Benign paroxysmal positional vertigo
Benign positional vertigo is the most common disease of the vestibular system. It is easily treatable and treatment leads to an immediate recovery in up to 90% of cases.
Benign positional vertigo usually manifests itself as rotatory vertigo, which is usually triggered by head movements, e.g. when the head is tilted forwards or backwards or when turning while lying down. Rotational vertigo is often associated with symptoms such as nausea, vomiting, sweating or palpitations. Typically, an attack of vertigo lasts about 30 seconds to a minute. If the dizziness lasts longer, another cause should be considered.
Together with the cochlea, the organ of balance forms the inner ear. The organ of equilibrium is divided into five components:
The semicircular canals are filled with a fluid, the endolymph. At the end of each semicircular canal is the cupula, a visible thickening that is equipped with a large number of hair cells. When the head moves, the endolymph in the semicircular canals deflects the hairs of the hair cells, which is interpreted by the brain as movement of the body.
In benign positional vertigo, it is assumed that calcium carbonate crystals (so-called otoconia) detach from the otolith organs and enter the semicircular canals of the inner ear. These crystals remain at the lowest point of the semicircular canal in a calm head position. As soon as the head is moved, the crystals also move due to gravity. This creates an unusually strong flow of endolymph, which is interpreted by the brain as a rotational movement. Since, in contrast, the eyes do not perceive movement, a conflict arises in the brain between the incoming information from the vestibular system, resulting in dizziness. This dizziness continues until the crystals have reached their new resting point.
Why the crystals detach from the otolith organs is often difficult to determine in individual cases. However, it has been proven that benign positional vertigo occurs more frequently after a head impact, in other diseases of the inner ear or in migraine patients. Positional vertigo can also develop after prolonged bed rest, for example after an operation.
Benign positional vertigo is diagnosed by moving the head in such a way that the crystals are mobilized and the vertigo is triggered. As the vestibular organ also controls eye movements, eye tremors (known as nystagmus) accompanying the dizziness can be used to determine whether it is actually positional vertigo. The type of nystagmus can also be used to identify which semicircular canal is affected – crucial information for treatment. The posterior semicircular canal is most frequently affected (in 60-90% of cases), less frequently the lateral semicircular canal (5-30%) and only very rarely the anterior semicircular canal (< 5%). This distinction is important because there are special positioning and release maneuvers for the diagnosis and treatment of each semicircular canal.
Most sufferers of positional vertigo can actively do something about their condition. We have compiled the most common rescue maneuvers for you.
In most cases, positional vertigo can be successfully treated without the use of medication, surgery or special devices by means of various liberation maneuvers. These maneuvers are performed by medical professionals and consist of a sequence of head and body movements designed to move the small crystals out of the affected semicircular canal and back to where they no longer cause symptoms.
In most cases, the symptoms disappear after the maneuver used for the corresponding diagnosis, but occasionally several attempts are required before the desired success is achieved. It can help if the maneuvers are also carried out independently at home.
In some cases, your doctor may prescribe medication to relieve accompanying symptoms such as nausea and dizziness.
In the first three days after the extrication maneuver, slight balance disorders may occur, such as dizziness (a feeling as if you were on a ship), an unsteady gait or nausea. During this time, avoid jolting, such as jogging or jumping, as well as downward head movements, for example when tying shoes or leaning over the sink to wash your hair. Dental treatment should also be avoided wherever possible. The position in bed should be as flat as possible.
Older people, who are particularly frequently affected by positional vertigo, are often so restricted in their mobility and mobility that conventional diagnostic and rescue maneuvers are very difficult to perform. The swivel chair, which was co-developed by doctors at the Vertigo Center, allows patients to be positioned in a targeted and comfortable manner. All examinations are carried out in a sitting position and usually take no more than 20 minutes. If a positional vertigo is detected, a corresponding repositioning maneuver can also be performed directly on the swivel chair.
Benign paroxysmal positional vertigo can be treated successfully and often disappears by itself, especially if there is no underlying cause. In some patients, however, the dizziness may return. The relapse rate is around 15 – 40%. However, recurring positional vertigo can also be treated as described above – usually successfully. In the event of recurrent positional vertigo, it is recommended to determine the vitamin D level and to take vitamin D if there is a corresponding vitamin D deficiency.