Symptoms and Diagnostic Path
The key symptom of BPPV is sudden, severe, and
limited episodes of vertigo without TINNITUS(ring-
ing or rushing sound in the ears) or hearing
impairment. The presence of either or both of the
latter suggests another disorder. Symptoms tend to
occur with certain positions, though symptoms
can occur even when avoiding trigger positions.
Between episodes, there are no symptoms. The
pattern of symptoms is fairly conclusive, though
doctors typically conduct a comprehensive AUDIO-
LOGIC ASSESSMENT to determine whether there is
any HEARING LOSSwith the expectation that results
will be normal.
Other diagnostic procedures for BPPV may
include
- Dix-Hallpike test, positional test performed dur-
ing physical examination; positive for BPPV
when it causes NYSTAGMUS(rapid and involun-
tary darting movements of the eyes) or brings
on an episode of vertigo - caloric test, in which the doctor gently instills
warm and then cold water into each ear; nor-
mal response evokes vertigo and abnormal
response, diagnostic of BBPV, evokes little or no
vertigo - electronystagmography, in which tiny electrodes
placed around the eyes detect the abnormal
darting eye movements characteristic of vertigo - imaging procedures such as COMPUTED TOMOGRA-
PHY (CT) SCAN orMAGNETIC RESONANCE IMAGING
(MRI) to rule out other possible causes for the
symptoms
The combination of test results and history of
symptoms helps the doctor distinguish BPPV from
other disorders that affect the vestibular system.
Treatment Options and Outlook
For many people who have BPPV, the symptoms
simply go away over time, generally within sev-
eral months, as the inner ear fluid dissolves the
otoconia. Some people benefit from ANTIHISTAMINE
MEDICATIONSor scopolamine, drugs that suppress
vestibular function, or antinausea medications.
There are several positional treatments (among
the most commonly used are the Epley maneuver
and the Semont maneuver) that some doctors
perform to attempt to jolt the otoconia out of the
semicircular canals and at least into the vestibule
if not back into the utricle. These maneuvers suc-
ceed 70 to 90 percent of the time.
Rarely the otolaryngologist may recommend
one of two operations for BPPV if it continues for
longer than a year without response to other
treatment:- Posterior ampullar neurectomy severs a branch
of the nerve that conveys motion signals from
the utricle, ending its ability to send messages
of motion to the brain. - Posterior canal plugging seals the involved
semicircular canal so the otoconia can no
longer float in its fluid.
Surgery nearly always ends BPPV; when it does
not, further examination typically reveals compli-
cating factors or conditions that contribute to the
symptoms. Nearly everyone who develops BPPV
eventually recovers fully from the condition, with
balance restored to normal. During the course of
the condition and while undergoing treatment
with one of the maneuvers, doctors recommend
avoiding positions that may trigger symptoms,
especially tilting the head back, until BPPV symp-
toms no longer occur. Once BPPV is resolved, it
generally does not recur.Risk Factors and Preventive Measures
Otoconia seem to naturally occur in many people,
causing problems only when they become lodged
in vestibular structures such that they interfere
with the movement of fluid that is essential for
balance. It also appears that the body’s natural
processes dissolve and absorb the otoconia over
time, so most of these calcifications do not become
large enough to obstruct the vestibular channels.
Because doctors do not know what causes otoconia
to form, there are no known methods for prevent-
ing them. Prompt treatment for ear and sinus infec-
tions to reduce further trauma to the inner ear may
help keep otoconia from causing symptoms.
See also ACOUSTIC NEUROMA; MÉNIÈRE’S DISEASE;
OPERATION; SURGERY BENEFIT AND RISK ASSESSMENT;
VESTIBULAR NEURONITIS.blowing the nose The process of clearing mucus
and congestion from the nasal passages. Blowing12 The Ear, Nose, Mouth and Throat