Vertigo is a common reason for consultation, the most frequent cause being Benign Paroxysmal Positional Vertigo.

 

It is a benign disorder that causes episodes of false sense of movement or “being on a boat.” Symptoms are triggered by head movements (turning, moving the head backwards).

 
 

Cause

The cause is malfunction of the semicircular canals which are found in the labyrinth of the inner ear and which regulate balance. The fall of calcium carbonate crystals, normally attached to another part of the labyrinth, to inside the canals produces the symptoms.

Symptoms

• Loss of balance
• Feeling of “being on a boat”
• Sweating
• Nausea and vomiting
• Nystagmus (involuntary eye movement)
• Feeling as though the room is spinning

 
 

Diagnosis

Diagnosis is made using medical history and examination including the Dix-Hallpike provocation manoeuvre, by a trained physician.

In this manoeuvre the person is moved from the sitting to lying position with the head rotated 45 degrees to one side and extended approximately 30 degrees below the couch. It is considered positive if the patient experiences vertigo typical of the disease when performed and the clinician can visualize the appearance of nystagmus or involuntary eye movement.

 

Sometimes it may be necessary to perform an imaging test such as Head CT or MRI to rule out other conditions (tumours, intracranial bleeding).

 
 

Treatment

Treatment of Benign Paroxysmal Positional Vertigo has a significant impact on the patient’s quality of life and can also prevent falls and complications such as head trauma and fractures in fragile elderly people.

 

Drugs such as Betahistine (antihistamine) or sulpiride (blocks brain dopamine receptors) may help control symptoms.

 

The Epley manoeuvre, performed by a trained physician, attempts to move the calcium crystals out of the semicircular canals.

 

The manoeuvre begins in the same way as the Dix-Hallpike provocation manoeuvre. The patient’s head is then rotated 90 degrees. The patient remains in this position for about 30 seconds. The whole body is then turned, with the head facing downwards and again holding this position for about 30 seconds, finally sitting the patient up again.

This manoeuvre is highly effective, but it often needs to be repeated in multiple sessions to clear the BPPV.

It is a disorder of the inner ear that affects balance and hearing.

 

The cause is unknown, but it is believed to be as a result of an increase in the fluid usually present in the inner ear.

 

It often appears from the age of 20-50 onwards.

 
 

Risk Factors

• Head injury
• Infections of the middle or inner ear
• Alcohol consumption
• Smoking
• Allergies
• Family history
• Recent viral disease
• Stress

 
 

Symptoms

• Disabling vertigo accompanied by nausea and vomiting
• Tinnitus (beeps in the ear)
• Hearing loss that progressively worsens over the years.
• Feeling of pressure in the affected ear

 
 

Diagnosis

Diagnosis is made using medical history, examination, and hearing tests.

 
 

Treatment

• Preventative measures: reduction in salt intake, avoiding alcohol and caffeine, treatment with diuretic drugs such as hydrochlorothiazide or acetazolamide.

 

• Symptomatic relief of attacks: corticosteroids, anti-emetics, benzodiazepines such as lorazepam.

 

• Surgical treatment: indicated in patients in whom conservative treatment is ineffective and who frequently experience severe and limiting attacks. The goal of surgical techniques is to improve attacks of dizziness, they are not effective in preventing hearing loss.