Benign Paroxysmal Positional Vertigo (BPPV) is the most common condition causing intermittent dizziness, with the underlying pathology occurring in the inner ear. The dizziness and spinning sensations often occur with changes in head position. This condition typically affects individuals aged 30-70 years (more common in adults than children) and is more prevalent in women than men, with a ratio of 1.5-2:1. It is also more common in the elderly (over 60 years old). BPPV can occur in both ears in approximately 15% of cases and may co-occur with migraine.
Causes
Normally, the inner ear (labyrinth) contains organs that control balance (utricle, saccule, semicircular canals) and hearing (cochlea). The utricle contains calcium deposits (otoconia) that help detect head movement. If these calcium deposits dislodge and move into another part of the balance system, the semicircular canal, their movement (canalithiasis) will stimulate the central nervous system, causing dizziness or vertigo when the head moves.
The most common causes of BPPV in those under 50 years old include:
- Accidents or head trauma
- Inner ear disorders
- Middle or inner ear surgery
- Infections
- Prolonged bed rest after major surgery
- Repetitive head movements (e.g., working at a computer, bending down or looking up frequently)
In people over 50 years old, the most common cause is the natural degeneration of the inner ear’s balance organs due to aging. However, in about half of BPPV cases, no clear cause can be identified.
Symptoms
Patients often experience dizziness or vertigo, feeling unsteady or losing balance, especially with rapid head movements, such as:
- Lying down or sitting up quickly
- Bending down to pick something up
- Looking up or down
- Tilting the head
These movements usually trigger dizziness that lasts for seconds to minutes, often accompanied by eye twitching, which may impair vision temporarily. The dizziness typically resolves after a brief period. However, it can return if the same head movement is repeated. Although the dizziness is often mild upon recurrence, it can happen multiple times throughout the day.
The condition may persist for days or weeks, gradually improving on its own. However, in some cases, it can relapse. Patients with BPPV generally do not experience ear fullness, tinnitus, numbness, weakness, speech difficulties, or fainting, unless other underlying conditions are present.
Triggers
Some conditions can exacerbate symptoms, such as:
- Changes in atmospheric pressure (e.g., rain, snow, storms, or strong winds)
- Insufficient sleep or rest
- Stress
Treatment
Treatment for BPPV typically involves repositioning maneuvers (such as the Epley maneuver) to help move the displaced calcium deposits back into their proper location. In some cases, medications may be prescribed to manage symptoms, but repositioning is generally the primary form of treatment.
