BENIGN PAROXISMAL POSITIONAL VERTIGO (BPPV)
As the name suggests, this disease is characterized by severe dizziness that occurs suddenly with head movements. Patients usually complain of very severe dizziness that starts suddenly when they bend over or stand up, or when they turn from right to left or left to right in bed, and lasts for about 30-40 seconds. When it first appears, it is very scary for the patient. Patients think that they are having a heart attack and will die.
WHY DOES BPPV HAPPEN?
The underlying cause of the disease is that the otoconia (popularly known as balance crystals) located in the saccule part of the balance organ in the inner ear break off and become half-formed. They fall into circular channels. In whichever semicircular canal the crystals fall, severe dizziness occurs when the head moves in that axis. The most commonly affected canal is the posterior semicircular canal.
WHO IS BPPV?
Although BPPV can be seen in all age groups, it is more common in older people. It is the most common cause of dizziness in people over the age of 65.
DIAGNOSIS OF BPPV
Diagnosis of BPPV is made by applying positional tests in which patients are placed in specific positions. The most commonly applied of these is the Dix Hall-Pike test. In this test, the patient is first seated on a stretcher. His head is turned to the right. Then, the head is quickly tilted to maintain this position and the head is suspended slightly from the stretcher. Meanwhile, the doctor monitors the patient's eye movements with Frenzel Glasses or videonystagmography to check whether specific eye movements called nystagmus occur. Then the patient is brought to a sitting position again and the test is repeated by turning the head to the opposite side. Nystagmus (jumpy rapid eye movements) occurs with the position on the affected ear.
TREATMENT IN BPPV
The disease usually resolves on its own in a short time. However, some patients do not recover spontaneously. These patients need to be evaluated by a doctor. The most commonly applied treatment in BPPV is repositioning maneuvers, that is, maneuvers in which the crystals are returned to their original place. Epley Maneuver is the most commonly used maneuver in posterior semicircular canal BPPV. Lateral (side) semicircular canal Barbecue Maneuver is frequently used in BPPV. These maneuvers provide 80-90% recovery from the disease at a time. Sometimes it is necessary to perform a second or third maneuver, and in this way, improvement is achieved in 90% of the patients. In unsuccessful patients, the problem is largely solved by applying habituation exercises. Very rarely, patients may not improve despite all treatments. In this case, surgical treatments come to the fore. The diseased semicircular canal can be closed surgically or the balance nerve on the diseased side can be cut.
Epley Maneuver (Right Ear):
DOES BPPV RETURN?
>BPPV is a disease that can recur. A recurrent BPPV attack occurs in 1/3 of the patients within the first year and in at least half within the first 5 years. However, this is not something to be afraid of. It is usually treated with corrective maneuvers as with the initial disease.
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