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INTRODUCTION

The following information will tell you about Benign Paroxysmal Positional Vertigo, or BPPV for short.

WHAT ARE THE SYMPTOMS OF BPPV?

People with BPPV complain of dizziness, or vertigo. This can make them feel as if they are spinning around. More usually, though, it feels as if the room is spinning around, often quite violently. When it occurs it is very unsettling, but it only usually lasts for a few moments.

Most people find that certain situations make them feel dizzy, and the most common situation include:

- Looking up, as when hanging up washing on the line, or getting something off a high shelf

- Looking down, as when picking something off the floor, or doing up shoelaces

- Lying down in bed, or sitting up from lying down

- Rolling over in bed

WHAT CAUSES BPPV?

BPPV is thought to be due to loose particles floating around inside the ear’s balance organ.

It is believed that when patients with BPPV put their head in certain trigger positions, such as those above, the loose particles come to fall against the balance organ’s sensor. This tells your brain that your head is moving, when in fact it isn’t. The balance organ on the other side is not affected in the same way, so tells your brain that you head is not moving, so your brain gets confused and you feel dizzy. After a few seconds usually, the balance organ’s sensor ignores the particle and the dizzy feeling goes away. The particle stays there though, so every time the head is put back into the trigger position the dizziness comes back.

WHO GETS BPPV?

In a lot of patients the particle may have been broken off a part of the balance organ by a head injury, for example. In others it may have been broken off the sensor by a virus infection of the ear (labyrinthitis). In most patients, however, the origin of the particle is unknown.

ARE ANY SPECIAL TESTS NECESSARY?

There are no special tests to confirm the diagnosis of BPPV, but your specialist will have done a test in the clinic, where you laid back quickly on the couch to make you dizzy. This test confirms the diagnosis.

WHAT TREATMENTS ARE AVAILABLE FOR BPPV?

The mainstay of treatment for BPPV is a type of physiotherapy called a Particle Repositioning Manoeuvre (PRM). This is also sometimes called the Epley manoeuvre, named after the doctor who developed it.

When you have the PRM done, there is about 70% chance that the BPPV will be cured. If the PRM fails, it can be repeated. Only a very small number of people are not helped by this and need to go on to have surgery.

There are 2 ways of treating BPPV with surgery: the first method involves blocking the part of the balance organ with the particle in it with wax. The second operation involves cutting the nerve which connects the balance organ to the brain. This stops the brain getting the mixed messages from the balance organ.

Both of the these operations are fairly major, and carry a risk of hearing loss and other serious complications, so are reserved for patients whose symptoms are very severe, and who have not been helped by other methods.

There is no drug that is effective at treating BPPV.

HOW DOES THE PRM WORK?

During the PRM, your specialist will put you into various positions, some of which may make you feel very dizzy. The aim of this is to dislodge the particle in your balance organ. The particle is not destroyed, but hopefully moved to a different position where it will no longer cause any problems

WHAT IS THE OUTLOOK FOR THE FUTURE?

Patients who have had the PRM performed successfully will usually never be troubled again by the symptoms of BPPV. A small proportion (about 1 in 10) patients will get a relapse, often a long time in the future.