Benign Paroxysmal Positional Vertigo (BPPV)

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo and dizziness. People with BPPV often experience brief episodes of spinning sensations triggered by changes in head position, such as rolling over in bed or looking up. These episodes usually last a few seconds, though some individuals may report lingering dizziness or a feeling of heaviness in the head.

What Causes BPPV?

BPPV occurs when tiny calcium carbonate particles, called otoliths (or “ear stones”), become dislodged from their usual location in a part of the inner ear called the utricle. These particles move into one of the semicircular canals, fluid-filled structures that help with balance. When the head moves, the otoliths shift within the fluid of the semicircular canal, stimulating balance nerve fibers. This sends incorrect signals to the brain, causing the sensation of spinning.

Types of BPPV

There are three semicircular canals in each ear, and the specific canal affected determines the type of BPPV. Currently, 14 variants of BPPV have been identified. To diagnose the exact type, healthcare providers perform positional tests, such as:

• Dix-Hallpike Test: Used to evaluate the posterior canal, which is the most commonly affected.
• Supine Roll Test: Tests the horizontal canal.
• Deep Head Hanging Test: Checks the anterior canal.

Each type of BPPV causes characteristic eye movements, known as nystagmus, which can be observed during these tests. These patterns help pinpoint the location of the otoliths within the canals. For example:

• Posterior canal BPPV has five subtypes based on the position of the otoliths, including long arm, short arm, or cupulolithiasis.
• Horizontal and anterior canal BPPV have their unique subtypes.

Nystagmus patterns are best detected using advanced tools like Video Nystagmography (VNG).

How is BPPV Treated?

BPPV is treated using repositioning maneuvers designed to move the otoliths back to their original location in the utricle. The type of maneuver used depends on the nystagmus pattern and the affected canal. Commonly used maneuvers include:

• Epley Maneuver
• Semont Maneuver
• Barbecue Maneuver
• Gufoni Maneuver

Proper diagnosis and precision in maneuvering are essential for effective treatment.

Advanced BPPV Care

Dr. Anita Bhandari’s Vertigo and Ear Clinic offers cutting-edge facilities for diagnosing and treating BPPV, including:

• High-resolution VNG: Equipped with infrared cameras for accurate recording of nystagmus, including torsional movements.
• BPPV Tracking Device: Ensures precise execution of repositioning maneuvers with correct angles and timing.
• BPPV Simulation: Allows for advanced study and management of the condition.

Dr. Anita Bhandari’s Vertigo and Ear Clinic has one of the world’s most advanced BPPV research lab where the following facilities are available:

• VNG with high resolution IR cameras for optimum nystagmus recording along with torsion detection
• BPPV tracking device to ensure precise repositioning maneuvers with proper angulation and timing
• BPPV simulation