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Chapters

0:00 Introduction
1:46 Symptoms of Benign Paroxysmal Positional Vertigo
2:22 Diagnosis for Benign Paroxysmal Positional Vertig0
2:52 Treatment of Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a disorder arising from a problem in the inner ear.[3] Symptoms are repeated, brief periods of vertigo with movement, characterized by a spinning sensation upon changes in the position of the head.[1] This can occur with turning in bed or changing position.[3] Each episode of vertigo typically lasts less than one minute.[3] Nausea is commonly associated.[7] BPPV is one of the most common causes of vertigo.[1][2]

BPPV is a type of balance disorder along with labyrinthitis and Ménière's disease.[3] It can result from a head injury or simply occur among those who are older.[3] Often, a specific cause is not identified.[3] When found, the underlying mechanism typically involves a small calcified otolith moving around loose in the inner ear.[3] Diagnosis is typically made when the Dix–Hallpike test results in nystagmus (a specific movement pattern of the eyes) and other possible causes have been ruled out.[1] In typical cases, medical imaging is not needed.[1]

BPPV is easily treated with a number of simple movements such as the Epley maneuver ( in case of diagonal/rotational nystagmus ), the Lempert maneuver ( in case of horizontal nystagmus ), the deep head hanging maneuver ( in case of vertical nystagmus ) or sometimes the less effective Brandt–Daroff exercises.[3][5] Medications, including antihistamines such as meclizine,[8] may be used to help with nausea.[7] There is tentative evidence that betahistine may help with vertigo, but its use is not generally needed.[1][9] BPPV is not a serious medical condition,[7] but may present serious risks of injury through falling or other spatial disorientation-induced accidents.

When untreated, it might resolve in days to months;[6] however, it may recur in some people.[7] One can needlessly suffer from BPPV for years despite there being a simple an very effective cure. Short-term self-resolution of BPPV is unlikely because the effective cure maneuvers induce strong vertigo which the patient will naturally resist and not accidentally perform.

The first medical description of the condition occurred in 1921 by Róbert Bárány.[10] Approximately 2.4% of people are affected at some point in time.[1] Among those who live until their 80s, 10% have been affected.[2] BPPV affects females twice as often as males.[7] Onset is typically in people between the ages of 50 and 70.[2] Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia or otoliths. In people with BPPV, the otoconia are dislodged from their usual position within the utricle, and over time, migrate into one of the three semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially "ear rocks") within the affected semicircular canal causes abnormal (pathological) endolymph fluid displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis.[citation needed] There is a direct link between the kind of nystagmus and which of the three semicircular canals is affected. With horizontal nystagmus ( left-right eye movement ) the horizontal ( also called lateral ) canal is affected, with vertical nystagmus ( up-down eye movement ) the superior ( also called anterior ) canal is affected, and with diagonal nystagmus ( diagonal or rotational eye movement ) the posterior canal is affected. Diagonal eye movement is easily confused with horizontal movement. This is important since it might result in selecting a wrong and thus ineffective cure maneuver.

In rare cases, the crystals themselves can adhere to a semicircular canal cupula, rendering it heavier than the surrounding endolymph. Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles, thereby inducing an immediate and sustained excitation of semicircular canal afferent nerves. This condition is termed cupulolithiasis.[citation needed]

There is evidence in the dental literature that malleting of an osteotome during closed sinus floor elevation, otherwise known as osteotome sinus elevation or lift, transmits percussive and vibratory forces capable of detaching otoliths from their normal location and thereby leading to the symptoms of BPPV.[12][13]

BPPV can be triggered by any action that stimulates the posterior semi-circular canal including