BPPV (Positional Vertigo)

Explained in simple words

1BPPV is the single commonest cause of giddiness. The good news is that it is also the easiest to cure.

2The full name is Benign Paroxysmal Positional Vertigo. Each word tells you something important.

3"Benign" means it is not dangerous. "Paroxysmal" means it comes in sudden short attacks. "Positional" means it is brought on by a change of position.

4Inside your inner ear there are tiny crystals of calcium, smaller than grains of sand. They are supposed to stay in one particular chamber.

5Sometimes these crystals get loose and fall into one of the fluid-filled tubes of the balance organ, where they do not belong.

6When you move your head, these loose crystals roll inside the tube and push the fluid, sending a false message to the brain.

7The brain thinks the head is spinning fast, but the eyes and body say it is not. This mismatch is felt as violent spinning.

8The typical story is very characteristic. The patient turns in bed at night, or gets up in the morning, and the room suddenly spins.

9It can also happen on looking up at a shelf, bending down to pick something up, or lying back at the barber or dentist.

10The spinning is intense but short. It usually lasts less than a minute, and then settles if you keep still.

11There is no hearing loss, no ringing in the ear, no headache and no weakness. That is an important point.

12Many patients are so frightened by the first attack that they fear a brain problem or a paralysis. In BPPV, the brain is completely normal.

13It becomes commoner with age, and can also follow a head injury, a long illness with bed rest, or an ear infection.

14The diagnosis is made by a simple bedside test. The doctor lies you down and turns your head in a particular way, and watches your eyes.

15When the crystals move, the eyes make a typical jerking movement that the doctor can see, sometimes with camera goggles.

16This tells us not only that it is BPPV, but exactly which ear and which tube the crystals have fallen into.

17The treatment is the beautiful part. It is not tablets. It is a manoeuvre — a series of slow head and body positions done by the doctor.

18These movements guide the loose crystals out of the wrong tube and back into the chamber where they belong.

19It takes only a few minutes, and most patients are completely cured in one or two sittings.

20It is common to feel giddy during the manoeuvre itself. That is expected and it means the crystals are moving.

21For a day or two afterwards you may feel slightly unsteady or "off". This settles on its own.

22Tablets for giddiness do not cure BPPV. They only dull the sensation, and taking them for months can actually delay the brain from adjusting.

23BPPV can come back in some people, months or years later. If it does, the same manoeuvre works again.

24If your giddiness comes in short bursts only on turning or lying down, please get examined — you may be curable in a single visit.