positional vertigo

What are a positional vertigo and its different types?

Positional vertigo, more commonly known as Benign Paroxysmal positional vertigo (BPPV), is a type of vertigo that causes false sensations of movement, spinning sensations, dizziness, & occasionally, headaches. It happens when the tiny calcium crystals inside the middle ear called otoconia, break loose from their original position & get deposited in the semicircular canals of the inner ear. There they cause episodes of BPPV which are often triggered by any kind of head or neck movements, or changes in the position of the head.

BPPV is often treatable with the right kind of vertigo treatments, vertigo medicines, & vertigo exercises. The key to getting adequate treatment for BPPV is to get yourself checked by a doctor as soon as you experience the first episode of BPPV.

BPPV is one of the most common vestibular disorders in medical literature, & is the leading cause of vertigo (a false sensation of spinning or moving around) among people. It is usually not life-threatening, as is apparent from the word benign in its name, it is often triggered by a change in position of the head, as signified by the word positional in the name, it occurs in sudden spells of recurrent episodes as implied by the word paroxysmal in its name, & it is a type of vertigo.

How does BPPV affect people?

The semicircular canals of the inner ear contain a fluid that doesn’t normally move with gravity. However, when the calcium crystals get dislodged into this fluid, they move with gravity & cause problems with the way signals are perceived by the brain.

Since the inner ear sends out movement signals to the brain, while the eyes & the muscles responsible for movement do not adhere to the movements, this causes the person to feel as if their surroundings are moving or spinning even when they are perfectly still.

BPPV vertigo causes almost always include the displacement of these motion-sensitive calcium crystals into the semicircular canal of the inner ear. This sensation usually lasts for a few minutes, although in some people it can last for a few hours as well. Some people feel significant symptoms during an episode of positional vertigo, while some others feel no symptoms at all.

What are the symptoms of positional vertigo?

BPPV symptoms differ for every individual. However, there are some symptoms that are common across all patients of positional vertigo.

These common symptoms include:

• A sensation of the surroundings spinning or moving around you
• Dizziness that occurs suddenly, & for short periods of time
• Nausea
• Motion sickness
• Vomiting
• Headaches, sometimes of migraine intensity

It’s important to note that any kind of emergency symptoms like trouble breathing, high fever, rashes or itching of any part of the skin, blue tint on lips & face, chest discomfort, pain in the neck, etc. are not positional vertigo symptoms. If you experience any of the following symptoms along with dizziness, get yourself checked out by a doctor immediately as these can be cause for concern.

• Constant dizziness that is not affected by positions or changes in positions
• Hearing problems or fainting
• Neurological symptoms like coordination problems, problems with movements, etc.
• Trouble speaking or lifting your arms, legs, upper body, etc.
• Any kind of facial drooping, sagging, or numbness
• Respiratory problems of any kind

BPPV is quite common among the middle-aged population, & is also the most common cause of vertigo, accounting for 80% of all cases. BPPV is also triggered by an everyday maneuver, getting out of bed in the morning or turning over to one side in the bed.

BPPV causes:

A number of conditions can cause BPPV. Some of these are easily treatable by a doctor, while some others require more aggressive & intensive care.
The most common positional vertigo causes include:

• Head or neck injuries
• Injuries like whiplash
• Meniere’s Disease, in which excess fluid builds up inside the ears causing problems with balance, hearing loss on one side, and a feeling of pressure inside the ear, along with tinnitus(a ringing, buzzing sound in the ears)
• Labyrinthitis, an inflammation of the labyrinth of the inner ear that houses the vestibular system
• Vestibular Neuritis, an infection of the vestibular nerve of the inner ear which is responsible for carrying balance-related signals to & from the brain

At times, there is no probable cause for BPPV, at least not one that appears in immediate diagnosis.

Different types of positional vertigo:

There are two types of vertigo when it comes to BPPV: one type occurs when the loose crystals move freely in the canal fluid and is also known as canalithiasis. Another type of vertigo occurs more rarely, where the crystals are sort of ‘hung up’ on the bundle of nerves that is responsible for sensing the fluid movement. This is also known as cupulolithiasis. In the case of canalithiasis, it takes less than a minute for the crystals to stop moving once head position change causes a spin.

Once the crystals stop moving, the fluid movement settles and the nystagmus and vertigo cease. With cupulolithiasis, however, the crystals that are stuck on the bundle of sensory nerves make the nystagmus and vertigo last for a longer duration. The symptoms in this case last until the head is moved out of the triggering position. It is important to make this distinction, as the treatment is different for each type of vertigo.

BPPV vertigo treatment:

Some cases of BPPV treatment go away on their own, while some may require treatment for proper relief. In most cases, BPPV vertigo treatment involves canalith repositioning maneuvers that help move the misplaced calcium crystals from the inner ear to the middle ear.
Epley Maneuver is one such well-known vertigo treatment exercise that helps move the displaced calcium crystals back into their original position in the middle ear.

How to perform the Epley exercises for Vertigo:

To perform the Epley Maneuver for Vertigo treatment, follow the steps in the exact order as given below.

• Sit on a bed with your legs out in front of you. Turn your head 45 degrees to the left side.
• Lie down with your head turned to the left. Hold this pose for at least 30 seconds.
• Next, turn your head to the right about 90 degrees, until it’s at 45 degrees in that direction.
• Rollover to the right direction before sitting up.

Note that these steps are for when you have left ear BPPV. If you have right ear BPPV, follow the steps similarly but turn onto your right side first. The Epley Maneuver is generally a safe vertigo exercise. However, you should check with your doctor if you have any of the following:

• Any neck or back disease or injuries,
• Any vascular conditions
• History of or currently suffering from retinal detachment

Some vertigo medicines like the Vertin tablet, meclizine tablet, & the Stemetil MD tablet also help in reducing vertigo symptoms & in vertigo treatment.

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