Benign positional vertigo (BPPD). Causes and treatment of benign paroxysmal positional vertigo Benign positional vertigo

Benign positional vertigo (BPPV) is a common disorder in the body. It is characterized by the sudden onset of short-term - no more than one minute - dizziness. It often manifests itself during a sharp change in the position of the head (for example, when jumping out of bed after waking up). The weaker sex is more susceptible to the disease after 40 years. In the strong half, young people are registered extremely rarely.

Causes of occurrence

Benign paroxysmal (periodic) positional vertigo dppg is directly associated with head movement, more often recorded with horizontal placement of the body. The word "benign" emphasizes that the disease goes away on its own. It can occur repeatedly throughout the day. "Positional" indicates the dependence of the anomaly on the accepted position.

Investigating benign positional vertigo (otolithiasis) and the reasons for its occurrence, doctors believe that it is mainly provoked by the deposition of calcium salts - statoliths - in the canal of the inner ear. Under the influence of various external factors, calcium carbonate crystals are rejected from the otolith membrane and affect the hairs of the receptors. The movement of statoliths during a rapid tilt (turn) of the head also causes a feeling of loss of orientation, movement and rotation of objects.

Otolithiasis can cause vertigo with sudden head movements, bending back and forth. Often, the ailment accompanies cervical osteochondrosis. More often it occurs during a night's rest at the time of turning in bed or with sudden movements after waking up. In some cases, paroxysms of vertigo appear during sleep, which leads to the awakening of a person.

Also, benign paroxysmal positional vertigo (BPPV) can overtake under the influence of the following circumstances:

with damage to the bones of the skull or soft tissues;
with pathological changes in the inner ear (Meniere's disease);
with improperly performed surgical intervention;
with the influence of certain antibacterial pharmaceuticals - gentamicin, etc.;
with viral infections;
with prolonged immobility of the head;
with constantly recurring migraines, which are based on the disturbed activity of the autonomic nervous system, spasm of the arteries passing in the labyrinth.

When considering benign positional vertigo and its causes, abrupt throwing back of the head should be especially avoided.

Symptoms

There are a number of features by which benign paroxysmal positional vertigo is diagnosed:

The malaise has a paroxysmal character. Each episode of BPPV can occur accidentally and just as suddenly stop.
There is a wiggling feeling, reminiscent of motion sickness.
There is pallor of the skin, excessive sweating, nausea, fever, vomiting, etc.
It is not difficult for patients to pinpoint the party suffering from the seizure.
The daily number of attacks can be one-off or occur repeatedly.
Recovery occurs quickly, the patient does not feel any negative consequences.
The attacks are most pronounced at the first change in the position of the head or body.

With otolithiasis, there is no headache, hearing remains normal, there is no feeling of ear congestion.

Varieties of BPPV

The anomaly can occur in any ear, therefore, both right-sided and left-sided vertigo are distinguished. Since the places of localization of moving particles of the otolithic membrane can be different, then otolithiasis is divided into the following forms:

Cupulolithiasis... Fragments are fixed on the cupula. This placement causes constant irritation of the ear receptors.
Canalolithiasis... Otoliths move freely along the endolymph in the canal cavity. Changing the position of the head leads to the development of an attack.

When establishing a diagnosis, doctors must indicate the side of the lesion, as well as the semicircular canal - posterior, anterior or external - where the pathology is detected.

Diagnosing positional head spin

The most justified method for identifying a painful pathology is the Dix-Holpayk test (reception). The patient is asked to sit on the couch, turn his head at an angle of 45 degrees, and look the doctor in the face. Then the patient is abruptly laid on his back, throwing his head back 30 degrees and keeping the turn in the direction where the anomaly is suspected.

Benign paroxysmal positional vertigo (BPPV) ranks first among all causes of vertigo.

It occurs when the position of the body changes, sometimes at the most unforeseen moments.

The nature of this symptom, methods of diagnosis and treatment methods will be discussed later in the article.

Positional dizziness can occur after a traumatic brain injury or a viral infection.

It can also appear after improper surgical treatment or as complications from antibiotic treatment (gentamicin).

The disease is always benign.

The periods of exacerbation can be repeated daily, but then a long period of remission occurs, which can last several years. The disease can begin at any age.

Causes of positional vertigo

The vestibular apparatus is located in the inner ear, which is responsible for the orientation of a person in space. On the eve of the inner ear, there are special receptors that are attached to the otoliths and transmit information about all changes in the spatial position of the body.

Benign positional vertigo is associated with displacement of the otoliths, as a result of which, when the position of the head changes, a feeling of dizziness appears. Particles of otoliths break off and fall into the posterior canal of the inner ear, from where they themselves cannot get out due to the low location of the canal at any position of the human body.

If you notice the appearance of new, uncharacteristic symptoms for you, do not delay the visit to the doctor. Dizziness can be both an easily solved problem and a symptom of more serious diseases.

Symptoms

With positional vertigo, seizures usually appear suddenly and are short-lived. Concomitant nausea and vomiting are possible. During the period of seizures, it is difficult for a person to endure, significantly reducing the quality of his life.

The suddenness of a seizure can be life-threatening due to the possibility of falling and getting injured, or, for example, seizures while driving. Symptoms are stronger in the morning when lying down or when turning in bed.

Distinctive features of positional vertigo:

the head is not constantly spinning, the symptoms appear in seizures;
short-term nature;
nystagmus - rapid involuntary eye movements;
symptoms of a violation of the autonomic system are accompanied by pallor, throwing into a fever, increased sweating, bouts of nausea;
during the absence of an attack, the patient has no complaints, he feels good;
after an illness, the body quickly returns to normal;
with dizziness, there is often no tinnitus and a feeling of deafness, headache rarely appears.

Forms of the disease

In BPPV, or otolithiasis, there are 2 forms:

Canalolithiasis is a clot of otolith fragments located in the smooth part of the canal.
Cupulolithiasis - the fragments were fixed in the ampulla of one of the canals.

When making a diagnosis, the affected side and the semicircular canal are always indicated.

The suddenness of your symptoms should be alarming. Try to find a pattern so that you can tell the doctor about it later - a certain time for, body position, a provoking factor.

Diagnostics

The diagnosis is quite simple and is based mainly on the complaints of the patient himself.

To confirm the diagnosis, the patient undergoes special tests.

For example, the Dix-Hallpike test. It is clinically significant that the patient experiences involuntary eye movement when feeling dizzy.

It is very important to correctly diagnose the occurrence of dizziness. There are cases when a patient has osteochondrosis of the cervical spine or vascular problems in the brain and these factors have been classified as the main cause of dizziness. At the same time, these were only concomitant diseases, since dizziness was caused precisely by the wrong location of the otoliths and turning the head.

Diagnosis is the most important step on the path to treatment. Be attentive to the sensations of your body so that the doctor can correctly determine the cause of the dizziness.

Treatment principles for positional vertigo

The main place in the treatment of benign positional vertigo is allocated to the conduct of special positional maneuvers.

In this case, the doctor conducts a series of tilts and turns of the head in such a way as to achieve the cessation of the symptom.

For example, the Epley maneuver moves otolith particles from areas of the inner ear where they cause dizziness to other areas.

The maneuver can be carried out by both the doctor and the patient independently at home. The scheme of the maneuver is quite simple - you need to change your location five times, while tilting your head at a certain angle.

Drug treatment is ineffective. The existing drugs are not able to eliminate the acute attack. In severe cases, in the absence of results after medical meneuvers, surgical intervention may be indicated.

In general, the prognosis for the treatment of benign positional vertigo is favorable, and the effectiveness of treatment is high in most cases.

Constant and severe dizziness may indicate the presence of pathological processes in the body that are difficult to diagnose on their own. Here is a list of diseases that have this symptom.

Are vestibular exercises effective?

Rehabilitation maneuvers will be effective for positional vertigo, during which it is possible to achieve the disappearance of otolith deposits from the area of the inner ear canal.

Vestibular exercise can help relieve dizziness.

The patient is in this position or lying down for about 15 seconds, and then returns to the sitting position, but turns his head to the other side. Such exercises have a 75% positive effect.

The treatment of positional vertigo is in most cases up to you. Regular exercise and doctor's prescriptions - and you will get rid of this problem forever.

With benign positional vertigo, the main thing is to diagnose it correctly so as not to start erroneous therapy. Further recovery depends in most cases on the patients themselves - regular performance of special exercises and practically no financial spending.

Age-related changes in the functioning of the vestibular apparatus can lead to dizziness. help relieve an unpleasant symptom. See the list of recommended drugs.

Should I see a doctor if periodically there is a slight dizziness? Let us consider the main causes of this syndrome.

Video on the topic

The most common inner ear disorder is benign paroxysmal positional vertigo (BPPV). It is diagnosed in 17-35% of patients with disorders of the vestibular apparatus. Symptoms inherent in this pathology can accompany other diseases, therefore a special diagnostic method was created - the Dix-Hallpike test. Revealed BPPV is quickly cured with simple techniques. Pathology can disappear after a while, even without medical intervention.

What is positional benign vertigo

BPPV causes discomfort to the patient, but usually does not cause serious consequences. The pathology of the middle ear in this case manifests itself in short-term dizziness with a certain movement of the head.

Problems with the vestibular apparatus can have more serious causes. BPPV symptoms resemble orthostatic hypotension or vertebral dizziness. During the diagnosis, doctors are able to identify the described pathology for a number of signs.

How to distinguish BPPV

Differential diagnosis of paroxysmal positional vertigo and orthostatic hypotension is manifested in the absence of "flies" before the eyes. Comparison of blood pressure values in the supine and seated positions helps to establish the correct diagnosis. The absence of pain in the neck, inherent in osteochondrosis of this spine, excludes the presence of this disease.

Hearing impairment and tinnitus indicate Barre-Lieu syndrome (vertebral artery syndrome, cervical migraine), accompanied by dizziness and pain in the head. Any problems with the vestibular apparatus are only the consequences of other pathologies, therefore it is important to determine the sources of the disease and begin the correct therapy.

Vertebral dizziness, along with the described pathology, is one of the most common causes of similar symptoms. It manifests itself with pivoting movements of the head and neck. Injuries and inflammations in the cervical spine cause muscle spasms and poor circulation.

BPPV should also be distinguished from diseases of the posterior fossa, characterized by central nystagmus and neurological symptoms.

Causes of occurrence

Since BPPV is directly related to loss of balance, the problem should be sought in the organ responsible for this function.

The key to recognizing this disease was the examination of the inner ear. The free movement of membrane fragments - otoliths - causes disturbances in the work of a complex three-channel system. There are two main types of this pathology, depending on the localization of pieces of the otolith membrane of the bag containing hair cells.

Fragments of calcite break off and irritate the receptors.

Cupulolithiasis- the particles are attached to the cupula of the semicircular canal.
Canalolithiasis- they move without obstacles in the channel, having got there under the influence of gravity.

Some doctors combine the two terms under the general concept of otolithiasis. In 50–70% of clinical cases, the sources of the appearance of otoliths cannot be identified.

Among the understandable reasons for this pathology of the inner ear, the following factors are called.

In 17% of cases, the problem is caused by craniocerebral trauma.
Interior otitis appears to be the cause of benign dizziness in 15% of patients.
In about 5% of people diagnosed with the disease Meniere this pathology was also identified.
Antibiotics can have toxic affecting the inner ear, causing BPPV.
Neurocircular dystonia can cause nausea and positional vertigo.

Symptoms

Patients are most often able to pinpoint the problem side and demonstrate head movement that causes dizziness. During movement, otoliths disrupt the work of the inner ear, the vestibular analyzer cannot perform its functions fully:

Usually pathology manifests itself when cornering heads in different directions, flexion and extension of the neck. Symptoms can occur even when rolling over in bed.
Dizziness goes on from 5 to 30 sec. It is rare, repeated several times a week or daily.
Systemic dizziness is sometimes accompanied by a sensation wiggle. Nausea is possible.
Symptoms do not manifest themselves if the patient excludes movement, provoking the disease.
Pathology is not accompanied pains in the ears and head, hearing loss and other signs, therefore, it is considered benign.

Diagnostics

To clarify the diagnosis, the patient undergoes the Dix-Hallpike test, first proposed in 1952. The procedure is carried out as follows: the patient is seated on the couch facing the doctor, while the gaze is directed at the bridge of the doctor's nose.

The subject's head is turned 45 ° to the problem side, causing dizziness. The patient is quickly placed on his back. The head tilts back 30 ° while maintaining the tilt.

A positive test is indicated by an attack of dizziness after 1-5 seconds. It is accompanied by a rapid movement of the eyeballs, called rotator nystagmus in medicine.

In most cases, the last sign is difficult to fix accurately, therefore special devices are used: Frenzel or Blessing glasses, as well as infrared observation of eye movements. When the patient returns to a sitting position, nystagmus and dizziness recur to a lesser extent.

The absence of the symptoms described indicates a negative test. However, with frequent repetition of the procedure, nystagmus ceases to appear.

The test helps to identify BPPV due to the fact that when the head is tilted, fragments move away from the cupula, causing it to deviate. As a result, the receptor cells are irritated, causing nystagmus and dizziness. After the particles reach the far part of the canal, the symptoms disappear.

When returning to a sitting or standing position, the process is repeated in the opposite direction with a similar but weakened effect, since the neuroepithelial cells are inhibited rather than irritated.

With frequent carrying out of such a test, the channels are depleted and nystagmus does not appear. A similar picture can be observed if the doctor did not notice this symptom due to its weak manifestation.

Treatment

Doctors have developed several types of vestibular gymnastics that help patients to quickly cope with paroxysmal benign dizziness.

The Brandt-Daroff exercise is performed as follows:

Immediately after waking up, you must take sedentary position on the edge of the bed.
In the second stage, the patient lays down on the right (left) side, tilting the head up 45 °. The position is maintained until the dizziness disappears. This usually takes no more than 30 seconds.
A patient comes back to the starting position and repeats the procedure with the opposite side.
Steps described are carried out up to 5 times in a row. If symptoms appear, then the complex of movements should be repeated two more times: in the afternoon and in the evening. In their absence, the next approach will only need to be done the next morning.

Exercise Epley-Simon provides relief of signs of the disease in 95% of patients:

A patient sits down on the bed from a lying position, with your back straight.
Head turns towards the sore ear for 30 sec.
The patient lies down on bed, head thrown back 45 °.
Then he must return to initial position and repeat the movement in the opposite direction from the pathological organ for 30 seconds.
A patient turns on the side and lies on the healthy ear.
Sick smooth sits on the bed with his feet flat on the floor.

Surgery is one of the treatments for positional vertigo. The use of this method is necessary only in extreme cases and is associated with great risks to the inner ear.

Self-localization of the affected side can be difficult in the early stages, therefore, the doctor prescribes treatment procedures after a thorough examination. The patient should strictly follow the instructions of doctors for a speedy recovery, avoiding self-medication.

Thanks to the described positional maneuvers, the mechanics of the inner ear are normalized. As a result, the patient regains control over his own balance.

Consequences and complications

As a result of the protracted development of benign dizziness, the patient cannot calmly lead a full life:

loses working capacity;
exposed dangers in cases where absolute care is required: when crossing the carriageway, driving a car or driving on an icy sidewalk in winter.

In 1/5 of patients with BPPV, a new attack of the disease is observed one year after treatment. Otherwise, symptoms are not an obstacle to daily activities. Pathologies detected in time allow you to quickly cope with the discomfort caused by dizziness.

Prevention

At risk are people involved in sports, construction work and other professions where there is a high probability of getting a head injury. Based on the clinical picture of the disease, the following precautions are offered as preventive measures:

Should be avoided dangerous situations and protect your head from falls and bumps. When riding a motorcycle, do not give up a high-quality protective helmet, and when crossing the road, follow not only the color of the traffic light, but also the approaching cars.
Regular complex examination will help identify pathology in the early stages and distinguish symptoms from signs of more dangerous diseases.

Paroxysmal positional benign vertigo is caused by a malfunction in the inner ear. Treatment consists of following medical advice and performing specific exercises.

In most cases, the causes of the development of pathology (the formation of deposits of calcite fragments of the membrane in the canals of the inner ear) remain completely unclear, but the clinical picture is generally clear, and therapy effectively restores the function of the vestibular apparatus.

Dizziness of any kind should not be ignored; dangerous pathologies can be hidden behind it. High-quality differential diagnosis allows you to distinguish BPPV from diseases with similar symptoms, therefore, if dizziness develops when turning the head or tilting the neck, it is recommended to consult a doctor and undergo a comprehensive examination.

For more than 50 years, the Dix-Hallpike test has been helping to recognize BPPV by the characteristic eye movement and the appearance of the main symptom - brief dizziness. To eliminate errors, research is carried out and the identification of signs of other diseases.

As a preventive measure, specialized measures are not called. It is recommended to avoid traumatic situations and perform exercises to normalize the functioning of the vestibular apparatus.

The content of the article

Definition

Benign paroxysmal positional vertigo (BPPV) is a paroxysmal vestibular vertigo caused by a change in the position of the head and body. It differs from other forms of positional vertigo in the effectiveness of treatment and the possibility of self-resolution.

BPPV classification

Depending on the location of the freely moving particles of the otolith membrane in relation to the structures of the semicircular canal the most common forms of BPPV are distinguished:

cupulolithiasis- the particles are attached to the cupula of one of the vestibular receptor channels;
canalolithiasis- the particles of the macula are located freely in the cavity of the canal.
When formulating the diagnosis, the side of the lesion and the semicircular canal (posterior, anterior, external), where the pathology is detected, should also be indicated.

Etiology of BPPV

In 50-75% of all cases of the disease, the cause cannot be established, and therefore we are talking about the idiopathic form. Most likely reasons:

injury
neurolabyrinthitis
Meniere's disease
surgical operations (both general cavity and otological)

BPPV pathogenesis

Currently, there are two main theories of BPPV - cupulolithiasis and canalolithiasis, in some works combined by the term "otolithiasis". The mechanism for the development of dizziness is associated with the destruction of the otolith membrane, the reasons for which have not yet been clarified, and the formation of freely moving particles in the otolith and ampullar receptors of the inner ear.

The development of positional dizziness and nystagmus in patients with otolithiasis is due to the fact that the cupula of the sensory epithelium of the ampullar receptor deviates due to the "piston effect" of freely moving particles of the otolith membrane or a change in its position due to the sagging of particles attached to it. This is possible when the head moves in the plane of the affected canal or the head and body at the same time.

The deflection of the cupula is accompanied by mechanical deformation of the hairs of the vestibular sensory epithelium, which leads to a change in the electrical conductivity of the cell and the occurrence of depolarization or hyperpolarization. In the unaffected vestibular receptor of the other side, such changes do not occur and the electrical activity of the receptor does not change. At this moment, there is a significant asymmetry in the state of the vestibular receptors, which is the reason for the appearance of vestibular nystagmus, dizziness and autonomic reactions. It should be noted that with a slow change in the position of the head, the same slow movements of particles occur in the plane of the affected canal, which may not cause dizziness and positional nystagmus.

The "good quality" of dizziness is due to its sudden disappearance, which, as a rule, is not affected by the ongoing drug therapy. This effect is most likely associated with the dissolution of freely moving particles in the endolymph, especially if the calcium concentration in it decreases, which has been proven experimentally. In addition, particles can move into the vestibule sacs, although this happens spontaneously much less frequently.

Positional vertigo with BPPV is usually most pronounced after awakening the patient, and then usually decreases during the day. This effect is due to the fact that the acceleration when the head moves in the plane of the affected channel causes dispersion of the clot particles. These particles are dispersed in the semicircular canal, and their mass is no longer sufficient for the occurrence of initial hydrostatic changes in the endolymph during displacement, therefore, with repeated inclinations, positional vertigo decreases.

DPPV clinic

The clinical picture of BPPV is characterized by sudden vestibular dizziness(with a sensation of objects rotating around the patient) when changing the position of the head and body. Most often, dizziness occurs in the morning after sleep or at night when turning in bed. Vertigo is very intense and lasts no more than one to two minutes. If the patient returns to the starting position at the time of the onset of dizziness, the dizziness stops faster. In addition, provocative movements can be throwing the head back and tilting down, therefore, most patients, having experimentally determined this effect, try to make turns, getting out of bed and tilting the head slowly and not using the plane of the affected canal.

As a typical peripheral vertigo, an attack of BPPV can be accompanied by nausea and sometimes vomiting.

BPPV is characterized by the presence of specific positional nystagmus, which can be observed when an attack of positional vertigo occurs. The specificity of its direction is due to the localization of particles of the otolithic membrane in a particular semicircular canal and the peculiarities of the organization of the vestibulo-ocular reflex. Most often, BPPV occurs due to the defeat of the posterior semicircular canal. Less often, the pathology is localized in the horizontal and anterior canals. There is a combined pathology of several semicircular canals in one or both ears of one patient.

Important for the clinical picture of BPPV is the complete absence of other neurological and otological symptoms, as well as the absence of changes in hearing in patients due to the development of this dizziness.

Diagnosis of BPPV

Physical examination

Specific tests for establishing BPPV are the positional tests of Dix-Hallpike, Brandt-Daroff, etc.

The Dix-Hallpike positional test is performed as follows: the patient sits on the couch and turns his head 45 ° to the right or left. Then the doctor, fixing the patient's head with his hands, quickly moves him to the supine position, while the patient's head, held by the doctor's hands, hangs over the edge of the couch by 45 ° and is in a relaxed state. The doctor observes the patient's eye movements and asks him if dizziness has occurred. It is necessary to warn the patient in advance about the possibility of the appearance of his usual dizziness and convince him of the reversibility and safety of this condition. The nystagmus that arises in this case, typical of BPPV, necessarily has a latency period, which is associated with some delay in the movement of the clot in the plane of the canal or deflection of the cupula when the head is tilted. Since the particles have a certain mass and move by gravity in a liquid with a certain viscosity, the sedimentation rate builds up over a short period.

Typical for BPPV is positional rotational nystagmus that is directed toward the ground (geotropic). This is typical only for the pathology of the posterior semicircular canal. When looking away from the ground, vertical movements can be observed. Nystagmus, characteristic of the pathology of the horizontal canal, has a horizontal direction; for the pathology of the anterior canal, it is torsional, but directed from the ground (ageotropic).

The latent period (the time from performing the tilt to the appearance of nystagmus) for the pathology of the posterior and anterior semicircular canals does not exceed 3-4 s, for the pathology of the horizontal canal - 1-2 s. The duration of positional nystagmus for canalolithiasis of the posterior and anterior canal does not exceed 30-40 s, for canalolithiasis of the horizontal canal - 1-2 minutes. Cupulolithiasis is characterized by prolonged positional nystagmus.

Always typical positional BPPV nystagmus accompanied by dizziness, which arises with nystagmus, decreases and also disappears with it. When a patient with BPPV returns to the original sitting position, reversible nystagmus and vertigo, directed in the opposite direction, are often observed and are usually less bright than when bending over. When the test is repeated, nystagmus and dizziness are repeated with proportionally reduced characteristics.

When examining the horizontal semicircular canal to determine BPPV, it is necessary to turn the head and body of the patient lying on his back, respectively, to the right and left, fixing the head in extreme positions. Positional nystagmus is also specific for BPPV of the horizontal canal and is accompanied by positional vertigo.

Patients with BPPV experience the greatest balance disorder in a standing position at the time of throwing back or turning the head in the plane of the affected canal.

Instrumental research

It is recommended to use devices that enhance visual observation of nystagmus and eliminate gaze fixation: Blessing's or Frenzel's glasses, electrooculography, videooculography.

Differential diagnosis of BPPV

Diseases of the posterior cranial fossa, including tumors, which are characterized by the presence of neurological symptoms, severe balance disorder and central positional nystagmus.

Central positional nystagmus is characterized primarily by a special direction (vertical or diagonal); fixation of the gaze does not affect it or even intensifies it: it is not always accompanied by dizziness and is not exhausted (it lasts all the time while the patient is in the position in which he appeared).

Positional nystagmus and dizziness can accompany multiple sclerosis and vertebrobasilar circulatory failure, however, neurological symptoms characteristic of both diseases are recorded.

BPPV treatment

Non-drug treatment

Brandt-Daroff method... It is often performed by the patient independently. According to this technique, the patient is recommended to do the exercises three times a day, five inclinations in both directions in one session. If dizziness occurs at least once in the morning in any position, the exercises are repeated in the afternoon and evening. To perform the technique, the patient must, after waking up, sit in the center of the bed with his legs hanging down. Then he lies on one side, with the head turned upward by 45 °, and is in this position for 30 s (or until the dizziness stops). After that, the patient returns to his original sitting position, in which he stays for 30 s, after which he quickly lies on the opposite side, turning his head up 45 °. After 30 seconds, he takes the starting position sitting. In the morning, the patient makes five repetitive inclinations in both directions. If dizziness occurs at least once in any position, the inclines must be repeated in the afternoon and evening.
The duration of such therapy is selected individually. It cannot be completed if the positional vertigo that occurs during the Brandt-Daroff exercises does not recur within 2-3 days.
Semont's maneuver... It is performed with the help of a doctor or independently. Starting position: sitting on a couch, legs hanging down. Sitting, the patient turns his head in the horizontal plane by 45 ° to the healthy side. Then, fixing the head with his hands, the patient is placed on his side, on the affected side. He remains in this position until the dizziness stops. Further, the doctor, quickly moving his center of gravity and continuing to fix the patient's head in the same plane, puts the patient on the other side through the "sitting" position without changing the position of the patient's head (ie, forehead down). The patient remains in this position until the dizziness disappears completely. Further, without changing the position of the patient's head, he is seated on a couch. Repeat the maneuver if necessary. It should be noted that the peculiarity of this method lies in the rapid movement of the patient from one side to the other, while the patient with BPPV experiences significant dizziness, vegetative reactions in the form of nausea and vomiting are possible; therefore, in patients with diseases of the cardiovascular system, this maneuver should be performed carefully, resorting, if necessary, to premedication. To do this, you can use betahistine (24 mg once, 1 hour before the procedure). In special cases, thiethylperazine and other centrally acting antiemetic drugs are used for premedication.
Epley maneuver(with pathology of the posterior semicircular canal). It is advisable to be performed by a doctor. Its feature is a clear trajectory, slow movement from one position to another. The initial position of the patient is sitting along the couch. Previously, the patient's head is turned 45 ° towards the pathology. The doctor fixes the patient's head in this position. Then the patient is placed on his back, the head is thrown back at 45 °. The next turn of the fixed head is in the opposite direction in the same position on the couch. Then the patient is laid on his side, and his head is turned with the healthy ear down. Then the patient sits down, the head is tilted and turned towards the pathology, after which it is returned to its usual position - looking forward. The patient's stay in each position is determined individually, depending on the severity of the vestibulo-ocular reflex. Many professionals use additional agents to accelerate the settling of freely moving particles, which increases the effectiveness of the treatment. Typically, 2-4 maneuvers per treatment session are sufficient to completely stop BPPV.
Lempert's maneuver(for BPPV horizontal semicircular canal). It is advisable to be performed by a physician. The initial position of the patient is sitting along the couch. The doctor fixes the patient's head throughout the entire maneuver. The head is turned 45 ° and a horizontal plane towards the pathology. Then the patient is laid on his back, successively turning his head in the opposite direction, and after that - on the healthy side, the head, respectively, is turned with the healthy ear downward. Further, in the same direction, the patient's body is turned and laid on his stomach; the head is given a position with the nose down; as it turns, the head turns further. Following this, the patient is placed on the opposite side; head - with a sore ear downward; the patient is seated on the couch across the healthy side. The maneuver can be repeated.It is important that after performing the maneuver, the patient observes the mode of limiting the inclinations, and on the first day he slept with the head of the bed raised by 45-60 °.

Surgery

Shown at ineffectiveness of treatment maneuvers in 0.5-2% of cases:

Filling the affected semicircular canal with bone chips.
Selective neuroectomy of the vestibular nerves.
Labyrintectomy.
Laser destruction of the labyrinth.

Forecast
Auspicious, with complete recovery. The disability of a patient with BPPV persists for about a week. In the case of cupulolithiasis, these periods may be lengthened.

Benign paroxysmal positional vertigo (BPPV) is a fairly common pathology. It is characterized by sudden attacks of dizziness that last less than a minute. Usually, this condition is associated with a change in the position of the head and is much more common in women.

Causes of positional vertigo

It is believed that deposition of calcium salts in the canal of the inner ear leads to the development of this disease. These salts are called statoliths. They break off from the otolithic membrane and move when the head is turned or tilted, which causes the sensation of rotation. It is this state that a person perceives as dizziness.

BPPV is its usual bending forward or backward. BPPV can also cause dizziness when standing up suddenly, and most often it occurs suddenly after sleep or during a night's rest.

You can find out more about the causes of dizziness manifested in various categories of patients (the elderly, children and women) if you read on our website.

Positional dizziness often manifests itself in cervical osteochondrosis. You can read more about this disease and its symptoms at this link:

In about half of the cases, it is not possible to identify a reliable cause of the development of the disease, and therefore they speak of the presence of an idiopathic type of pathology. In other situations, the reasons for the development of benign positional vertigo can be:

traumatic skull injuries;
incorrectly performed surgical intervention;
Meniere's disease;
the action of some antibacterial drugs - for example, gentamicin;
labyrinthitis - an infectious inflammatory process in the canals;
regular migraines, which are caused by dystonia and spasms of an artery in the labyrinth.

Symptoms

Symptoms of benign positional vertigo can manifest in the following forms:

Sudden attacks of dizziness develop in a specific position or during certain movements. Often, seizures appear when turning or bending the neck.
The duration of an attack is about 30 seconds, but many patients tend to exaggerate this period.
People with this disease accurately identify the affected ear by noting which side they have an attack on.
Often, patients notice the appearance of nausea during an attack.
Dizziness can be single, but sometimes it occurs regularly - from a few cases a week to several attacks a day.
If the patient does not make provoking movements, then there are no manifestations.

BPPV is not accompanied by hearing impairment, tinnitus, headache, or other symptoms. Moreover, in women, this pathology is observed approximately twice as often as in men. The disease can appear at any age, but often it occurs at the age of 50-60.

Treatment

The tactics of treating positional vertigo is to prescribe drugs that help improve the patient's condition. Therefore, remedies are often used to eliminate nausea, dizziness, emotional stress. Also, medications can be used to help normalize blood circulation in the vessels of the brain.

If the dizziness is of high intensity, then the patient is shown bed rest. Recently, exercises that help prevent or control seizures have been actively used to treat paroxysmal benign positional vertigo. In especially severe cases, surgical ones are used.

It should be noted that dizziness is not always a symptom of any disease. Let's say that ordinary toxicosis can be the cause.

In order to better understand the nature of this ailment, we advise you to familiarize yourself with. It contains detailed information on the symptoms and manifestations of dizziness in people of different ages and genders.

Exercise and gymnastics

Regular gymnastics helps to gradually dissolve calcium salts in a special semicircular canal and reduce the manifestations of pathology without the use of drugs. The most effective exercises are the following:

Brandt-Daroff method. A person can do this exercise by himself. Sit in the center of the bed with his legs down. Then lie on either side, turn your head up 45 ° and stay in this position for 30 seconds. Return to its original position for half a minute. Lie quickly on the other side and turn your head up 45 °. After half a minute, take a sitting position again.
In one session, you need to do 5 inclinations in both directions. This exercise should be done three times a day. If no seizures are observed within three days, gymnastics may not be performed. The effectiveness of this method of treatment is approximately 60%. Other exercises should be done under the supervision of your doctor. Their efficiency is up to 95%.

But sometimes performing such exercises can cause severe dizziness, which is accompanied by nausea and vomiting.
Therefore, people with cardiovascular diseases are prescribed betahistine before starting exercise.

Therapeutic gymnastics according to the Brandt-Daroff method

Epley maneuver. Sit along the couch and turn your head 45 ° in the direction where vertigo is observed. The doctor needs to fix it in this position. Lay the person on his back, and his head should be thrown back 45 °. Turn it in the opposite direction. Lay the person on their side, turning the healthy part of the head down. Then sit down, tilt your head and turn it towards dizziness. Return to normal position. Usually, 2-4 repetitions are done to stop the attack.

This video will teach you how to do Epley gymnastics on your own:

Semont's maneuver. Sit down, lower your legs down. Turn the head 45 ° in a healthy direction. Fix it with your hands and lie on the side of the pathology. Stay in this position until the attack has completely stopped. Then the doctor puts the person on the other side, and the head remains in the same position. The person is in this position until the attack stops, then sits down. If necessary, the maneuver can be done again.
Lempert's maneuver. Sit along the couch and turn your head 45 ° to the affected side. The doctor holds the patient's head throughout the session. Lay the person on their back, turning their head in the opposite direction. Then it is deployed in a healthy direction.
It is also necessary to turn the patient's body, placing it on his stomach. Turn the head downwards. To accompany the change in the position of the body by turning the head. Put the patient on the other side, and turn the head down with the sore side. Put the person on the healthy side.

With early treatment, this disease usually does not pose a particular health hazard. Therefore, when the first symptoms of pathology appear, you need to consult a doctor. The specialist will prescribe medications and select a set of exercises to stop the manifestations of pathology.