Benign paroxysmal positional vertigo is among the common causes of vertigo. It is the sudden sensation of the spinning of your head which occurs with the change of position of your head. It is a disorder of the inner ear. It occurs when calcium carbonate crystals accumulate in large numbers in any one of the ear canals and stimulate abnormal fluid movement in the inner ear. This sends false signals of head movement to the brain. This can also crop up post head injury. Rolling over the bed or quick head movements like when sitting up in bed can also trigger this condition. 

The common symptoms of benign paroxysmal positional vertigo are as follows: 

Vomiting and nausea. 
Vertigo Blurred vision
Intense dizziness 
Loss of balance 
Benign paroxysmal positional vertigo may be treated in the following manner: 

Medication to get relief from the spinning of your head. 
Epley's Maneuver involves transportation of the calcium particles to a different part of the ear which will no longer cause any problems. 
Brandt-Daroff exercises. 
Sometimes watchful waiting can help a person to recover without having to undergo any other treatment but it is a long process and often involves risk factors. 
Surgery: This option is used rarely when other treatments fail. 
A very important thing to remember is that vertigo can lead to falls and driving should be avoided. The patient will need support during an episode to avoid injuries.

All About Benign Paroxysmal Positional Vertigo

Dizziness is usually described as variety of sensations, which comprise of a feeling of faintness, unsteady, weak, light headed, giddy or woozy. When dizziness causes a false feeling of spinning and the moving surroundings is known as vertigo.

Dizziness can be one of the most common reasons for a visit to the doctor. However, constant feeling of dizziness can affect a person's life drastically, but it is rarely life threatening. The treatment of dizzy sensation and dizziness mostly depends on the symptoms.

Causes of dizziness
The common causes of dizziness are medication, motion sickness and ear problems, especially disturbances of the inner ear. An injury, infection or poor blood circulation can also lead to dizziness. The triggers of dizziness and the sensations it provides are used to evaluate the cause. Also, the duration of the dizziness and the symptoms lead to a clue towards the cause of the same.

Dizziness caused by the inner ear problems
The balance of the body depends on the combined effort of many parts of the sensory system. These are:

1. Sensory nerves: these send messages to the brain in regard to the body positions and its movements
2. Inner ear: the inner ear has the organ of corti which are responsible for detecting the motions and thereby help in the balance of the body.

In vertigo a person might feel that the things around them are moving, thus creating a swaying or a spinning motion. Vertigo is usually caused by the problems of the inner ear. 

The common causes are:

1. Benign paroxysmal positional vertigo (bppv), this happens when the calcium particles accumulate in the inner ear canals. The inner ear is responsible for the body movements and balance.

2. Meniere's disease, a problem of the inner ear mainly caused by the build up of the fluids, thereby leading to a change in pressure. This causes vertigo along with hearing loss and tinnitus.

3. Vestibular neuritis is the problem of the inner ear and is largely due to infection. Infection leads to swelling of the nerves of the inner ear which affect the body movements.

Treatment of vertigo includes:
1. Rehabilitation of the vestibular system by physical therapy in order to strengthen it.
2. Canalith repositioning by suggesting some body and head movements basically for bppv. These movements help to move the calcium deposits from the inner ear canals to one of the chambers, which are further absorbed by the body. When the canaliths (calcium deposits) move, it might give rise to vertigo.
3. Medicines are given to relieve symptoms of motion sickness and nausea. Antibiotics can be taken in case of infection and swelling.
4. Surgery in some cases.

Dizziness and Ear Problems

Vertigo is a feeling that your head or your surrounding is spinning. It is an illusion of movement. People with vertigo cannot bend down to pick up stuff, as they may feel the spinning sensation.
There are two types i.e. objective and subjective. Vertigo is said to objective when the surrounding seems to be spinning; subjective is when the person feels their head is spinning. Vertigo can be slightly mysterious to diagnose. There are, however, some causes which can help you understand it better. There are two main types of vertigo: Central and Peripheral. Central vertigo is when there is an issue in the brain that is causing vertigo. Middle ear problems leading to vertigo is known as peripheral vertigo.

Central vertigo:

Paroxysmal positional vertigo (BPPV): Also known as, Benign paroxysmal positional vertigo (BPPV). These episodes are benign and occur in paroxysms or spurts. The person will feel the attack with simple actions like turning over in bed. They do not last long, often about 20 to 30 seconds.
Migraine: Known for the severe headaches, migraine can also cause vertigo.
Head trauma: This type of vertigo usually subsides with time as the person recovers from trauma.
Neck injuries: Injury to nerves and blood vessels in the neck can also lead to vertigo.
Health conditions: General health issues like arteriosclerosis, multiple sclerosis, and diabetes lead to vertigo.
Stroke or blood flow blockage: When blood does not reach the base of the brain, it can result in vertigo.
Peripheral vertigo:

Middle ear infections: Labyrinthitis (either bacterial or viral) a middle ear infection can cause vertigo. Common viruses include herpes, influenza, measles, rubella, hepatitis, and EBV.
Meniere s disease: Another ear problem causing vertigo is Meniere s disease. This is known for its 3 symptoms   vertigo, ringing in the ears (tinnitus) and hearing loss. This can be caused by various factors, some of which can include ear infections, head injuries, or heredity. The exact cause of the condition is not established clearly.
Acoustic neuroma: A tumor of the nerve tissue in the inner ear may cause vertigo. The person can also have hearing loss and ringing sensation.
Other causes of vertigo include:

Pregnancy: During the first trimester, in particular, the various hormonal changes can cause vertigo. The expanding uterus puts pressure on the blood vessels, leading to reduced blood supply to the brain, which can also induce vertigo. As the baby continues to grow, lying on the back can put pressure on the blood vessels to the heart, causing vertigo.
Stress: It is known to worsen vertigo, which a person may already have. Anxiety and panic attacks are known to worsen vertigo.
Travelers: Be it ship, air, or train, some people experience a spinning sensation with any form of travel.


Vertigo In Adults - Why It Happens?

Vertigo refers to dizziness, or spells of dizziness, or rotational dizziness, which can be short term or long term. It is a general symptom for a variety of conditions of the brain, inner ear, sensory nerve pathway, and other sensitive organs. Vertigo has the capability of hampering the day to day functioning of the person. Furthermore, due to these reasons, it has the potential to cause anxiety and depression.

Types of Vertigo & Diagnosis:

Vertigo can be categorized into two major types based on the underlying cause:

1. Peripheral Vertigo: It is said to occur if it is related to the problems of the inner ear, such as its inflammation or an infection in its tiny parts or displacement of tiny particles present in the inner ears.

2. Central Vertigo: It is said to occur if it is related to the problems of the brain (the Central Nervous System) or the sensory nerve pathways.

Vertigo can be diagnosed by physical examination, assessing the medical history followed by undergoing a CT scan or an MRI, as required.

Treatment:

It is important to essentially understand the root cause of the condition and then treat that accordingly for best results.

1. A bacterial infection can be addressed through antibiotics.

2. Nausea and motion sickness can be reduced by using anti-emetics and antihistamines.

3. Sometimes, for patients with intractable Benign Paroxysmal Positional Vertigo (BPPV), surgery is performed to block the area triggering Vertigo.

4. Exercises can also help in managing the milder symptoms of Vertigo without visiting to the doctor for the same.

5. Most of the time, in case of BPPV, physiotherapy is the recommended treatment.

6. Certain lifestyle changes and precautions can be adopted to avoid conditions that trigger Vertigo.

7. Vestibular Rehabilitation Therapy goes a long way in managing Vertigo.

Vestibular Rehabilitation Therapy (VRT) for Managing Vertigo:

Vestibular Rehabilitation Therapy, abbreviated as VRT, is a program based on exercise that promotes the retraining of the Central Nervous System and repositioning of the free flowing particles in the fluid present in the inner ear. This helps in treating the condition of the inner ear for managing Vertigo. Its application is based on scientific research and evidence. The major goal of this type of treatment is to let the brain establish coordination again with the inner ear, with eye, and with the proprioceptive system for processing information.

The proprioceptive system consists of the sensory receptors which respond to pressure and stretch. Hence, VRT is effective in improving the diminishing quality of life due to Vestibular Disorders like Vertigo, by addressing both, the primary as well as secondary consequences of the condition. Over a period of time, when the patient becomes sufficiently trained under professional guidance, VRT can then be carried out at home at prescribed intervals based on the specific requirement.

Methods for VRT-

Depending on the clinical examination, the three major methods of exercise for Vestibular Rehabilitation Therapy can be prescribed, as described below:

1. Habituation exercises are prescribed for those patients who experience dizziness by movement and by visual stimulation.

2. Gaze Stabilization exercises are prescribed for those patients who experience uncontrolled eye movements leading to unclear vision.

3. Balance Training exercises are prescribed for improving steadfastness, to prevent falling, and to restore balance during performing activities like bending, standing and turning, reaching, walking, and running for helping patients return to their daily lives confidently.

Take Away:

Vertigo is the vestibular condition of dizziness that can be managed through methods like Vestibular Rehabilitation Therapy for re-training the brain to coordinate with the affected organs. It helps in restoring the quality of life. VRT is mainly practiced through habituation exercises, gaze stabilization exercises, and balance training exercises.

Managing Vertigo Through Physiotherapy And VRT!

Are you feeling lightheaded, unbalanced or woozy lately? Are you having strange sensations in the ears and eyes? These indicate that you are suffering from dizziness, a condition affecting the body s sensory organs. It can cause fainting at times as well. It is not a disease, but a symptom of several disorders. Dizziness is caused by inner ear disturbances, effects of medication, motion sickness and underlying health conditions, such as poor blood circulation, infections or injuries.

Test and diagnosis
If you feel dizzy for a prolonged period of time or if the dizziness occurs and reoccurs, a special treatment is required. This is because dizziness may make you prone to several risks in everyday life. Several tests are carried out to find out the cause of the dizziness. If a stroke is suspected, an MRI scan or CT scan is carried out. A physical examination is undertaken in which the way you walk and balance are observed and the nerves of the central nervous system are checked. Hearing and balance tests may also be required, which are as follows:

Eye movement testing in which the path of the eyes is observed while tracking an object in motion. An eye motion test may be given where cold and warm water is placed in the ear canal.
Head movement tests are carried out when benign paroxysmal positional vertigo is suspected.
Treatment
Treatment of dizziness includes medicines, therapies and balance exercises.

Medicines

Water pills are prescribed when a patient has Meniere s disease, which helps in reducing dizziness.
Antihistamines provide temporary relief from dizziness.
Therapy

Head position maneuvers: A technique known as canalith repositioning helps in resolving dizziness quickly. It can be performed by a doctor, therapist or audiologist. The position of the head is maneuvered in the process.
Balance therapy: Several exercises help in making the body s balance system lesser sensitive to motion. This technique, known as vestibular rehabilitation, is used for people suffering from dizziness due to inner ear conditions.
Psychotherapy: This therapy may be used for patients who experience dizziness because of anxiety disorders.
Use of antibiotics: An antibiotic by the name of gentamicin may be injected in the inner ear for disabling the balance function. The unaffected ear performs that function.
Other procedures: A procedure known as labyrinthectomy may be used for disabling the vestibular labyrinth in the affected ear.
If you experience dizziness continuously, it is important for you to visit an ENT specialist. An ENT specialist deals with problems related to the ear, nose and throat and will be able to provide you with the best diagnosis and treatment for dizziness.

Dizziness - Can it be a Sign of Ear Disturbance?

Vertigo is that sensation when a person feels that the world is spinning around him. It is a feeling of off balance.

While having a Vertigo, people often complain about feeling dizzy, basic daily activities like walking or moving becomes really intense for them. These episodes can impact everyday life.

Is Vertigo common?

Experiencing Vertigo at least once during a lifetime is quite common. It is often seen in older people, but it can happen to anyone at any age. Women are a little more prone to experience an episode of Vertigo than men.

Types of Vertigo:

There are two major types of Vertigo:

Central Vertigo: Central Vertigo occurs when there is a sudden and temporary malfunction in the brain, precisely in an area called the cerebellum.

Peripheral Vertigo: Peripheral Vertigo occurs due to a problem in areas of vestibular nerve or the inner ear. This area connects the inner ear and the brain. Peripheral Vertigo is the most common type of Vertigo.

According to the American Institute of Balance, Peripheral Vertigo is generally a more serious and dangerous problem compared to Central Vertigo.

Recurrent Spontaneous Vertigo with Head-Shaking Nystagmus:

Recently, researchers discovered a new type of Vertigo called  Recurrent Spontaneous Vertigo with Head-Shaking Nystagmus  or (RSV-HNS).

To diagnose RSV-HNS, the patients need to sit in a room without lights. The examiner changes the position of their heads, first in forward direction, then in side to side direction for about 15 seconds. The camera records the patient s eye motions. It results in those who have RSV-HSN making an eye movement which lasts longer than the others. This movement is known as  nystagmus .

Compared to other types of Vertigo, RSV-HSN shows a more severe sensation of motion sickness. People with RSV-HSN experience things like nausea, headaches, vomiting, and an unwillingness to head motions. These symptoms can be experienced anywhere from a couple of times a week to once a year.

The reason behind RSV-HSN is still unknown. Doctors recommend that proper medication helps to improve the condition.

Treatment for Vertigo:

A major part of the treatment of Vertigo depends on the cause of the Vertigo. Often, Vertigo goes away without any treatment. The reason behind Vertigo curing itself is that people adapting to the inner ear changes and finding different mechanisms to maintain balance.

Why a neurologist is the right choice to consult for vertigo?

The patient of vertigo should not visit an ENT doctor and must consult a good neurologist as basically it's either a problem of brain or of abnormal signals from the vestibular nerve from the ear. In no way it is a problem of ear per se. A neurologist has the training and expertise to deal with it, not an ENT doc. Also, it's important to consult urgently as sometimes it can be a sign of brain stroke (specially if associated with imbalance). Importantly, to rule out brain lesions like cyst, tumor, clots and nerve infections, consulting a neurologist is the best option available.

Apart from this, these are a few treatments:

Medicines: Medication tends to give relief to symptoms like motion sickness associated with Vertigo.

Vestibular Rehabilitation: Under this treatment, doctors try to aim at the patient s vestibular strengths which send the signals to the body movement and head related to  gravity.

Canalith Repositioning Manoeuvres: In this treatment, a physical therapist suggests different head and body movements, which help to release the deposit out of the canal and into an inner ear which can be absorbed by the body. This treatment is quite effective to treat Vertigo.

Surgery: If the reason behind causing Vertigo is some serious internal problem like tumor or a head injury, then, in such circumstances, surgery is highly recommended.

Conclusion:

There are many treatments and medicines available for Vertigo. They are totally dependent upon the cause, symptoms, and condition of the patient. This is why it is important to consult a doctor or specialist for the best treatment option.

Vertigo - Know The Types & Treatment Of Them!

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