Benign Positional Vertigo (BPV) dizziness is thought to be due to the dislodging of small calcium carbonate crystals (known as calcite or “otoconia”) within the inner ear. How these crystals come loose is not clear, but has been attributed to head injury, migraine headaches, infection, surgery or long periods spent on one’s back, and disorders of the inner ear. The crystals also may have degenerated with the aging process. However, there is often no discernible cause for BPV.
BPV contributes to about 20% of all dizziness cases. While BPV can occur in children, the incidence of BPV seems to increase with age. Close to 50% of all dizziness in older people is due to BPV.
BPV symptoms include the acute onset of severe dizziness or vertigo that is precipitated by a change of head position with respect to gravity. Getting out of bed or rolling over in bed are common “problem” motions. The vertigo is most often described as an intense spinning sensation and the impending sense of falling that lasts several seconds to 1-2 minutes and subsides rapidly. Nausea, vomiting, and sweating can often accompany vertigo. Because people with BPV often feel dizzy and unsteady when they tip their heads back to look up, sometimes BPV is called “top shelf vertigo.” Since the small crystals often dissolve spontaneously, intermittent symptoms are often the rule, where vertigo occurs for several days in a row, and then can disappear completely before returning again.
BPV is often diagnosed with a thorough history and physical examination by our highly trained otologists. Most commonly, a Dix-Hallpike test is performed in the office, and a positive test is virtually diagnostic. In cases that are less easy to diagnose, the otologist may order additional vestibular testing such as an ENG or an MRI.
If BPV is diagnosed, the treatment can be performed in the office with a success rate of approximately 80-90% after the first treatment. Occasionally, a second treatment is required 1-2 weeks later. The Epley maneuver (known as particle repositioning or canalith repositioning procedure) involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPV after these maneuvers is 25-30% at one year.