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Vertigo, a perception of movement in which the individual or the individual’s surroundings seem to spin and whirl, is usually a rather unpleasant experience. Vertigo can affect balance, leading to falls which can be dangerous in the elderly, and may be accompanied by dizziness, a feeling that you are spinning or falling, and in serious instances migraine headaches, vomiting, nausea, an inability to see properly (nystagmus), as well as fainting.

Vertigo can have many causes, but one of them is related to hearing – benign paroxysmal positional vertigo, abbreviated BPPV. It is attributable to calcium crystals that form naturally in the inner ear. Termed otoconia or otoliths, these crystals usually cause no trouble for people. In BPPV, the crystals migrate from their normal locations into the semicircular canals of the inner ear. When this occurs, and the individual with BPPV changes the orientation of their head relative to gravity, these crystals move about, resulting in an abnormal displacement of endolymph fluid, which leads to vertigo.

Everyday motions such as tilting your head, looking up and down or rolling over in bed can trigger the benign paroxysmal positional vertigo. The vertigo sensation comes on very suddenly and has a short duration. These symptoms can be made worse by sleep disorders, anxiety, or changes in barometric pressure, such as occur before snow or rain. Although BPPV can start at any age, it is more common in people over 60 years old. The specific reason behind BPPV is difficult to determine for any given person, but from time to time it can be brought on by a blow to the head.

BPPV is differentiated from other forms of dizziness or vertigo in that it is almost always prompted by head movements, and in that its effects usually subside less than a minute. Physicians may diagnose it by having the affected individual rest on their back and then tip their head to one side or over the edge of the exam table. Other tests which can be used to diagnose BPPV include videonystagmography or electronystagmography, which test for abnormal eye movement, and magnetic resonance imaging (MRI), whose primary role is to eliminate other potential causes, such as brain abnormalities or tumors.

The standard treatment for BPPV is canalith repositioning, including the Semont maneuver and the Epley maneuver, both of which are a sequence of physical motions used to shift the crystals to an area of the inner ear in which they no longer cause trouble. In rare cases (under 10 percent), if these treatments don’t provide relief, surgery may be recommended. If you suspect BPPV or have been experiencing vertigo or dizziness for over a week, consult a specialist well-versed in balance and vertigo disorders.