Positional vertigo and BPPV

Two-thirds of all acute dizzy spells are caused by dysfunction of the inner-ear equilibrium organ. And here again half of those affected suffers from a positional vertigo. The positional vertigo is thus the most common cause of acute dizziness and vertigo. It manifests itself as a fierce, only a few seconds lasting vertigo that occurs in certain movements of the head, typically e.g. when turning from one side to the other in bed. Because it is a harmless and well treatable form of vertigo, he is also called “benign paroxysmal positional vertigo” or BPPV.

The positional vertigo is caused by small crystals in the inner ear, which usually sense gravity and acceleration. However, these crystals get disloged and subsequently lost in the so-called semicircular canals, which are the fluid-filled accelerometer of the inner ear. Certain head movements whirle them around just like the snow in a snow globe. This leads to an extremely violent vertigo, which quickly fades away when the crystals sink down again.

The shift of the crystals is triggered, among other things, by concussion or whiplash. However, tension of the cervical spine is a accompanying symptom, although the relationships are not yet conclusively clear.

The diagnosis of a positional vertigo can be determined by the ENT specialist by means of a positional test. He brings the patient on the couch with his head in a low position and triggers a dizzy spell by abruptly turning the head. By observing eye movements during the following dizzy spell BPPV can clearly be diagnosed.

The treatment of the benign paroxysmal positional vertigo consists in so-called positioning maneuvers by which the stray crystals are to be conveyed out of the archways. Depending on which archway is affected, different storage maneuvers come into question. The exercises can be done by the doctor alone at home and usually lead to success after a few days. Not to be confused with these exercises are a dizziness training for chronic dizziness.

The most common positioning maneuver is the Epley maneuver.

Author: Dr. med. Uso Walter (ENT specialist)