BPPV: features of diagnosis and treatment of benign vertigo

The abbreviation BPPV stands for “benign positional paroxysmal vertigo”. This disease is associated with a disorder of the vestibular apparatus, formed under the influence of otoliths – calcium crystals. The main symptom of BPPV is general instability and apparent rotation of surrounding objects.

Features of the vestibular apparatus

The vestibular apparatus is a system responsible for the direction of movement of the body. This part of the body has a rather complex structure. It includes:

  • semicircular canals;
  • endolymphfilling the system;
  • ciliated cells that transmit signals to the CNS.

Physiologically, the vestibular apparatus is located under the temporal bone in direct contact with the inner ear. When a person, for example, turns his head, the fluid inside the system begins to move. Because of this, the receptors that create nerve impulses are activated. As a result, the central nervous system receives a signal and the brain forms an idea of the position of the body in space.

Why does BPPV occur?

Loss of balance will make a person dizzy, because the body simply cannot understand where it is. The appearance of BPPV is due to the fact that calcium deposits accumulate in one of the channels of the vestibular apparatus. As a result, when turning the head, the crystals move along with the liquid and distort the overall picture. Because of this, the characteristic symptoms of the disease appear. Among other reasons for the formation of BPPV are:

  • inflammation in the inner or middle ear;
  • exposure to certain types of drugs;
  • vascular and heart diseases;
  • cervical osteochondrosis .

Also, BPPV can appear in the presence of neoplasms in the body. This happens when the tumor affects the central or peripheral nervous system. As a result, the person develops characteristic symptoms.

Varieties of BPPV

The two main types of vertigo are vestibular and non- vestibular . Doctors also distinguish central and peripheral BPPV. Hearing impairment is considered a specific symptom of the latter type. Non- vestibular vertigo occurs due to:

  • neurological diseases;
  • mental problems.

Over time, dizziness can progress. First, the patient notes some episodes of BPPV. After that, the number of attacks increases, and their intensity increases.

Symptoms of benign vertigo

The first sign of BPPV is the onset of rotational vertigo attacks . Usually, symptoms appear with a change in body position or tilting of the neck and head. In this case, the patient does not have any hearing impairment. The duration of the attacks starts from a few minutes, but some patients report long-term disorders lasting up to a day.

How to Diagnose BPPV

The first thing a doctor does before making a diagnosis is taking an anamnesis. This allows you to form a typical clinical picture indicating benign dizziness. In addition, a neurological examination is performed , including an assessment of:

  • sensitivity level;
  • the state of the central and peripheral parts of the NS;
  • eye movements;
  • coordination of movements and balance;
  • reflexes.

To diagnose BPPV, a Dix-Hallpike test is performed . To do this, the doctor turns the patient’s head on the affected ear and lays the person on his back (while the head should be tilted 45 degrees). The doctor observes whether the patient develops dizziness or nystagmus in this position. If there are characteristic symptoms, their duration is measured.

The doctor can recommend the patient and laboratory diagnostics. It includes a general and biochemical blood test. From diagnostic studies, the patient is sometimes advised tomography of the cervical spine, MRI of the brain and electronistamography .

How to treat BPPV

Positional maneuvers are considered the most effective method of therapy. The procedure should be performed only by an experienced specialist. In the course of work, he gives the head and body of the patient the desired position and gradually changes the position of the body in order to remove the otoliths from the canals of the vestibular apparatus. Repeat exercises should be 2-3 times.

In parallel, medications may be prescribed to the patient. Most often it is betahistine in combination with antiemetics. If it is not possible to remove calcium deposits in the traditional way, surgical intervention is used (obstruction of the semicircular canal). However, this method is used extremely rarely, since the operation is considered quite risky.

General conclusion

Benign vertigo is a disease that is not life-threatening. However, it has unpleasant symptoms that prevent the patient from leading a normal life. Therefore, it is important to conduct a timely diagnosis and determine the method of treatment for BPPV that is suitable for a particular patient. Most often, therapy is based on the performance of vestibular maneuvers by a medical specialist.

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