Our previous post discussed the topic of a specific type of vertigo called Benign Paroxysmal Positional Vertigo (BPPV). This post will discuss more about the causes, recurrence, and prognosis of BPPV, along with provide an understanding of different types of vertigo that produce similar symptoms.
Positional vertigo (BPPV) is a fairly common form of vestibular vertigo. It may be accounted for approximately 20-30% of diagnoses related to vertigo. BPPV may occur at any age, however is most commonly experienced in individuals over the age of 50. It is more common in women than men.
The exact cause of BPPV unknown, with the majority of cases arising almost out of nowhere. However, there are some causes that have been associated with increasing your chances of getting BPPV. This may include, but is not limited to, an injury or trauma to your head, an inner ear infection or disorder, migraines, or prolonged periods of time lying on your back.
Once you have BPPV, it is fairly common that it may come back, even after a successful treatment. Since there is not too much we know about the causes of positional vertigo it is hard to say how frequently or when you may experience an episode of BPPV again. However, it has recurrence rates as high at 50% within 5 years. This seems to be especially true if your positional vertigo is a result of head trauma.
Without proper treatment from a trained individual, BPPV symptoms may worsen over time. However, it is possible that this may go away on its own but may take up to 6 weeks. Within that time frame, it is possible for the severity and number of episodes to be minimized by paying attention to your head position.
Keep in mind that while anti-motion sickness drugs may be used to reduce any nausea symptoms you have, they should not be taken over long periods of time and will not cure your positional vertigo. It is important to recognize that another form of dizziness may be causing your symptoms.
As mentioned previously, vertigo is a type of dizziness that is commonly described as a spinning sensation or as false sense of movement. Vertigo can be further sub categorized as peripheral vertigo or central vertigo.
Peripheral vertigo is related to issues that regard your inner ear, while central vertigo is related to issues with your brain or brainstem. Since peripheral vertigo is related to your inner ear, these cases tend to be more severe as they affect our main balance system in comparison to central vertigo.
Aside from Benign Paroxysmal Positional Vertigo (BPPV), other forms of peripheral vertigo may include Labyrinthitis, Vestibular Neuritis, or Meniere’s Disease. Below you will find a short description about each.
Labyrinthitis is an inner infection that results in the inflammation of the vestibular labyrinth found in our inner ear. This infection may also include inflammation of other structures in the inner ear, which in turn may provide false information to our brain. More specifically, it affects both divisions of our vestibulocochlear nerve, the vestibular branch being responsible for our balance and the cochlear branch being responsible for our hearing.
The signs and symptoms of Labyrinthitis include vertigo, dizziness, and hearing loss to name a few. Most often, this condition only affects one ear. Labyrinthitis is not very common and majority of the symptoms will go away over time. This form of vertigo is typically the result of a viral infection, but may also arise from a bacterial infection, although it is not as common.
Vestibular Neuritis, similar to Labyrinthitis, is a disorder that occurs with the swelling or inflammation of our vestibulocochlear nerve. However, only the vestibular branch, responsible for our balance, is inflammed, in comparison to both branches being inflamed in Labyrinthitis.
The signs and symptoms of Vestibular Neuritis include vertigo, dizziness, hearing loss, or ringing in the ear. Vestibular Neuritis is most often the result of a viral infection infection of the inner ear, or of a viral infection that may have occurred somewhere else in the body. The symptoms of both Vestibular Neuritis and Labyrinthitis may occur at any age, however is less reported in children.
Meniere’s Disease is an inner ear disorder that may cause the sudden onset of vertigo lasting up to, but no more than 24 hours. This is considered a chronic condition that may occur at any age, but typically arises between young and middle-aged adults. In most cases, only one ear is affected.
The signs and symptoms of Meniere’s disease may include recurring vertigo episodes, ringing in your ears (tinnitus), hearing loss, and pressure or a feeling of fullness in the affected ear. While the exact cause of Meniere’s disease is unknown, the symptoms experienced seem to be a result of an increased or abnormal amount of fluid called endolymph fluid in your inner ear.
The content used on this post and site are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Dizziness can be used to describe a wide range of sensations correlating with a sense of feeling off balanced, also known as a sense of disequilibrium. When this dizziness causes the feeling that you or your surroundings are moving or spinning, this can be sub-classified as vertigo. Treatments for dizziness are dependent on both the cause and your symptoms.
Our primarily focus will be on Benign Paroxysmal Positional Vertigo (BPPV). BPPV is considered to be the most common form of vertigo, the exact cause of BPPV is unknown and still under review. However, you can typically tell if you have BPPV if you are experiencing dizziness with changes in position of your head. For example, you might experience an episode of BPPV when you lie down, turn over, or sit up in bed.
To get a better understanding of what Benign Paroxysmal Positional Vertigo (BPPV) means, let’s break it down and define each component.
Benign: not harmful or non-life threatening
Paroxysmal: a sudden onset of symptoms that lasts only a short time
Positional: related to or determined by position
Vertigo: sensation of motion or movement that may cause dizziness or loss of balance
Symptoms of General Dizziness:
A loss of balance or feeling unsteady
Difficulty focusing your eyes
Lightheadedness
Symptoms of BPPV:
A loss of balance or feeling unsteady
A sense that you or your surroundings are spinning or moving
Commonly lasts less than one minute
Dizziness
Lightheadedness
Nausea
Vomiting
Our ability to balance is due to a combination of our vision, our awareness of our body position and movement (proprioception), and our vestibular system. The vestibular system is the main system that contributes to our balance. This system is located in our inner ear and is able to communicate and relay information to your brain.
Inside of your ear, you have a tiny organ called the vestibular labyrinth. This labyrinth consists of three loop- shaped structures called our semicircular canals and two otolith organs.
The three semicircular canals contain a fluid that moves when you rotate your head, moving tiny hair-like sensors which in turn sends information to your brain about the direction you are moving in. In comparison, the two otolith organs are responsible for communicating linear accelerations of the head (acceleration or deceleration) and your head’s position in relation to gravity. Rather than fluid, otolith organs are covered a gelatin-like membrane the contains tiny crystals of calcium carbonate (otoconia).
These microscopic crystals have been identified as being the primary cause of BPPV. For various reasons, some of which are still unknown, these crystals can break off the membrane and move into one or more of the semicircular canals. Once these crystals are stuck in the semicircular canal, changes in your head position will cause the crystals to send a signal to your brain that you are moving, even though you may not be. This signal confuses our brain, which as a result causes the spinning sensation of vertigo.
It is important to both understand and recognize that BPPV symptoms are caused by changes in head movements and that this spinning sensation last typically less than one minute. Between episodes of BPPV, some individuals may feel mild symptoms of BPPV, while others may feel completely symptom free.
Please keep in mind, BPPV is something that can be treated and will only cause dizziness with changes in head position. BPPV will NOT create a constant dizziness, nor will it affect your hearing, produce a headache or faint feeling, create numbness or tingling, or cause issues in your speaking or movement.
The content used on this post and site are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Citations:
Image 1: The inner ear and canalith repositioning. 2018, Mayo Foundation for Medical Education and Research . www.mayoclinic.org/tests-procedures/canalith-repositioning-procedure/about/pac-20393315.
“Benign paroxysmal positional vertigo (BPPV).” Mayo Clinic, Mayo Foundation for Medical Education and Research (MFMER). , 30 June 2019, www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055.
Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. The Vestibular Labyrinth. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11130/
35-40% of the people in the U.S. complain of moderate to severe symptoms from Allergic Rhinitis. These can include nasal congestion, runny nose, post-nasal drip, watery itchy eyes, sinus pressure, itchy skin, and wheezing.
There are many interventions which can significantly alleviate these symptoms, many of which do not involve medication. To start, optimizing the home and work environments can significantly make a difference. If the air you breathe is as clean as possible, there will be less inflammation in the nose.
Good prevention methods include dust mite covers on the mattress and pillows, a HEPA-grade air filter and keeping bedroom windows closed. Daily nasal irrigation can also help. Nasal irrigation can be administered by a kit and distilled water. In terms of medication for allergies, generally antihistamines are effective. These can come in pills and nasal sprays.
Nasal steroid sprays are also effective. Recent research has shown that a combination spray with both an antihistamine and a steroid component is the most effective. Basically, one should start with optimizing their environment, and performing daily nasal irrigation. By coming in to see an ENT specialist it can be determined if allergy testing is needed.
Symptoms of allergic rhinitis:
nasal congestion
runny nose
post-nasal drip
watery, itchy eyes
sinus pressure or pain
itchy skin
wheezing
Causes for allergic rhinistis:
tree pollen
grass pollen
dust mites
animal dander
cat saliva
mold
Methods for treatment and management:
Keep windows and doors closed during high pollen periods
use air conditioning in your home and car
use an HEPA grade air purifiers for indoor environments
Wear eye protection for outdoors
Use “mite-proof” bedding covers to limit exposure to dust mites
Use a dehumidifier to control mold
Wash your hands after contact with any and all animals
When to see a physician:
your symptoms last longer than a week
your symptoms are bothersome
over the counter allergy medications are ineffective
you have another condition such as asthma making your allergy symptoms worse
symptoms are all year round
symptoms are severe
considering immunotherapy or allergy shots
The content used on this post and site are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
