Benign positional vertigo refers to small displaced crystals of calcium carbonate which called otoconia, otoliths, or canaliths. These crystals are typically attached to the otolithic membrane within the utricle of the inner ear. Sometimes due to trauma or aging, the otoconia can separate from the utricle, and become displaced in the semicircular canal within the inner ear. With head movements, the detached otoconia can stimulate sensitive nerve endings. The brain receives fall signals, which in turn, causes a spinning sensation or dizziness. Symptoms typically occur less than a minute and are precipitated by specific head movements against gravity.
The ear exam is typically normal. Physical examination, however, will typically elicit nystagmus or jerking eye movement indicating the affected ear.
Treatment involves repositioning the otoconia so as to stop false signals of movement to the brain. Canal positioning procedure, also known as the Epley maneuver, will move the canaliths or otoconia from the semicircular canals back to the utricle. Hopefully, the otoconia will then re-adhere to the otolithic membrane, dissolve, or disintegrate and therefore relieve patient’s chronic debilitating symptoms. The Epley maneuver is performed by a trained professional. Following the procedure, appropriate precautions are provided so as to prevent the otoconia from returning back into the semicircular canal. The Epley maneuver has a success rate of 80%. The recurrence rate is relatively low and more likely in patients that have spontaneous onset of BPV rather than related to trauma.
Brandt-Daroff exercises are also recommended for patients with BPV. They are done multiple times while at home until 2 days after the bouts of positional vertigo have ended.
