Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of
vertigo, the symptom that describes the feeling of intense spinning of the head. BPPV describes the situation where the spinning sensation lasts only a few minutes and often stops by itself. There may be recurrent episodes without any specific reason or cause.
While there are many causes of vertigo, BPPV is the term that is used for vertigo that comes and goes (paroxysmal), without a specific associated illness (benign). It is often a frustrating situation for patients because the episodes are frightening and difficult to predict. However, it is related to the labyrinth system inside the inner ear.
The labyrinth system is located in the inner ear and is responsible for maintaining balance in the body. There are three semicircular canals that contain nerve endings and fluid that tell the body where it is in relation to gravity, acting almost like a gyroscope. Small crystals (cupuloliths) sit on top of nerve stalks and should they fall off, they can cause irritation to the fluid contained within the canals and this can lead to vertigo, the sensation that the head is spinning in relation to the rest of the world. Some researchers also suggest that in addition, some free-floating particles in the labyrinth system exert a force to additionally cause vertigo symptoms.
Many people have experienced the spinning sensation (vertigo) as a child. After spinning around for a period of time and then stopping quickly, there is a sensation that the spinning continues for a few seconds and sometimes the child falls down. This occurs because the fluid in the semicircular canals continues to
spin after the head has stopped. This gives the person a sensation of vertigo. This may also happen during or after an amusement park ride and there can be associated nausea and vomiting if the vertigo is severe enough.
The definitive treatment for BPPV requires that crystals causing inflammation
in the semicircular canals be moved out of those canals. This can be done by the
Epley maneuvers, where the head is taken through a series of position changes
that allow the crystals to be emptied out of the canals. Epley maneuvers require
a special skill set, first to know which canal the crystals are in, and second,
how to "shake" the head to get them removed. If a person without these skills is not available, medication may be helpful
in decreasing or resolving symptoms.
Several medications, including common motion sickness remedies, may relieve symptoms of BPPV and may be used for less severe episodes of vertigo or in addition to the Epley maneuvers. Examples of these medications include:
Bonine, Dramamine II, D-Vert)