If you’ve ever sat up quickly or rolled over in bed abruptly and felt like the room was spinning or whirling around you when you’re actually still, you may have experienced a condition called benign paroxysmal positional vertigo (BPPV) without knowing what it was. This vestibular disorder—one that affects the inner ear—is one of the most common causes of vertigo, and it can make people feel very dizzy, unsteady, sweaty, even nauseous. Individual bouts tend to be brief—usually lasting 15 to 60 seconds at a time—but they can recur with certain head movements, make it difficult to function, and increase the risk of falling.
Nedim Durakovic, an associate professor of otolaryngology and neurotology at the Washington University School of Medicine in St. Before the condition was well understood, “people thought that patients were having strokes when they had vertigo, [but] this is not the stroke form of vertigo.” With BPPV, tiny calcium carbonate crystals—called otoconia—that usually sit on hair cells in the inner ear get dislodged from where they belong and travel into one of the three semicircular canals of the inner ear. A change in head position, such as while rolling over in bed or tipping your head back in the shower, is what usually triggers BPPV symptoms.
It’s natural for these crystals to be in the ear. Gail Ishiyama, a professor in the departments of neurology and head and neck surgery and director of the Vestibular Clinical Laboratory at the UCLA School of Medicine. With BPPV, “they’re just in the wrong place, and that can cause vertigo.” BPPV affects twice as many women as men, and it’s particularly common between the ages of 40 and 70.
It can happen anytime, but head trauma or dental procedures involving drilling are two of the more common triggers, Ishiyama says. People who have Menière’s disease (a chronic inner ear disorder), diabetes, hypertension, high cholesterol, hypothyroidism, migraine, anemia, osteoporosis, or peripheral neuropathy are particularly susceptible to BPPV, research has found. And research increasingly suggests that low vitamin D levels are a risk factor for BPPV.
Getting the right diagnosis for BPPV isn’t always straightforward. That, he says, is the easiest way to diagnose BPPV. Using something called the Dix-Hallpike maneuver, a health care provider will have the patient move between a seated and supine position and move their head in different directions while the provider examines their eyes.
If the person’s eyes rapidly, repetitively, and involuntarily move up and down or in a twisting motion, these are signs of nystagmus, a condition involving sudden eye movements. Nystagmus often accompanies vertigo caused by BPPV, and if it does, the diagnosis is clear. If the patient doesn’t exhibit nystagmus, other diagnostic maneuvers may be used to trigger telltale symptoms.
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