Benign Paroxysmal Positional Vertigo or BPPV

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Benign Paroxysmal Positional Vertigo or BPPV


Disease/Disorder Name: 
Benign Paroxysmal Positional Vertigo or BPPV 
ICD-9 Description: A balance disorder that results in the sudden onset of dizziness, spinning, or vertigo when moving the head.
ICD-9 Code Family: 386.11

BPPV is a type of vertigo that has an organic cause. It is caused by calcium carbonate crystals breaking loose from the wall of the inner ear organ of balance (vestibule) and floating in the fluids of the vestibule.

Debris (CACO3) in the posterior semicircular canal of the inner ear (BPPV)

The vestibular system is one half of the cochlear function and controls our body’s sense of balance.  The body senses its different positions and also controls it’s balance through fluid dynamics in the 3 semicircular canals that comprise the vestibule. Messages sent to the brain as to the head’s changes in position are generated by the fluid in the semicircular canals acting on calcium carbonate (CACO3) crystals that shift on their bed of sensory hairs in two fluid-filled cavities at the base of the of the vestibule, the utriculus and sacculus.  It is when a number of these CACO3 crystals break free and float around in the fluids and inadvertently touch the chamber walls, that vertigo occurs.

Symptoms of BPPV

Because the errant CACO3 crystals move freely within the fluid of the inner ear canals, when the head moves, they sometimes brush up against the hairs lining the vestibule giving false signals to the brain as to the position of the body and head. Even though the body and head may be upright and in a normal position, the loose particles give conflicting messages to the brain, which attempts to overcorrect the false signals and causes the vertigo.

The vertigo associated with BPPV comes on suddenly and can last from seconds to minutes, rarely longer. There are usually no hearing loss symptoms.

Diagnosis of BPPV

Diagnosing BPPV is a matter of ruling out other symptoms that may cause vertigo:

  • migraines
  • stroke
  • blood flow caused by
    • anemia
    • low blood sugar
    • hyperventilation
    • dehydration
    • heart problems

These conditions that mimic BPPV can be ruled out by various blood tests and a CT scan.

A strong indicator of BPPV is having the patient follow a pencil or finger moving back in front of the eyes. If there is a jerky motion, this is good indicator of BPPV.

Possible Treatments for BPPV

In 1983, an Otolaryngologist by the name of John Epley developed a method of moving the free-floating CACAO3 crystals out of the canals through a specific series of head movements. Called the Epley maneuver (from the man who invented it, naturally!), it usually cures about 80% of BPPV symptoms. Essential the maneuver attempts to shift the crystals out of the vestibule by a combining gravity with a shifting sequences of head positions to move the crystals out of harms way. The following is the Epley maneuver is usually done with the assistance of a physician:

Epley maneuver performed in a physician’s office.

You can also perform certain exercises at home by yourself using the Brandt-Daroff exercises

The need for surgery is very rare, but in such cases a procedure known as “posterior canal plugging” can be done. This blocks most of the canal’s function, which can reduce the symptoms.