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Vertigo – a sensation of motion in which the individual or the individual’s surroundings seem to spin and whirl – is, typically an undesirable event. The sensations of vertigo sometimes include dizziness, spinning or falling. Any time vertigo affects balance, it can result in falls and accidental injuries – especially among the elderly. More extreme cases can also cause nausea, vomiting, migraine headaches, fainting spells and visual irregularities known as nystagmus.

There can be many causes for vertigo, but one form of it – benign paroxysmal positional vertigo, or BPPV – is related to hearing. It is due to calcium crystals that form naturally in the inner ear called otoconia or otoliths, and which generally cause no problems. In individuals who suffer from BPPV, however, these crystals become dislodged from their normal position and migrate into one of the semicircular canals of the inner ear that control our sense of balance. Once they are within the semicircular canals, the crystals cause an abnormal displacement of endolymph fluid whenever a person alters the position of their head (relative to gravity). This is actually the root cause of the vertigo sensations in cases of BPPV.

BPPV can be triggered by such common actions as tilting or turning your head, rolling over in bed, and looking up or down, and is characterized by the episodic (paroxysmal) nature of the episodes. These symptoms can be worsened by sleep disorders, stress, or changes in barometric pressure, such as before rain or snow. Although BPPV may start at any age, it is more common in people over 60 years old. The precise reason behind benign paroxysmal positional vertigo is difficult to determine for any given individual, but from time to time it can be brought on by a blow to the head.

BPPV is different from other types of vertigo or dizziness because the attacks are transient (generally under a minute), and because it is always triggered by head movements. Doctors usually diagnose BPPV by having the individual rest on their back on an exam table, tilting their head to one side or over the edge of the table to observe whether this action triggers an episode. More substantial tests can be used in certain cases including electronystagmography (ENG), videonystagmography (VNG) and magnetic resonance imaging (MRI). ENG and VNG test for abnormal eye movements while MRI is used to rule out other potential causes of vertigo such as brain abnormalities or tumors.

The most common treatment for BPPV is canalith repositioning, including the Epley maneuver and the Semont maneuver, both of which are a sequence of physical movements used to guide the crystals to a position in the inner ear in which they no longer cause problems. In approximately 10 percent of cases, surgical treatment may be suggested if these therapies don’t deliver satisfactory outcomes. If you have encountered unexplained dizziness or vertigo that persists for over a week, see your health care provider.

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