Introduction to Benign Paroxysmal Positional Vertigo
Introduction[edit | edit source]
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo that arises from a peripheral vestibular disorder. It accounts for 20 to 30 percent of all patients seen for vertigo in clinics that specialise in dizziness.[1]
While the overall incidence of BPPV in the general population is around 2.5 percent,[1] it is more common in older adults. Some studies show that 50 percent of older adults have BPPV.[2]
Symptoms tend to be provoked by head movements, such as:[3]
- Looking up
- Lying down flat quickly
- Bending forwards
- Rolling in bed
BPPV is a biomechanical problem in which one or more of the semicircular canals is inappropriately excited, resulting in vertigo, nystagmus and occasionally nausea.[3] It occurs when there is displacement of calcium-carbonate crystals or otoconia from the utricle into one of the three fluid-filled semicircular canals of the inner ear.[3][4] For more information on the anatomy of the vestibular system, please click here.
Aetiology[edit | edit source]
It is not yet known what causes BPPV. The majority of cases are idiopathic, but it is more likely to recur in older adults.[2]
The two primary theories about its aetiology are that it is:
- Related to ischaemia and cardiovascular disease[5]
- Related to vitamin D deficiency and calcium metabolism (seasonal variations may be present)[6][7]
Predisposing factors include:
- Head trauma in all age groups[7]
- In a younger population head trauma is a leading predisposing factor
- The recurrence rate may be higher and treatment may not be as effective in a head trauma population[3]
- Surgical trauma to the inner ear[8]
- Vestibular labyrinthitis / neuritis[8]
- Migraines[1]
- Ischaemia of the anterior vestibular artery and cardiovascular disease[3][9]
The majority of BPPV occurs in the posterior canals (85 to 95 percent). 5 to 15 percent occurs in the horizontal canals and 1 to 5 percent occurs in the anterior canals.[10]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710-5.
- ↑ 2.0 2.1 Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging. 2018;13:2251-66.
- ↑ 3.0 3.1 3.2 3.3 3.4 Tonks B. Benign Paroxysmal Positional Vertigo Course. Physioplus, 2021.
- ↑ Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470308/
- ↑ Zhang D, Zhang S, Zhang H, Xu Y, Fu S, Yu M, Ji P. Evaluation of vertebrobasilar artery changes in patients with benign paroxysmal positional vertigo. Neuroreport. 2013;24(13):741-5.
- ↑ Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260(3):832-8.
- ↑ 7.0 7.1 Chen J, Zhao W, Yue X, Zhang P. Risk factors for the occurrence of benign paroxysmal positional vertigo: A systematic review and meta-analysis. Front Neurol. 2020;11:506.
- ↑ 8.0 8.1 Kansu L, Aydin E, Gulsahi K. Benign paroxysmal positional vertigo after nonotologic surgery: case series. J Maxillofac Oral Surg. 2015;14(Suppl 1):113-5.
- ↑ Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y et al. Risk factors for the recurrence of benign paroxysmal positional vertigo: a systematic review and meta-analysis. Ear Nose Throat J. 2020:145561320943362.
- ↑ Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47.
