15 W. Dry Creek Circle                                                                                           6169 S. Balsam Way; Suite 290
         Littleton, CO  80120-4427                                                                                                                                   Littleton, Colorado  80123
     Phone: (303)  798-1309                                                                                                                                        Fax: (303) 798-2319
Ear, Nose & Throat Center
Specialists of the Ear, Nose and Throat   /  Head and Neck Surgery  /  Facial Plastic Surgery
Evaluation  of  Dizziness  &  Vestibular Disorders

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BENIGN  PAROXYSMAL POSITIONAL VERTIGO

You bend over to tie your shoelaces, roll over or sit up in bed and it hits you like a tornado, leaving your head spinning like a top.  Benign paroxysmal positional vertigo is one type of dizziness which can cause these symptoms.  Victims describe it as a severe dizziness, the kind that frequently causes nausea.  If it occurs often enough, it can make it nearly impossible for its victims to function in their day to day routines.

While dizziness is not life threatening, it is a serious health problem especially among older people.  More than 90,000,000 Americans have experienced a bout of dizziness at one time or another, and it is the third most frequent reason people see their doctors.  For people ages 75 and older it is the most frequent reason for a doctor's visit.  The ailment challenges doctors and frustrates patients because there are many causes and few effective treatments.  Between 8% and 25% of people who suffer bouts of dizziness have benign paroxysmal positional vertigo.  It occurs most often in adults 50 years old and older, and causes about 160,000 new cases of dizziness annually in the United States.

The problem begins when tiny particles break off from the walls of a small compartment in the inner ear called a utricle.  Doctors believe this flaking can be part of the natural aging process or it can be caused by a sharp blow to the head.  Some individuals seem to be more prone to have this condition, and it can occur recurrently over the years.  After time, the particles float into the adjacent fluid filled semicircular canals, which help produce a sense of balance, and gather to form tiny clumps. When the victim lies down or gets up, the clumps slide back and forth in the canals, acting a little like plungers that push and pull the fluid.  This rushing motion bends the tiny hair cells that help regulate balance, triggering the dizzy sensation.  



Patients who have the disorder produce jerky eye movements that not only confirm the diagnosis but also pin point which ear is involved.  Symptoms can include double vision, nausea, and vomiting.  Typically the symptoms last five or ten minutes after a positional change and then improve, only to recur after the patient changes position again.  Eventually the clumped particles will be resorbed by the body and the dizziness will resolve, but this may take weeks to months to occur.  Treatment is usually medical with the initial therapy involving medications to suppress and sedate the central nervous system so the dizziness is not severe.  These include medications such as Antivert and Valium.  In some cases head maneuvering techniques ( see Epley Proceedure ) to attempt to get the particles to fall back into the utricle have been successful.  Surgery is generally not an option in this disease process. Benign paroxysmal positional vertigo is a frustrating problem, but as the name would imply it is a benign process that is not associated with any increased risk of stroke and is not associated with any type of tumor.  It unfortunately does have a tendency to recur over the patient's life.