   • Dix-Galpine maneuver: The doctor performs a series of maneuvers to test whether certain head movements and positions cause vertigo symptoms. This maneuver may also be used to treat DPG.
4. Ruling out other causes of dizziness: Your doctor may also perform other tests and imaging studies to rule out other causes of dizziness, such as inner ear disorders, migraines, heart disease, and other medical conditions.

Benign Paroxysmal Vertigo - Diagnosis

Benign positional vertigo (BPV) can mimic or be accompanied by other medical conditions, so it is important to perform a differential diagnosis to rule out other possible causes of vertigo. Some conditions and diseases that may be considered in the differential diagnosis include:

1. More serious vestibular disorders: There are other more serious vestibular disorders such as vestibular neuritis, labyrinthitis, meningioma, acoustic neuroma, and others that can cause vertigo. Differentiating between DPG and these disorders may require specialized tests and examinations.
2. Migraine: Dizziness may be a symptom of migraine, especially in those with migraine with aura. However, DMG and migraine can mimic each other, so it is important to evaluate all symptoms and conduct further tests if necessary.
3. Central nervous system disorders: Central nervous system disorders, such as diseases of the brain or spinal cord, can cause dizziness. This includes strokes, brain tumors, multiple sclerosis, and other conditions.
4. Cardiac causes of dizziness: Certain cardiac problems, such as arrhythmia or myocardial ischemia, can cause dizziness. Cardiac dizziness can mimic vestibular dizziness.
5. Cervical osteochondrosis: Cervical osteochondrosis can cause irritation of blood vessels and nerves, which can lead to dizziness when moving the head.

Treatment of benign paroxysmal vertigo

Benign positional vertigo (BPV) can often be successfully treated with manual techniques called "maneuvers." These maneuvers help return the pebble to its normal position within the semicircular canals of the ear, relieving the symptoms of vertigo. Here are two of the most common maneuvers used for BPV:

1. Epley Maneuver: This maneuver is commonly used to treat posterior semicircular canal BPH caused by a stone in the posterior semicircular canal. The procedure is performed as follows:

   This maneuver is repeated several times. It may cause a short-term worsening of the dizziness symptoms while it is being performed, but after that the condition usually improves.

   • The patient first sits on the edge of the bed with his head tilted to the left at 45 degrees.
   • He then lies on his back with his head turned to the left at 45 degrees.
   • He then turns his head 90 degrees to the right so that it looks down at a 45 degree angle.
   • The patient then sits on the edge of the bed with his head tilted down.

2. Semont Maneuver: This maneuver is often used to treat DPH associated with a stone in the horizontal semicircular canal. The procedure is performed as follows:

   This maneuver may also cause a temporary worsening of symptoms, but the patient's condition usually improves after this.

   • The patient first sits on the edge of the bed with his head tilted to the left.
   • Then he lies down on his right side so that his head is below the level of his back.
   • After this, he quickly changes position, moving to his left side with his head turned down.
3. Medication: Your doctor may prescribe antiemetic and antivertigo medications to help relieve symptoms and reduce nausea and vomiting that may accompany dizzy spells.
4. Vestibular Exercises: Physical therapy may include specific exercises to strengthen the vestibular system and improve balance.
5. Diet and lifestyle: It is important to avoid positions and movements that cause dizziness. You may also need to avoid situations that can worsen symptoms, such as tilting your head back.
6. Avoiding stress: Stress can make symptoms of BPH worse, so it is important to manage stress and seek help from a psychologist or psychiatrist if needed.
7. Compliance with physician's instructions: Patients should strictly follow the instructions of the physician and physical therapist to achieve maximum benefit from treatment.

Benign Paroxysmal Vertigo - Treatment