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“Soaring, tumbling, freewheeling, through an endless diamond sky” is an apt description of Princess Jasmine’s magic carpet ride, as well as what patients feel if they have benign paroxysmal positional vertigo (BPPV). BPPV is a dysfunction of the inner ear that results in an abnormal sensation of spinning or unsteadiness. Although greatly disorienting, BPPV is not life-threatening and comes in sudden, brief episodes, usually triggered by changing positions or certain movements of the head.

 BPPV can feel like being in a constant rollercoaster.

Image Source: Miguel Navarro

BPPV starts in the utricle, a part of the inner ear, in which calcium carbonate crystals become dislodged and migrate into one of the three fluid-filled semicircular canals. The fluid in these canals is used to detect head motion. Accumulation and errant movement of these crystals interferes with the normal fluid movement, which causes the inner ear to send false signals where the body is in space (known as proprioception).  When the signals reach the brain, they do not match the visual cues and signals from the other ear, causing a false sensation of spinning.

The most common symptoms of BPPV can include dizziness or unsteadiness, feeling that the room is rotating or spinning, or nausea and vomiting. The symptoms may last from a minute to several minutes at a time. Between acute episodes, patients can feel symptom-free while others may feel a mild sense of imbalance or disequilibrium. An otolaryngologist can easily diagnose BPPV during a detailed patient health history and physical exam of the ear.

Fortunately, most cases of BPPV spontaneously resolve within a 2 month period without the need for any treatment. Some cases, however, can last much longer than that.  Next week, we will look at treatment options for chronic, extended episodes of BPPV. In the meantime, the following are some habits to avoid doing if BPPV is suspected:

  • Avoid sleeping on the affected side or in an aggravating position
  • Avoid quickly changing positions. When rising, get up slowly and sit on the edge of the bed for a minute, allowing the crystals to settle in their new positions.
  • Avoid bending down to pick up things or looking up at things. If necessary, slowly move your body to bring things into view.

Feature Image Source: Justin Chin

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