BPPV (Positional Vertigo)


As the name suggests, this disease is characterized by sudden onset of severe dizziness with head movements. Patients usually complain of very severe dizziness that starts suddenly and lasts for about 30-40 seconds when they bend over and get up, or when they turn from right to left or left to right in bed. It is very frightening for the patient when it first appears. Patients think they are having a heart attack and will die.


The underlying cause of the disease is that the otoconies (popularly known as balance crystals) located in the saccule part of the balance organ in the inner ear break off and fall into the semicircular canals. In whichever semicircular canal the crystals fell, severe dizziness occurs when the head moves in that axis. The most commonly affected canal is the posterior semicircular canal.


Although BPPV can be seen in all age groups, it is more common in older people. It is the most common cause of dizziness in people over 65 years of age.


Diagnosis in BPPV is made by applying positional tests in which specific positions are given to the patients. The most common of these is the Dix Hall-Pike test. In this test, the patient is first seated on a stretcher. His head is turned to the right. Then, the head is tilted rapidly to maintain this position and the head is suspended from a stretcher. Meanwhile, the doctor monitors the patient’s eye movements with Frenzel Goggles or videonystagmography, checking to see if specific eye movements, called nystagmus, occur. Then the patient is brought back to the sitting position and the test is repeated by turning the head to the opposite side. Nystagmus (rapid eye movements of a jumping nature) occurs with the position on the side of the sick ear.


The disease often goes away on its own in a short time. However, some patients do not recover spontaneously. These patients should be evaluated by a doctor. The most common treatment in BPPV is repositioning maneuvers, that is, maneuvers in which the crystals are sent back to their original place. The Epley Maneuver is the most commonly used maneuver in posterior semicircular canal BPPV. In the lateral semicircular canal BPPV, the Barbecue Maneuver is often used. These maneuvers provide 80-90% recovery of the disease at a time. Sometimes it is necessary to perform the second or third maneuver, and in this way, 90% of the patients recover. The problem is largely solved by applying habituation exercises in unsuccessful patients. Very rarely, patients may not improve despite all treatments. In this case, surgical treatments come to the fore. The diseased semicircular canal can be closed surgically or the balance nerve on the diseased side can be cut.

Epley Maneuver (Right Ear):


BPPV is a recurrent disease. BPPV relapse is seen in 1/3 of the patients in the first year and in at least half of the patients in the first 5 years. However, this is not something to be afraid of. It is usually treated with corrective maneuvers as in the first disease.

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