Benign positional vertigo

Answer 1

Definition

Benign positional vertigo is a condition in which a person develops a sudden sensation of spinning, usually when moving the head. It is the most common cause of vertigo.

Alternative Names

Vertigo - positional

Causes, incidence, and risk factors

Benign positional vertigo is due to a disturbance within the inner ear. The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to movement of the fluid, which occurs as you change position. The fluid movement allows your brain to interpret your body's position and maintain your balance.

Benign positional vertigo develops when a small piece of bone-like calcium breaks free and floats within the tube of the inner ear. This sends the brain confusing messages about your body's position.

There are no major risk factors. However, the condition may partly run in families. A prior head injury (even a slight bump to the head) or an inner ear infection called labyrinthitis may make some people more likely to develop the condition.

Symptoms

The main symptom is a spinning sensation, which:

• Is usually triggered by head movement
• Often starts suddenly

Most often, patients say they cannot roll in bed or tilt their head up to look at something.

Other symptoms can include:

• Vision complaints, such as a perception that things are jumping or moving
• Vomiting (in severe cases)

Signs and tests

To diagnose benign positional vertigo, the health care provider will often perform a test called the Dix-Hallpike maneuver. The doctor holds your head in a certain position and asks you to lie quickly backward over a table. As you do this, the doctor will look for abnormal eye movements and ask if you feel a spinning sensation. The doctor may use various methods to help evaluate your eye movements.

A physical exam is otherwise normal. A complete medical history and careful neurological exam should be done to rule out other reasons for your symptoms. Tests that may be done include:

• EEG
• Electronystagmography
• Evoked auditory potential studies
• Head CT
• Head MRI
• Magnetic resonance angiography of the head
• Warming and cooling the inner ear with water (caloric stimulation) to test eye movements

Treatment

The most effective treatment is a procedure called "Epley's maneuver," which can move the small piece of bone-like calcium that is floating inside your inner ear. Other exercises that can readjust your response to head movements are less effective.

Occasionally, medications may be prescribed to relieve the spinning sensations. Such drugs may include:

• Antihistamines
• Anticholinergics
• Sedative-hypnotics

However, such medicines often are not very effective for treating vertigo.

Expectations (prognosis)

Benign positional vertigo is uncomfortable, but usually improves with time. This condition may occur again without warning.

Complications

Patients with severe vertigo may get dehydrated due to frequent vomiting.

Calling your health care provider

Call your health care provider if vertigo develops that has not been evaluated or if treatment is ineffective. Also call if you develop any associated symptoms (such as weakness, slurred speech, visual problems) that may indicate a more serious condition.

Prevention

Avoid head positions that trigger positional vertigo.

References

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo: Mosby; 2005:3226.

Hain TC. Cranial nerve VIII: vestibulocochlear system. In: Goetz CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 12.

Answer 2

Definition

Benign positional vertigo is a condition in which a person develops a sudden sensation of spinning, usually when moving the head. It is the most common cause of vertigo.

Alternative Names

Vertigo - positional; Benign paroxysmal positional vertigo; BPPV

Causes, incidence, and risk factors

Benign positional vertigo is due to a disturbance within the inner ear. The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to movement of the fluid, which occurs as you change position. The fluid movement allows your brain to interpret your body's position and maintain your balance.

Benign positional vertigo develops when a small piece of bone-like calcium breaks free and floats within the tube of the inner ear. This sends the brain confusing messages about your body's position.

There are no major risk factors. However, the condition may partly run in families. A prior head injury (even a slight bump to the head) or an inner ear infection called labyrinthitis may make some people more likely to develop the condition.

Symptoms

People with this condition feel as though they are spinning or moving, or that the world is spinning around them. They may experience:

• Nausea, vomiting, hearing loss, and a loss of balance
• Vision problems, such as a feeling that things are jumping or moving

The spinning sensation:

• Is usually triggered by moving the head
• Often starts suddenly
• Lasts a few seconds to minutes

Most often, patients say the spinning feeling is triggered when they roll over in bed or tilt their head up to look at something.

Signs and tests

To diagnose benign positional vertigo, the health care provider will often perform a test called the Dix-Hallpike maneuver.

• The health care provider holds your head in a certain position and asks you to lie quickly backward over a table.
• As you do this, the health care provider will look for abnormal eye movements and ask if you feel a spinning sensation. The doctor may use different methods to help evaluate your eye movements.

A physical exam should otherwise be normal. A complete medical history and careful brain and nervous system (neurological) exam should be done to rule out other reasons for your symptoms.

Tests that may be done include:

• EEG
• Electronystagmography(ENG)
• Head CT
• Head MRI
• Hearing test
• Magnetic resonance angiography of the head
• Warming and cooling the inner ear with water (caloric stimulation) or air to test eye movements

Treatment

The most effective treatment is a procedure called "Epley's maneuver," which can move the small piece of bone-like calcium that is floating inside your inner ear. Other exercises that can readjust your response to head movements are less effective.

Occasionally, medications may be prescribed to relieve the spinning sensations. Such drugs may include:

• Antihistamines
• Anticholinergics
• Sedative-hypnotics

However, these medicines often do not work very well for treating vertigo.

To prevent your symptoms from getting worse during episodes of vertigo, avoid the positions that trigger it.

Expectations (prognosis)

Benign positional vertigo is uncomfortable, but usually improves with time. This condition may occur again without warning.

Complications

Patients with severe vertigo may get dehydrated due to frequent vomiting.

Calling your health care provider

Call your health care provider if:

• You develop vertigo
• Treatment for vertigo has not worked
• You develop symptoms such as weakness, slurred speech, or vision problems that may be signs of a more serious condition

Prevention

Avoid head positions that trigger positional vertigo.

References

Crane BT, Schessel DA, Nedzelski J, Minor LB. Peripheral vestibular disorders. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 165.

Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010;82:361-369.

Reviewed By

Review Date: 08/31/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington.