Benign paroxysmal positional vertigo is a very common condition, particularly amongst other individuals. In this condition whenever the person turns their head in a particular axis of motion they feel that the world is spinning around them. If they stop moving as their had the vertigo would spontaneously resolve after a few seconds. Once they move their headache again the vertigo returns. Although patients can be extremely nauseated and uncomfortable between individual vertigo attacks, as long as they are holding very still the world would not spin. This is different from labyrinthitis or vestibular neuritis in that the patient has continuous spinning for 24-48 hours irrespective of head movement or body position. BPPV should also be distinguished from motion sensitivity in that many patients with migraine disorder are extremely sensitive to motion and body position changes. In BPPV patient would only experience vertigo when their head is moved in a particular axis.
The true cause of BPPV is unknown but has been related to head trauma, aging, and previous issues with the inner ear. The mechanism has been thoroughly worked out and link to displacement of “crystals” in the inner ear that are responsible for sensation of balance. These crystals, correctly called otoconia, are embedded in a gelatinous membrane in the vestibule which is the part of the inner ear that sences acceleration and inertia in horizontal and vertical axes. When these otoconia are dislodged from the gelatinous membrane they could tract inside the semicircular canals which are responsible for sensation of head rotation in X, Y, and Z axes. Because of otoconia displaced the fluid in the semicircular canals they give the patient a sensation of motion with any head motion in the axis of that particular balance canal. The most common canal for these otoconia to get trapped in is the posterior canal since it is gravity dependent and only open in one end.
Intraoperative findings as well as high resolution experimental MRI scans have confirmed presence of otoconia in balance canals in patients suffering from BPPV.
Treatment of the posterior canal BPPV is done through repositioning maneuvers. One such maneuver is called Epley which could be performed at our office. The other ones are habituation exercises including Semont and Brandt-Daroff exercises which could be done at home. Unfortunately the condition tends to be recurrent but with increased physical exercise, performing a detritions exercises and increasing balance reserve the problem seems to be not as bothersome when it recurs.