Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo ( BPPV ) is a harmless, though very unpleasant, very common form of vertigo.

Synonyms are: Cupulolithiasis, canalolithiasis and ( shortened ) Benign positional vertigo (not to be confused with dizziness postural ); Benign paroxysmal positional vertigo ( BPPV ); Benign paroxysmal positional vertigo ( BPPV ).

Frequency

Reliable and systematic studies on the incidence of benign positional vertigo are hardly. One reason for this is the high rate of spontaneous remissions that make the dizziness disappear even before the doctor consultation. In addition, systematic surveys are complicated by frequent misdiagnosis. It is assumed a prevalence of 2.4% in the general population.

Epidemiological figures come from an incidence of 64 cases per 100,000 inhabitants per year (about 160,000 in the U.S.). Figures from Germany suggest that the BPLS for about 1 /3 of the forms of vertigo attributable to a disorder of the inner ear is responsible.

Causes

The cause of benign positional vertigo, the replacement of intact or degenerated otoconia ( calcium carbonate crystals consisting of ) is adopted from the located in the inner ear utricle of the vestibular system. But even organic material is suspected as the cause. Intact otoconia may dissolve as a result of trauma. " Degenerate " otoconia are probably the cause of positional vertigo in the elderly. Following the widely accepted theory of the so-called canalolithiasis, these otoliths enter the semicircular canals of the inner ear and move here at corresponding head movements back and forth. By this motion, suction is triggered, which irritates the archway receptors. Such irritation typically occurs only with a nod in the corresponding plane of the semicircular canal. The consequence is that the brain receives a message via a movement that is not signaled by other sensory systems. The result is contradictory information in the brain ( vestibular mismatch) that lead to dizziness.

Why replace the otoliths, is only partially understood. Studies suggest that this is part of the normal aging process. Phased otoliths can be detected without that they suffer from dizziness among many people and even already in children. The detachment of otoliths only seems to grow with age, which also increases the probability of developing a benign positional vertigo in old age. But there are still other factors that replace large amounts of otoliths and thus increase the risk of benign positional vertigo: traumatic brain injury, inner ear surgery and inflammation in the area of the inner ear. Also of Meniere's disease and migraine are risk factors for BPPV dar.

Symptoms

Patients complain when lying down, turning the head, at the up or down looking over short vertigo attacks that rarely last longer than 30 seconds. Many patients complain of nausea, some even vomiting. Some complain after the vertigo attacks also has a feeling like walking on cotton wool. Some patients develop quickly an avoidance behavior to no longer experience the perceived as very unpleasant dizziness need.

Diagnosis

The diagnosis is made after targeted survey and implementation of a special provocation maneuver, the Dix- Hallpike storage sample found. To this end, the patient is placed on a examination table and put down quickly with the side head turned to cause the dizziness. The physician observes the eyes to detect nystagmus. It is typical that the symptoms only occur with a latency of about 1-2 seconds after provocation.

Therapy

Because of the benign positional vertigo is caused by located in the portico otoliths, the treatment consists in a sequence of body storage and head bearing exercises that this conveyed out of the semicircular canals of the vestibular system and placed in an innocuous position of rest. One of these treatment methods is the so-called Epley maneuver. In addition to treatment by the physician in principle, there is also the possibility of self-treatment. However, this should be done only after a confirmed diagnosis by a doctor. Only he can reliably distinguish between a benign positional vertigo and possible other causes of dizziness. Patients should be made ​​clear that the mere avoidance of symptoms leads to an extension of the duration of the disease, the selective triggering of symptoms but to a certain habituation, possibly due to cerebral adaptation processes.

Course and prognosis

The benign positional vertigo is a harmless but extremely unpleasant disease. Although he disappears without treatment usually after a few days and weeks, but in some patients experience larger movements on, partly for months or even years. Therefore, and because of the considerable psychological strain is a therapy in any case justified and should not be delayed by a reference to the spontaneous remission.

The benign positional vertigo occurs with or without treatment in 30-50 % of patients within two years again. By special storage procedure, the patient can such relapses independently treat at home (see web link).