Mr Nigam ENT Treatments - Benign Paroxysmal Positional Vertigo (BPPV)
Positional 
Vertigo (BPPV) dizziness is thought to be due to debris that has collected within a part of the inner ear. This debris can be thought of as "ear rocks," although the
formal name is otoconia. Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the utricle (Figure 1).
Symptoms
The symptoms of BPPV include dizziness or vertigo, light-headedness, imbalance, and nausea. Activities that bring on symptoms will vary among persons, but symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common problem motions.
Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, sometimes BPPV is called "top shelf vertigo." Women with BPPV may find that the use of shampoo bowls at the hairdressers brings on symptoms. An intermittent pattern is common. BPPV may be present for a few weeks, then stop, and then come back again.
Investigations
The most common cause of BPPV in people under age 50 is head injury. In older people, the most common cause is degeneration of the vestibular system of the inner ear. BPPV becomes much more common with advancing age. In half of all cases, BPPV is called idiopathic, which means it occurs for no known reason. Viruses affecting the ear such as those causing vestibular neuritis, minor strokes such as those involving anterior inferior cerebellar artery (AICA) syndrome, and Menieres disease are significant but unusual causes. Occasionally BPPV follows surgery, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear.
Your doctor can make the diagnosis based on your history, findings on physical examination, and the results of vestibular and auditory tests. Often, the diagnosis can be made with history and physical examination. Most other conditions that have positional dizziness get worse on standing rather than lying down (for example, orthostatic hypotension). A magnetic resonance imaging (MRI) scan will be performed if a stroke or brain tumour is suspected. It is possible but very uncommon to have BPPV in both ears (bilateral BPPV).
BPPV has often been described as "self-limiting" because symptoms often subside or disappear within six months of onset. Symptoms tend to wax and wane. Motion sickness medications are sometimes helpful in controlling the nausea associated with BPPV but are otherwise rarely beneficial. However, various kinds of physical manoeuvres and exercises have proved effective.
Treatment
The treatment of BPPV is usually performed in the consulting room. The treatment is very effective, with roughly a 90% cure rate.
The manoeuvre, named after their inventor, is intended to move debris or "ear rocks" out of the sensitive part of the ear (posterior canal) to a less sensitive location. The manoeuvre takes about 5 minutes to complete. It involves sequential movement of the head into six positions, staying in each position for roughly 30 seconds.
The recurrence rate for BPPV after these manoeuvres is about 30% at one year, and in some instances a second treatment may be necessary. Sleep semi-recumbent for the next two nights. This means sleep with your head halfway between being flat and upright (a 45-degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch.