what is Benign paroxysmal positional vertigo?

Answer 1

Vertigo is the sudden sensation that you are unsteady or that your surroundings are moving. You may feel like you're spinning around on a merry-go-round or that your head is spinning inside. Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo.

The condition is characterized by brief episodes of intense dizziness associated with a change in the position of your head. It may occur when you move your head in a certain direction, lie down from an upright position, turn over in bed or sit up in the morning. Moving your head to look up also can bring about an episode of benign paroxysmal positional vertigo.

Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in your inner ear that sense movement and changes in the position of your head.

Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.

Answer 2

Benign Paroxysmal Positional Vertigo is a disorder of balance.

BPPV is a disorder of the organ of balance such that the mechanism keeps giving the brain a signal of movement. So the patient feels off balance, often as if the room is spinning, nauseated and wanting to vomit.

To understand BPPV you must first understand the organ of balance. These are the paired "semicircular canals" (see the wiki page).

These are a pair of organs made up as 3 semi-circles set at right angles to each other so that when you tilt your head in space, the stuff inside sloshes around a bit.

The stuff inside consists of "otoliths" also called "canaliths" or "otoconia" which are small crystals of calcium, hair cells which bend and thus detect movement and all this is suspended in a gel-fluid called "endolymph".

Normal physiology:
You start at rest - the stuff is at rest. The hair cells do not bend (much) and do not detect acceleration.

Then you turn your head and the canals move. However, due to inertia, the otoliths tend to stay and as the canal moves around the hair cells bend (?in response to the otoliths) and we detect this stimulus and interpret it as acceleration.

BPPV
With advancing years, the canals become craggy. Otoliths can be trapped behind irregularities in the canal and this causes a shift of the substances within the canal. If this causes some of the hairs to be bent and trapped in a bent state then there will be a constant movement detection message from the organ of balance but none from the other organ or from the eyes (our other major movement sensor). Our brain does not like the signal mix up and we get "vertigo" - a sensation of movement when there is none.

Treatment
(1) Otolith repositioning (eg Epley's manouver) is successful in up to 80% of cases, or so it has been quoted.
(2) Medications: Serc, Stemetil (prochlorperazine), etc. have been used with varying success.

Answer 3

BPPV, is an inner ear problem that causes you to suddenly feel dizzy when you move your head in a certain direction or roll over in bed (familydoctor.org)

BPPV is defined as an abnormal sensation of motion that is elicited by certain critical provocative positions. The provocative positions usually trigger specific eye movements (ie, nystagmus). The character and direction of the nystagmus are specific to the part of the inner ear affected and the pathophysiology (emedicine)

Causes: A few factors predispose patients to BPPV. These include inactivity, acute alcoholism, major surgery, and central nervous system (CNS) disease. A complete neurotologic examination is important because many patients have concomitant ear pathology, as follows:
Idiopathic pathology - 39%
Trauma - 21%
Ear diseases - 29%

Medical Care: Treatment options include watchful waiting, vestibulosuppressant medication, vestibular rehabilitation, canalith repositioning, and surgery
Otitis media - 9%
Vestibular neuritis - 7%
Ménière disease - 7%
Otosclerosis - 4%
Sudden sensorineural hearing loss - 2%
CNS disease - 11%
Vertebral basilar insufficiency - 9%
Acoustic neuroma - 2%
Cervical vertigo - 2%