Benign Paroxysmal Positional Vertigo, BPLS, Benign Paroxysmal Positional Vertigo, BPPV

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPLS) is a paroxysmal vertigo that occurs repeatedly when the head is in a certain position. It lasts for a few seconds and is often accompanied by severe nausea and vomiting. This disease of the inner ear is triggered by deposits in certain parts of the equilibrium organ. It is the most common cause of vertigo. Diagnosis and treatment are carried out through positioning maneuvers. If left untreated, benign paroxysmal positional vertigo resolves in well over 50 percent of cases within a few days to weeks, and rarely persists for months or years. Early treatment usually shortens the duration of the symptoms. The benign paroxysmal positional vertigo occurs mainlyin old age and can develop again after a symptom-free period.

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• What are the causes of benign paroxysmal positional vertigo?
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What are the causes of benign paroxysmal positional vertigo?

The benign paroxysmal positional vertigo is caused by freely moving, calcareous deposits in a semicircular canal of the vestibular organ (organ of equilibrium) in the inner ear. These deposits are called otoconia or otoliths.

There are three semicircular canals in both inner ears

• the posterior (rear - most often affected),
• the anterior (front) and
• the lateral (lateral) or horizontal (horizontal) semicircular canal.

Sensory cells in the semicircular canals register rotational movements of the head and forward this movement information to the brain. The semicircular canals are filled with a fluid (endolymph). Deposits that can move freely in the endolymph of a semicircular canal lead to incorrect activation of these sensory cells during certain movements.

The vertigo develops by sending contradicting position or movement information of different body structures to the brain.

The debris sends rotational information from the affected semicircular canal to the brain that does not match information from the following structures:

• the unaffected parts of the diseased equilibrium organ of the same inner ear,
• the balance organ of the other inner ear,
• the eyes and
• the musculoskeletal system.

The benign paroxysmal positional vertigo often occurs when sitting up or turning in bed after sleeping or after lying for a long time (e.g. due to illness). Benign paroxysmal positional vertigo can also develop after an accident (especially bruised skull). It can also occur after an acute labyrinth failure (temporary loss of function of the balance organ).

Benign paroxysmal positional vertigo is more common:

• in old age,
• if you have high blood pressure, hyperlipidemia (increased fat in the blood) and migraines or
• after a stroke.

This fact could point to an influence of circulatory disorders in the development of the benign paroxysmal positional vertigo.

Vitamin D deficiency appears to be a risk factor for the recurrence of benign paroxysmal positional vertigo and possibly also for the development of this disease. Bone breakdown with release of calcium compounds in osteopenia or osteoporosis could play a role in the development of this disease. In addition, the influence of viral infections and a genetically determined susceptibility to the development of benign paroxysmal positional vertigo are discussed.

What are the symptoms?

The benign paroxysmal positional vertigo develops when the head is in a certain position. Which head position triggers the dizziness depends on the semicircular canal affected. One to thirty seconds after changing position, the vertigo becomes more and more intense, which becomes weaker after a few seconds and then usually disappears. An attack of vertigo usually lasts half a minute. However, the duration of the vertigo attacks can also be shorter or longer (a few minutes at most).

This triggers rapid eye movements (nystagmus), which causes some affected persons to perceive a sudden rotation of the environment. In addition, many people affected suffer from severe nausea and vomiting. The more frequently the position that triggers the vertigo attack, the less dizziness will be in many cases. Between attacks of dizziness there may be slight imbalance.

How is the diagnosis made?

The doctor can make a suspected diagnosis based on the typical symptoms. Positional or movement-dependent vertigo can also result from damage to the brain stem or cerebellum (central positional vertigo) and low blood pressure. However, through a careful examination, the doctor can rule out other causes.

He / she performs certain positioning maneuvers in order to be able to detect a position-dependent dizziness and a typical nystagmus. The doctor may put glasses on the person concerned, the lenses of which prevent the eyes from focusing (Frenzel glasses). This enables s / he to better assess the eye movements during the maneuver. In addition, a clinical neurological examination is carried out to rule out a neurological disease.

Imaging diagnostics (e.g. sonography of the arteries supplying the brain, CT, MRT) are seldom necessary when the test results are unclear.

How is vertigo treated?

The treatment of benign paroxysmal positional vertigo can usually be carried out on an outpatient basis. A hospital stay is only necessary in the event of severe impairment due to dizziness or severe vomiting.

Positioning maneuvers

For treatment, a positioning maneuver (e.g. Epley liberation maneuver) is carried out, with which the deposits are transported out of the semicircular canal. Different maneuvers are used depending on the semicircular canal affected.

Carrying out the maneuver is safe and very efficient, but mostly uncomfortable for the person affected. A pronounced feeling of dizziness as well as nausea and vomiting can be triggered. In some cases, the doctor will therefore give an antivertiginous drug (drug that reduces dizziness), rarely a benzodiazepine (sedative), before treatment. For many people, one to three positioning maneuvers are sufficient to eliminate the symptoms. Depending on the semicircular canal affected, however, it may be necessary to perform these maneuvers much more frequently in order to reduce the symptoms of vertigo.

Since the symptoms sometimes do not resolve completely immediately or the benign paroxysmal positional vertigo can recur, the patient is taught a positioning maneuver that should be performed several times a day until the symptoms are free.

After successful treatment, a slight postural vertigo with accompanying imbalance may persist for a few days. The repositioning maneuver rarely transports the deposits into an adjacent semicircular canal and again triggers benign paroxysmal positional vertigo when taking another position.

A positive effect of Antivertiginosa (except before carrying out a positioning maneuver) and drugs that stimulate blood circulation could not be proven.

Note Avoiding the movements that trigger a vertigo attack will prolong the duration of the symptoms.

Surgical treatment

Surgical treatment is very rarely necessary. The affected semicircular canal can be opened and then filled with bone tissue. This means that it loses its function. Another treatment option is the surgical interruption of the nerve supply to the defective semicircular canal. This means that incorrect movement information can no longer be passed into the brain. Irradiation of the damaged semicircular canal using an argon laser may be another treatment option. This irradiation leads to ossification of the semicircular canal. The effectiveness of this treatment method has not yet been fully investigated in clinical studies.

Temporary dizziness or hearing loss may occur after surgery. Permanent hearing loss occurs after a surgical procedure in five to ten percent of those affected, depending on the method. Rare complications are nerve or vascular injuries or infections.

Whom can I ask?

Diagnosis and therapy of benign paroxysmal positional vertigo can be carried out, for example, by the family doctor or a specialist in ear, nose and throat medicine.

Note If you experience vertigo, you should contact a doctor immediately, as it can also be triggered by serious illnesses (e.g. stroke).

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (e.g. BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see Costs and Deductibles.

In the case of certain services (e.g. inpatient stays) - depending on the health insurance provider - patient co-payments are provided. For information on the respective provisions, please contact your health insurance provider, which you can find on the website of your social insurance company, for example.