Benign Paroxysmal Positional Vertigo – Diagnosis and Treatment
Diagnosis
When diagnosing benign paroxysmal positional vertigo (BPPV) and other vestibular disorders, providers observe symptoms like dizziness, vertigo, and imbalance that appear with certain head movements.
Providers look for vertigo triggered by moving the head or lying down. These symptoms usually last less than a minute.
Shifts in the inner ear, especially in the semicircular canals and otolith organs such as the utricle and saccule, often cause these symptoms. During exams, providers watch for involuntary eye movements called nystagmus.
Providers often use the Dix-Hallpike maneuver during the visit. In this test, the provider asks the patient to lie back with the head turned and tilted. This movement may trigger symptoms or abnormal eye movements if BPPV is present.
Movement of tiny particles called canaliths or otoconia in the semicircular canal causes this response.
If the diagnosis remains unclear, providers may use special tests:
| Test Name | Purpose |
|---|---|
| Electronystagmography (ENG) | Measures eye movement with electrodes during head or balance stimulation. |
| Videonystagmography (VNG) | Uses cameras to track eye movements to detect signs of vestibular disorders. |
| Magnetic Resonance Imaging (MRI) | Provides brain images to rule out other causes of vertigo, such as tumors or strokes. |
Providers consider symptoms like nausea, vomiting, loss of balance, lightheadedness, and presyncope.
People with BPPV may have repeated episodes caused by daily activities involving head motion.
Identifying these patterns and using the right diagnostic steps helps providers pinpoint BPPV and plan treatment.
Treatment
Moving Inner Ear Particles
Medical professionals or physical therapists often guide repositioning maneuvers to manage benign paroxysmal positional vertigo.
These maneuvers aim to move small particles, called canaliths, out of sensitive inner ear areas that trigger vertigo.
Steps in this therapy typically include:
- Specific head and body movements, such as the Epley maneuver or liberatory maneuver
- Holding each position for about 30 seconds, or until dizziness stops
Providers usually perform these maneuvers in a clinic, but they may teach patients how to do them at home.
Table: Key Points of Repositioning Therapy
| Feature | Description |
|---|---|
| Setting | Clinic or at home |
| Goal | Move particles to a harmless place |
| Additional support | Vestibular rehabilitation or balance exercises may help with full recovery |
Doctors may use vestibular suppressant medication for short-term relief, but these medicines do not fix the underlying problem.
Physical therapy and balance exercises can help if symptoms continue.
Surgery for Stubborn Cases
If repositioning procedures do not work, doctors may suggest surgery.
Surgeons use a small bone plug to block the canal in the inner ear that causes dizziness. This procedure stops the ear’s response to moving particles and often works well.
Summary of Surgical Option:
- Posterior canal plugging is the most common operation.
- Doctors use surgery only if other treatments fail.
Surgery carries some risks but usually helps in severe or persistent cases.
Everyday Habits and Tips for Managing at Home
People with BPPV can use simple routines at home to lower their risk of falls and manage dizziness.
Avoiding sudden head movements, like looking up quickly, can help prevent symptoms. When feeling dizzy, sitting down right away can help prevent injuries.
Keeping rooms well-lit, especially when getting up at night, reduces the chance of accidents. Some people may need a cane for steady walking.
Staying in touch with a healthcare provider helps control symptoms. While BPPV may return after treatment, careful management and home strategies can make daily life safer.
Getting Ready for Your Medical Visit
Steps to Take Before Your Visit
Being organized before seeing a healthcare provider for symptoms like dizziness or vertigo can help.
Here are some tips to prepare:
List All Symptoms: Write down what you are feeling. Include when symptoms began, how often they happen, and if anything triggers or relieves them.
Record Any Recent Injuries: Note any bumps or injuries to the head, even small ones.
Make a table of your medical details:
| Condition | Medicine/Supplement |
|---|---|
| High blood pressure | |
| Diabetes |
Bring this information to your appointment.
- List Important Questions: Prepare questions about your symptoms, possible causes, needed tests, and next steps if tests are not clear. Include questions about activity limits, specialist referrals, and treatment options.
Example questions to ask:
- What tests, like MRI or audiometric testing, are needed?
- Should I see an ENT or neurologist?
- If the first treatment does not work, what will be done next?
- Can this issue come back?
If a provider refers you to a specialist, ask about options like electronystagmography (ENG), videonystagmography (VNG), or other diagnostic tests.
How the Doctor Will Approach Your Case
The healthcare provider usually starts by asking about your symptoms and medical history.
These questions can include:
- Which symptoms do you have?
- When did they start, and how long do they last?
The provider may also ask if your symptoms are constant or if they come and go.
They might ask if certain movements or activities make your symptoms worse. The doctor will want to know if you have hearing loss, headaches, vision changes, or nausea.
They may ask if you have a history of head injuries. You might be asked about other ongoing health problems or treatments. The doctor performs a neurologic examination to check your balance, eye movements, and hearing.
They may also discuss or order diagnostic tests such as ENG, VNG, MRI, or audiometric tests, depending on your symptoms and history.
The provider may advise you about activity restrictions or refer you to an ENT specialist or neurologist.
