Causative & risk factors
BPPV is a benign condition of the inner ear with no serious underlying cause. Episodes of vertigo are precipitated by certain movements of the head. This condition is thought to occur due to the presence of floating crystals of calcium carbonate in the labyrinth fluid.
Clinical presentation
BPPV is characterized by sudden, short episodes of vertigo which last for a few seconds up to a maximum of 1 minute. Moving the head in certain directions is the trigger for vertigo. The common culprits are looking up, rolling over in the bed or getting up from the bed.
The vertigo may be accompanied by nausea or vomiting.
Investigations
The diagnosis of benign paroxysmal positional vertigo can be made clinically. The doctor performs a clinical test known as Dix-Hallpike manoeuvre to confirm BPPV. This test entails that the patient perform a series of movements which trigger an attack of vertigo.
Treatment
Treatment is not necessary in patients with BPPV since it often disappears on its own within a few months.
The simplest and most effective treatment for BPPV is the Epely manoeuvre. This is a series of head movements that are performed by the doctor on the patient. The success rate is almost 80%.
Brandt-Daroff exercises are a set of recommended exercises if the Epely manoeuvre does not work.
If the symptoms remain persistent in spite of the above measures, inner ear surgery may be performed.
Facts and figures
The prevalence of BPPV can range anywhere from 10 to 64 per 100000 according to current statistics. Amongst the elderly population, approximately half of them suffer from BPPV at some point.
