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The Consumer Handbook on Tinnitus

Chapter 6
Benign Paroxysmal Positional Vertigo (BPPV)

Lornes Parnes MD

University of London
London, Ontario, N6A 5A5 Canada

For some, a session with the bed spins is a terrifying event that might occur during an alcoholic binge. Imagine though that while perfectly sober, each time you lay down, turn over in bed or look up, you launch into such a spin. This is the essence of benign paroxysmal positional vertigo (BPPV). Fortunately, unlike the alcohol related bed spin, the BPPV spin (technically known as vertigo) lasts but for a few seconds and rarely results in vomiting. Unfortunately, it can occur with each and every such head movement for weeks to months (and rarely years) on end.

Of all of the inner ear disorders that can cause dizziness/vertigo, benign paroxysmal positional vertigo (BPPV) is by far the most common, occurring in about one in five patients seen in dizziness clinics. It is a condition that is usually easily diagnosed and, even more importantly, readily treated with a simple office-based procedure. Dr. Robert Barany, the Austrian neurologist/otologist who won the Nobel Prize in Physiology/ Medicine in 1914 for his work on the physiology and pathology of the vestibular (balance) apparatus, first described the condition in 1921. He gave the following account from one of his patients:

“The attacks only appeared when she lay on her right side. When she did this, there appeared a strong rotatory nystagmus to the right. The attack lasted about thirty seconds and was accompanied by violent vertigo and nausea. If, immediately after the cessation of these symptoms, the head was again turned to the right, no attack occurred, and in order to evoke a new attack in this way, the patient had to lie for some time on her back or on her left side.”

Since this initial description, there have been major advances in the understanding of this common condition. In this chapter, I will review the normal vestibular physiology as it relates to BPPV, discuss the causes and mechanisms of BPPV, and then go on to discuss diagnostic tests, office-based management, and finally, surgical management.