Benign positional vertigo or B. P. V. causes dizziness
due to abnormalities in the inner ear. The inner ear normally has small sensory
structures where hair cells are embedded in a soft structure containing crystals
of calcium carbonate (See
Drawings). The soft structure sometimes
fragments and creates masses of loose tissue in the inner ear. They fall or are
moved on to other structures, creating abnormal perceptions of balance. The
symptoms of positional vertigo can include dizziness, lightheadedness, imbalance
and nausea. Activities that bring on the symptoms will vary but almost always
are precipitated by a position change of the head with respect to gravity.
Getting out of bed or rolling over in bed are common problem motions. Because
people with benign positional vertigo often feel dizzy and unsteady when they
tip their head back to look up, sometimes BPV is called the top shelf vertigo.
Individuals who experience the symptoms often find that when the symptoms begin
their problems are more severe but over time they tend to be resolving on their
own. While no one knows what really causes benign positional vertigo, some
individuals experienced trauma just before the symptoms appeared. Some of these
dramatic triggers may include rapid movement of the head. The diagnosis can be
established by examining a patient’s eye movement while positioning them. Other
doctors feel that history alone may be sufficient. Many individuals experience
symptoms particularly when they go to bed or arise in the morning. Avoiding a
completely flat position sometimes can resolve problem. Individuals who sleep
with a slight head up position find that their symptoms are less severe. Lights
and firm surfaces minimize problems
Treatment
Benign positional vertigo is often self-limiting and
symptoms can subside within six months. The symptoms tend to wax and wane
without apparent reason. Motion sickness medications sometimes help but can tend
to prolong the recovery period. There are kinds of physical maneuvers or
exercises that have also been proven to be effective.
Epley maneuver
A physical therapist can be trained in the use of the
Epley maneuver. The Epley maneuver involves sequentially moving the head in
several different positions. The recurrence rate following this is relatively
low, about 5 to 10 percent, and in some instances a second treatment is
necessary. After you undergo the Epley maneuver it should be noted that patients
should avoid rapid movement's that would reposition debris. The Epley is thought
to place otolithic debris in a portion of the inner ear where it becomes fixed.
Most therapists recommend that you sleep in a semi
recumbent position for approximately two or three days. During this
period of time you may not move your head quickly return to one side. Rather
harsh exercise should be avoided during this period of time. After approximately
a week, patients may resume most activities that should do so gradually.
Surgical treatment
If exercise is ineffective, there are numerous
options for treatment. Those individuals who have proven benign positional
vertigo can consider surgical procedures such as a vestibular nerve section,
Canal obstruction procedure, singular nerve section or other operations.
The vestibular nerve section
Vestibular nerve section is an operation designed to cut
the entire balance nerve to one side. Behind its use is the theory that if the
vestibular function is eliminated from one side, symptoms will completely
disappear over a longer period of time. The body can adapt to no information, it
cannot handle incorrect information. The vestibular nerve section is performed
by making an incision directly behind the ear. The incision extends down into
the neck and an opening is created into the skull. By separating the area
between the brain and the temporal bone that houses the inner ear, the surgeon
can identify the vestibular nerve as it enters into the inner ear. The nerve is
then divided into two segments one containing the balance fibers and the other
containing hearing portions of the nerve. The nerve is then cut only on the
balance side. Most individuals experienced one last severe experience of
dizziness. A recovery can take up six months.
Canal obstruction procedures
A canal obstruction procedure is generally shorter in
duration and involves less risk. The operation is done through the mastoid bone
directly behind the ear. An incision is made in the crease behind the ear and
some of the bone is removed. After entering the area near the inner ear, the
surgeon identifies the posterior semicircular canal. This canal is usually the
offending semicircular canal. The surgeon then opens a segment of bone housing
the canal and plugs it with ground up bone. This prevents fluid from moving in
this segment of the semicircular canal. Patients who have this, find that they
experience one relatively mild attack of dizziness following the procedure and
then have complete resolution of their symptoms. Sometimes because of injuries
to the membranes or because the bone is forced into other segments of the ear,
patients may experience hearing loss as well. Perhaps a third of those
individuals who undergo the operation will experience permanent in irreversible
hearing loss.
Singular nerve section
Dr. Richard Gacek introduced the singular nerve
section in the '60s. The operation has fallen out of favor recently because of
its 20 percent (deafness) hearing loss rates. Most individuals who experience
hearing loss had no functional hearing left in the operating ear. The advantage
is that those individuals who have success from the operation are almost
immediately cured. Many can go home the same day. Some individuals experience
dizziness and have to be hospitalized briefly following the procedure. Other
complications such as facial weakness are very very rare.
There's no reason for someone with benign positional
vertigo suffer permanently. It is uncommon for individuals with benign
positional vertigo to be permanently disabled by their condition. Most people
who have this can eventually experience improvement in their symptoms.
