Posts tagged inner ear disorder

A young woman holding her head due to BPPV.

What is BPPV? (Benign Paroxysmal Positional Vertigo)

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It may look like a mouthful to say, but the medical condition known as benign paroxysmal positional vertigo (BPPV) can easily be understood by breaking it down into its constituent terms. Benign means non-life threatening and paroxysmal means that it occurs only in sudden bursts. Positional means that it is triggered by specific positions or head movements and vertigo is a sensation of dizziness. Taken altogether, someone who has BPPV would experience brief periods of dizziness, which are brought on by abrupt, unanticipated head motions.

Your Body During a BPPV Episode

Many of the issues which affect your balance originate in the inner ear, like BPPV. It starts when some of the calcium carbonate crystals which are normally carried in the gel of the utricle, somehow navigate out of that environment and into at least one of the three semi-circular canals, which are filled with fluid, and are thus also capable of hosting the crystals.

These semi-circular canals depend on fluids to determine head motions, and when the fluids become oversaturated with calcium carbonate crystals, your ability to balance is disrupted. These particulates cause excessive movement in the fluids within your inner ear, creating what we commonly know as vertigo (dizziness).

When this fluid moves, there are nerve endings inside the ear which sense that motion and transmit messages to the brain about head movements. Inaccurate signals are sent to the brain, and as a result, the BPPV patient feels dizzy and disoriented.

People Affected by BPPV

Even though you might never have heard of BPPV, it’s not an exceptionally rare condition. In fact, more than 100 out of every 100,000 people in America are affected by BPPV, most of whom are adults. The disorder rarely impacts children, and is far more prevalent in older people, particularly seniors.

The cause of the disorder is not yet understood, with most people reporting that they simply woke up one day, and as they got out of bed, realized that the bedroom was spinning all around them. Although the beginnings of BPPV are unclear, scientists and doctors have noted a correlation between the disorder and other diseases such as diabetes, osteoporosis, and inner ear infections.

A diagram of the inner ear, as related to BPPV

In diagnosing BPPV, ENT doctors look for nystagmus, which is an pattern of eye movements caused by the sensation of vertigo.

Diagnosing BPPV

It can be difficult to diagnose BPPV, because the movement of the calcium carbonate crystals does not show up on imaging scans such as magnetic resonance imaging (MRI). However, a BPPV can abruptly position their head in a way that causes the crystals to move within the fluid of the semi-circular canals, which triggers the false signals that induce dizziness.

This dizziness causes the person’s eyes to move in a very definite and predictable pattern known as nystagmus. This occurs because there is a close relationship between the eye muscles and the inner ear, which allows for a person to remain focused on immediate surroundings during head movements.

Because the false signals sent to the brain make it think the head is moving, it also mistakenly triggers eye movement, which is supposed to help maintain equilibrium. However, in this false scenario, nystagmus acts as a telltale sign.

Treatment of BPPV

Sometimes medications are prescribed as a treatment for BPPV, and in other cases, surgical solutions are recommended. But in most cases, the most effective treatment by far is relocating the wandering calcium carbonate crystals back into the utricle chamber where they belong.

The first step in this mechanical approach calls for identification of which semi-circular canal(s) the crystals have migrated to. Once that is known, a doctor will guide the patient through a series of head maneuvers which are designed to encourage the crystals to return to their original position. Self-treatment is not recommended, and it calls for a doctor who is skilled in guiding a patient through the proper maneuvers so that no damage is done to the head or neck areas.

Effectiveness of Treatment Programs

Studies have demonstrated that the success rate for properly diagnosed and guided BPPV treatment is around 90%. Once the calcium carbonate crystals have been returned to their proper position, most patients report no more than minor residual spinning sensations, and even these diminish within a couple of months.

However, it is possible for the condition to recur, and come back in full force. This usually occurs within five years of treatment, and when it does come back, it can again be treated successfully, using the gravity method of guiding the crystals back to their proper position in the ear.

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