Benign paroxysmal positional vertigo (BPPV): symptoms, treatment

Causes

The causes of benign positional paroxysmal vertigo have not been established. Presumably, it could result from:

traumatic brain injury;
viral infection affecting the inner ear (labyrinth);
Meniere's disease;
taking antibiotics with ototoxic effects;
ear surgery;
spasm of the labyrinthine artery.

However, doctors believe that in more than half of the cases the causes of BPPV are not pathological. There are several theories explaining the mechanism of benign positional vertigo. The main one is cupulolithiasis.

The vestibular analyzer, responsible for maintaining balance, consists of two sections - central, located in the brain, and peripheral, located in the inner ear. The peripheral section includes the semicircular canals and the vestibule.

At the ends of the channels there are extensions - ampoules in which receptor hair cells are located; their clusters are called cupules (flaps). The cavities of the inner ear are filled with fluids - perilymph and endolymph. When moving, the pressure of fluids changes and irritation of receptors occurs, as a result a signal is sent to the brain about a change in the position of the body or head in space.

In the vestibule of the internal one there are two sacs - the utriculus and the sacculus, communicating with the semicircular canals. They contain accumulations of calcareous cells - the otolithic apparatus. The processes of nerve cells are immersed in the otoliths. According to the theory of cupulolithiasis, the causes of BPPV lie in the fact that when the head is turned, tiny particles are torn off from the otoliths, which then stick to the cupula, it becomes heavier and deviates, causing dizziness. During the reverse movement, the particles fall away from the receptor cells, and the attack passes.

This theory is confirmed by the fact that during pathological examination, a basophilic substance was found on the cupulae of patients suffering from positional vertigo. Doctors believe that the high incidence of BPPV in older people is due to otolith degeneration during aging.

What is benign paroxysmal positional vertigo? Causes and treatment

Dizziness is one of the most common symptoms and occurs for a variety of reasons.

One such cause may be benign paroxysmal positional vertigo. What kind of illness is this and how can you cope with it? You will find the answer to this and other questions in our article.

What it is?

When you turn your head quickly or change your body position suddenly, you may experience an attack of dizziness called benign paroxysmal positional vertigo (BPPV). This disease can be characterized as follows :

benign – without negative consequences for life and health;
paroxysmal – paroxysmal, sudden;
positional – manifested when changing the position of the head or body;
dizziness is a key symptom of the disease.

Although dizziness occurs in most diseases, with BPPV it has characteristic signs, based on which a specialist can make an accurate diagnosis at the first examination.

BPPV differs from other types in that a person can cope with it quite effectively on their own with the help of special exercises.

Most often, this disease occurs in people over 50 years of age. It occurs much more often in women than in men.

ICD-10 code

ICD-10 is the international classification of diseases, 10th revision , approved by the World Health Assembly in 1990.

It was created to encode diseases and pathologies and combine them into a single system.

This classification is used by doctors all over the world, since the alphanumeric code that denotes any diagnosis is universal and understandable to every medical professional, regardless of the level of proficiency in foreign languages.

ICD-10 consists of 22 disease classes. Each class consists of an alphanumeric code. Classes are divided into blocks, and those in turn are divided into headings and sub-headings. Thus, the final codes very accurately characterize various diseases.

According to ICD-10, BPPV is coded H81.1:

Class VIII. H60-H95 . Diseases of the ear and mastoid process.
Block H80-H83 . Diseases of the inner ear.
Category H81 . Vestibular dysfunction.
Subsection H81.1 . Benign paroxysmal vertigo.

The ICD is actively used in medical documentation. Alphanumeric codes, used instead of the verbal formulation of diseases, provide convenient data storage, analysis and retrieval. This classification contributes not only to the exchange of information between doctors, but also to the preservation of medical confidentiality.

Causes of BPPV

To analyze how benign positional vertigo occurs, it is necessary to understand the structure of the vestibular apparatus.

Three semicircular canals, which are located in the vestibule , a special organ in the inner ear, are responsible for recording human movements. In these channels there is an ampoule with a gelatin-like substrate - cupula. It is her movements that create a sense of body balance.

Also in the ampoule there is a certain amount of liquid, which contains calcareous formations - otoliths. They are formed throughout a person’s life, and as the body ages, they are destroyed and processed by special cells.

In some cases, otoliths are not destroyed and their parts float freely in the liquid, irritating the receptor apparatus. As a result, a feeling of dizziness appears, which disappears when the crystals settle in any area.

Depending on the location of the floating otoliths, 2 forms of benign paroxysmal positional vertigo can be distinguished:

Cupulolithiasis - otoliths are attached to the cupula of one canal.
Canalolithiasis – otoliths move freely in the canal cavity.

When formulating a diagnosis, the side where the lesion occurred and the semicircular canal (posterior, anterior, external) are also noted.

The following factors can cause the appearance of free otoliths::

chronic migraines;
head injuries;
Meniere's disease;
use of gentamicin antibiotics;
alcohol intoxication;
inner ear surgery;
viral labyrinthitis;
inflammatory processes in the ear canals;
spasm of the labyrinthine artery.

Symptoms

Sudden attacks of dizziness occur when there is a certain change in the position of the body or head (most often when getting up in the morning or when turning in bed).
The duration of such attacks is no more than 1 minute.
When dizziness occurs, a person feels as if he is falling, rising, or swaying, and surrounding objects are spinning before his eyes.
The appearance of nystagmus - involuntary movements of the eyeball.
dizziness may be accompanied by sweating, pale skin, irregular heartbeat, nausea, and vomiting.
The attacks are most severe in the morning. In the afternoon they practically do not occur.
In the absence of provoking movements, there is no dizziness.
Attacks can be either isolated or occur several times a day.
A certain position of the head provokes the appearance of dizziness (for example, throwing the head back or lowering it down).
Outside of attacks, the person feels well.
The attacks are always the same and there are no additional symptoms such as headaches, tinnitus, or hearing loss.

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Symptoms

What is the diagnosis of BPPV? What signs does it show? The main symptom of BPPV is short-term dizziness when changing head position. Most often, attacks occur when a person is lying down and suddenly turns over or throws his head back. The duration of dizziness is no more than a minute, then a feeling of instability may be felt for some time. Sometimes BPPV occurs during sleep and can be so severe that the person wakes up with discomfort.

Other symptoms of benign positional paroxysmal vertigo are nausea and vomiting, but these are rare. Headache and hearing loss are not typical for this condition.

As a rule, BPPV proceeds benignly: periods of exacerbations, during which attacks occur frequently, are replaced by a stable long-term remission - up to 2-3 years. In rare patients, the disease is accompanied by regular episodes of dizziness and severe autonomic disorders.

In general, benign positional paroxysmal vertigo is not dangerous for humans, but it can lead to fatal consequences if an attack occurs while driving, while at height, in water, and so on.

What it is?

benign – without negative consequences for life and health;
paroxysmal – paroxysmal, sudden;
positional – manifested when changing the position of the head or body;
dizziness is a key symptom of the disease.

Although dizziness occurs in most diseases, with BPPV it has characteristic signs, based on which a specialist can make an accurate diagnosis at the first examination.

BPPV differs from other types in that a person can cope with it quite effectively on their own with the help of special exercises.

Most often, this disease occurs in people over 50 years of age. It occurs much more often in women than in men.

Diagnostics

Benign positional paroxysmal vertigo is diagnosed by a neurologist based on the patient’s complaints. The diagnosis is confirmed by a positive Dix-Hallpike test. It is carried out like this. The patient sits on the couch and focuses his gaze on the doctor's forehead. The doctor turns the patient’s head to the right 45°, sharply lays him on his back and tilts his head back 30°. If a person experiences dizziness and nystagmus (oscillating eye movements), the test is assessed as positive. Then it is repeated on the other side. Nystagmus does not always appear.

BPPV is differentiated from vestibular neuronitis, labyrinthine fistula and vestibular type of Meniere's disease.

Additional diagnostic methods:

test using a stabilometric platform;
MRI of the brain;
CT or X-ray of the cervical spine.

Treatment

How is BPPV treated? In the past, doctors advised patients to avoid head positions that cause dizziness and to take medications as symptomatic treatment. As a rule, Meclozin was prescribed, a drug with antihistamine and anticholinergic properties. But practice shows the low effectiveness of drugs in the treatment of BPPV.

In recent years, the treatment of benign paroxysmal vertigo (BPPV) has been practiced with the help of various exercises that promote the return of otolith particles to their place - in the sacs. The Epley technique is considered the most effective way to restore inner ear mechanics and normalize balance control. Its algorithm:

The patient sits straight on the couch and turns his head towards the affected ear by 45º, then lies on his back, staying in this position for 2 minutes.
The doctor turns the patient’s head in the opposite direction (90º) and fixes it for 2 minutes.
The patient slowly turns his torso in the direction of turning his head, pointing his nose down and staying in this position for 2 minutes, then returns to the starting point.

The person may feel dizzy throughout the exercise. Usually 3 repetitions are required, after which there is a steady improvement in the condition. The number of procedures is determined by the doctor. Relapses occur in 6-8% of cases.

Another way to treat benign paroxysmal positional vertigo is vestibular gymnastics using the Semont method. Its essence lies in successive sharp changes in the position of the patient’s head and torso. It typically causes severe dizziness and is considered too aggressive by many doctors and is rarely prescribed.

If conservative treatment is ineffective and the disease is severe, neurosurgical surgery is performed on the inner ear.

Benign positional vertigo: causes, symptoms and treatments

Benign paroxysmal positional vertigo (BPPV) is dizziness that occurs as a result of sudden changes in position or rotation of the head. The disease occurs in all races of the population, it is more often present in women and in old age, but there have been cases of disorders in childhood.

Useful information In more than 50% of cases, patients who present with appropriate symptoms are diagnosed with benign positional vertigo (vertigo).

According to medical statistics, the number of patients increases every year, but this is not associated with the prevalence of BPPV, but with more frequent visits to hospitals.

It is believed that previously people were in no hurry to seek help from doctors due to the benign nature of the pathology.