Question

70 year old man complains that he gets this terrible feeling "like the room is moving around" and becomes nauseated when he rolls over in bed or bends over suddenly. It usually goes  away once he has been up for awhile. He has been told that his symptoms are consistent with benign paroxysmal positional vertigo.

1. What is the pathophysiology associated with this man's vertigo?
2. Why do the symptoms subside once he has been up for a while?
3. What methods are available for treatment of the disorder?

Answer 1

1. Benign paroxysomal positional vertigo or BPPV is a mechanichal disprder of the internal ear. When some of the calcium carbonate crystals (otoconia or otoliths) that are normally embedded in the Utricle gets dislodged from there and travels to one of the semicircular canal of the posterior ear. These semicircular canals have fluid in them which moves according to the movement of the head through the sensory hairs and thus maintain balance. When enough amount of otolith crystals aggregates into these semi circular canal, the free movement of the fluid gets interrupted and gives a false perception of balance. This causes the vertigo.

2. When the person is up for a while and if there is no sudden head movements, the otolith crystals settles at a particular place and thus the hinderence of the fluid movement doesnt occur and the vertigo subsides.

3. This conditionis treated with different head excercises or maneuvers:

a) Epley Maneuver ( Uses gravity to reposition the otoliths into the utricles)

b) Semont Maneuver ( Used for the otoliths present in the posterior semicircular canals)

c) Brandt- Daroff excercise ( Home excercise to make the patient habituated with the positions that causes vertigo)

d) Medication- Vestibular suppressants are also used in severe cases.