Benign Paroxysmal Positional Vertigo (BPPV) is an inner ear condition that causes dizziness and vertigo. Lifemark’s vestibular therapists presented an informative webinar on BPPV, its causes, and everything you need to know about this condition. You can access the full recording here. The first Q&A blog in this series explored your questions on the causes of this condition, check them out here. In this feature we’ll investigate the occurrence and re-occurrences of BPPV.
Q&A Occurrence and re-occurrences of BPPV
1. Why is BPPV more prevalent than it used to be?
This could be from better diagnostic practice and increased awareness, however; our ageing population will add to the prevalence.
2. Will a person always have BPPV? Can it come and go?
When we correct BPPV for someone we refer to it as putting the condition into remission rather than ‘curing’ it, simply because it has a rather high recurrence rate. That being said, at least half of people may never get it again whereas in the other half (particularly if it came on as a result of trauma) it may re-occur occasionally over the years.
3. What contributes to the development of BPPV?
Risk factors for occurrence include:
- female gender
- Vitamin D deficiency
- osteoporosis
- migraine
- higher total cholesterol
- trauma
- diabetes
- prolonged periods of bed rest (i.e., post-surgery, illness)
4. What can help prevent recurrence?
Daily self-repositioning maneuvers do NOT appear to affect reoccurrence rates. Reactivation of latent viruses, migraine, auto-immune disorders and metabolic disorders may increase reoccurrence. One study showed decreased recurrence with vitamin D and calcium carbonate supplementation for a year, but this was only in those who had low levels of vitamin D to begin with. (1)
5. Can a viral infection of the ear increase your BPPV risk?
It is not uncommon for an inner ear infection to trigger BPPV. An inner ear infection is different from a middle ear infection where the latter can cause pain and where your doctor can normally see that your eardrum looks abnormal. There is no pain and nothing that can be seen from the outside with an inner ear infection, however it could be preceded by a middle ear infection.
6. Do the inner ear crystals tend to go into the same displacement with each episode?
From my clinical observation it can vary, however the posterior canal will always be the most common as it at the lowest point relative to gravity. The affected side can vary, however if it (the BPPV) started because of trauma or other disruption to one inner ear, it would be reasonable to expect that a recurrence would be more likely to affect the same side. Remember to check back in with your vestibular therapist if you think you’re having a recurrence. They can make sure your symptoms are consistent with your current diagnosis and if so, perform the correct treatment maneuvers.
7. Can BPPV resolve on its own, without the Epley maneuver?
Studies looking at this vary but it appears that ~27-50% of people can experience symptom resolution without treatment. Unless there is a rare medical reason that treatment maneuvers should be avoided, medical guidelines discourage the ‘wait and see’ approach because of the secondary risks while living with BPPV such as increased fall risk, lost time at work or daily activities, anxiety, and reduced quality of life.
8. Do you have to be in an active episode for the best assessment?
If your positional vertigo has resolved by the time you’re being assessed, we can still explore the nature of what your symptoms were like, what other symptoms accompanied the vertigo and what triggered/relieved it to see if it sounded consistent with this diagnosis. If we are unable to reproduce the symptoms or eye movements with testing, we cannot be certain; however, it would allow us to test for other inner ear conditions and to determine that you don’t have any residual motion sensitivity or imbalance. Note, while sometimes people think their BPPV is gone, we actually find that there are still some crystals displaced and they’ve just become good at avoiding triggering positions.
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Jeong SH, Lee SU, Kim JS. Prevention of recurrent benign paroxysmal positional vertigo with vitamin D supplementation: a meta-analysis. J Neurol. 2022 Feb;269(2):619-626. doi: 10.1007/s00415-020-09952-8. Epub 2020 Aug 7. PMID: 32767116.
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