Benign positional vertigo (Benign paroxysmal positional vertigo -BPPV) is a disease characterized by dizziness that occurs with certain head positions and involuntary movements of the eyes (nystagmus), and can usually improve spontaneously over time.
The cause of the disease is that the small calcium crystals (canaliths) in the inner ear, which enable us to perceive gravity, break off from the area where they normally remain attached in the part of the inner ear called the vestibule, and are released into the inner ear fluid, and then escape into the balance canals opening to this area.
Crystals escaping into the balance canal cause stimulation of the nerve endings there after some head movements, resulting in typical complaints (canalithiasis). Although the shape and direction of the detected involuntary eye movements (nystagmus) vary depending on the balance canal where the problem occurs, in this disease the posterior balance canal, which is in the lowest position according to gravity, is generally involved, and involvement of the horizontal and upper/anterior canals is extremely rare.
< Before the mechanism of p>BPPV was clarified, various treatment methods were used in patients with this pathology.Today, in positional dizziness, "maneuver therapy - canalith reposition", which was first described by Epley and applied to remove the crystals from the channel they escape from, is used for the treatment of complaints.
Although the canalith repositioning maneuver relieves the complaints related to the disease, it does not prevent the shedding of new crystals. Therefore, in order to prevent the recurrence of the disease, if there is an inner ear pathology such as Meniere's Disease, which may affect the function of the nerve cells in the inner ear and cause crystal loss, or a systemic pathology such as circulatory disorder, diabetes, thyroid gland dysfunction, this problem must also be treated.
There are also various surgical techniques defined to be applied in BPPV cases that do not respond to other treatment methods and are severe enough to affect the life of the patients.
Diagnosis of Positional Dizziness
- Head movements and Dizziness caused by changes in body position Feeling of a throbbing sensation,
- Wheel rotation, the rapid phase of which is towards the lower ear, which occurs after a waiting period of 2-5 seconds while the patient's head is turned to one side and the head is tilted backwards (Dix-Hallpike test). Detection of involuntary eye movement (rotatory nystagmus) and the simultaneous development of dizziness or nausea in the patient,
- The nystagmus is short-term (usually less than 20 seconds),
- When returning to the sitting position Occurrence of nystagmus in the opposite direction and of shorter duration,
- Brain, brainstem, balance nerve and cerebellum pathologies have been ruled out by history, examination and, when necessary, hearing, balance tests and radiological evaluations.
Positional Dizziness Treatment
In most of the patients diagnosed with positional dizziness caused by crystal entry into the posterior balance canal, the complaints are relieved with the canalith repositioning maneuver (KRM).
After CRM, patients are advised not to lie on the side of the ear where the disease is located for 48 hours, to lie on their back or on the opposite side on a high pillow, not to lean forward, not to raise their heads to look up, and to avoid sudden movements. Patients are called for a check-up between 2 and 5 days, CRM is repeated in patients who detect nystagmus in the eyes and or dizziness with the control Dix-Hallpike test, and patients with no problems are excluded from follow-up to apply in case their complaints recur.
The cause of positional dizziness is most common. The main reasons that can be detected in some patients, although they cannot be found exactly in the patient; They are listed as head traumas or concussions, advanced age, circulatory disorders, periods of inactive bed rest and other ear diseases.
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