Do you feel dizzy? Do you feel spinning sensation? Consult your doc, it could be BPPV

Hyderabad: Do you feel dizzy when you get up from the bed or when you move your head up and down for some work or sports or even turn your head from one side to the other? If the answer is ‘yes’, you may be suffering from Benign Paroxysmal Positional Vertigo (BPPV), say doctors on the occasion of BPPV Awareness Month of March.

BPPV gives a false sensation of spinning

Vertigo is the perception of motion, where a patient has an illusory feeling of self-rotation or surrounding rotation. A patient may also describe vertigo as swaying, tilting, spinning, or feeling unbalanced. Vertigo can arise due to diseases of the central and peripheral vestibular system. In the peripheral vestibular system, problems in the inner ear or the inner ear’s nerves cause vertigo. Benign Paroxysmal positional vertigo (BPPV) is one of the most common causes of peripheral vertigo, accounting for 50-60% of the patients. It is called Benign because it is not life-threatening or dangerous. Paroxysmal means a sudden attack of symptoms, positional vertigo refers to getting vertigo during a change in the head position.

Symptoms

The most common symptoms in BPPV patients are a spinning sensation (a feeling that the surroundings are moving around them or they are moving around the surroundings), a sense of imbalance, nausea, and vomiting.

Elaborating on the symptoms, Dr Greeshma Pulluri, ENT and Cochlear Implant Surgeon Amrita ENT Hospital, Hyderabad said, “Patients usually will get vertigo early in the morning when they get up from bed after sleep. They also get vertigo when they roll over in bed from right to left or left to right side. Patients usually report that they get a spinning sensation when they move their heads up and down for any work. They tend to avoid the head movements in the positions where they get vertigo and also avoid sleeping on the side to avoid the feeling of vertigo. The spinning sensation is brief and will mostly not last more than a minute for each episode. Vertigo usually is more severe in the morning compared to the evening. While BPPV is vertigo associated with changes in head position, many people with BPPV also feel a mild degree of instability between their recurrent attacks of positional vertigo.”

Changes in the inner ear linked to BPPV

Dr Sujeet Kumar Sinha, Associate Professor in Audiology, All India Institute of Speech and Hearing, Mysuru, explained, “To understand BPPV, we have to understand the structures of the inner ear. The inner ear comprises five structures: A utricle, a Saccule, and three semi-circular fluid-filled canals or tubes that help to maintain balance. These structures detect the change in head position in different directions. Utricle has tiny calcium carbonate crystals or otoconia placed over it. BPPV occurs due to the displacement of calcium carbonate crystals or bio-crystals otoconia into the semicircular canals. Once the otoconia is present in the semicircular canal, the person will experience vertigo and imbalance during head movement. Though BPPV can appear at any age, it is more prevalent in the 50s and 60s age bracket.”

Causes vary from idiopathic to head injury

As per the National Institute of Health (NIH) - National Library of Medicine, USA, BPPV occurs in approximately 50% to 70% of individuals without any known cause, called primary or idiopathic BPPV. The remaining cases are often associated with an underlying pathology, such as head trauma, vestibular neuronitis, labyrinthitis, Meniere’s syndrome, migraine, ischemia, and iatrogenic illness (illness caused by medication or during treatment as a side effect). The most typical cause of secondary BPPV is a head injury, accounting for 7% to 17 % of BPPV cases. Trauma to the head may lead to the release of many otoconia into the endolymph (fluid that fills the inner ear’s labyrinth). And that is why most of these patients have bilateral BPPV. Viral labyrinthitis or vestibular neuronitis accounts for up to 15 % of BPPV cases.

Diagnostic tests

A complete case history of the patient is required to understand the signs and symptoms of BPPV. The initial step in managing benign paroxysmal positional vertigo is patient awareness, education, and proper counseling. If the patient feels that they have BPPV, they must seek help from an Audiologist, Neurologist, Otorhinolaryngologist, or Neurotologist, and advise doctors.

“With the help of videonystagmography equipment, tests such as the Dix Hallpike test and supine rollover test/Mcclure Pagnini test are conducted to confirm the diagnosis and the side of involvement. The videonystagmography detects abnormal and uncontrollable eye movement (nystagmus) during the tests. A particle repositioning maneuver (PRM) is performed in the cases of BPPV unless there is a contraindication. PRM helps to relocate the free-floating particles or crystals from the semi-circular canal back into the utricle, thereby relieving the patient of symptoms of vertigo. Medications usually administered to suppress vestibular (related to the inner ear or sense of balance) influence are not an effective treatment option for patients with BPPV. Most patients with BPPV will get better with repositioning maneuvers or it will resolve completely. The prognosis is excellent once the proper diagnosis and proper canalith repositioning maneuvers is done,” said Dr Sinha.