Disease Description (Causes and Symptoms)
- Definition: Benign paroxysmal positional vertigo (BPPV; otolithiasis) is a condition in which recurrent episodes of rotational dizziness (a sensation that the surroundings are spinning) lasting from a few seconds to within 1 minute occur in response to changes in head position.
- Pathophysiology: Otoconia (calcium carbonate particles) that have become dislodged from their normal position enter the semicircular canals of the inner ear, abnormally stimulating the flow of fluid within the canals and causing rotational dizziness accompanied by nystagmus.
- Main symptoms: Sudden rotational dizziness (especially triggered when lying down or turning over, turning the head, or looking up at the sky), nausea and vomiting, nystagmus, and balance problems. Symptoms usually disappear within a few seconds to 1 minute.
- Prevalence and risk factors: It can occur at any age but is more common after the 40s–50s. Trauma, reduced bone density, infection, or medications may be triggering factors.
Treatment Methods
- Standard treatment
- Canalith repositioning procedures: Positional maneuvers such as Epley and Semont, which guide otoconia in the semicircular canals back to their original position, are the first-line standard treatment. Many cases improve immediately after the procedure.
- Self-exercise therapy: Vestibular rehabilitation exercises that can be repeated at home, such as Brandt-Daroff exercises, may be helpful (used for recurrence and prevention purposes).
- Medication
- This is not a definitive treatment and is used short-term to relieve symptoms: antivertigo medications (e.g., meclizine), antiemetics (e.g., dopamine-based agents), and, in some cases, short-term benzodiazepines. Long-term use is not recommended.
- Procedures/Surgery
- Most cases improve with nonsurgical treatment, but in very rare recurrent or treatment-resistant cases, surgery (e.g., semicircular canal plugging) may be considered.
- Lifestyle management and precautions
- During an acute attack, immediately sit or lie down and prevent falls and injuries. Do not drive or operate heavy machinery.
- Canalith repositioning is recommended under the guidance of an experienced otolaryngologist or physical therapist. Improper procedures performed by an untrained person may worsen symptoms or cause injury.
- Because recurrence is common, follow-up evaluation is recommended if symptoms recur.
- Risk of complications
- The prognosis is generally good, but frequent recurrence, trauma from falls, and, rarely, delayed differentiation from other central nervous system diseases (such as stroke) may be problematic.
Outpatient Visit Checklist (Including Recommended Items and Example Questions)
- Recommended items to bring
- List of medications currently being taken (including prescription medications, OTC medications, and herbal medicines)
- Medical history (especially head trauma, otitis media or ear surgery, osteoporosis, and cerebrovascular disease)
- Symptom record: date of first occurrence, duration (seconds or minutes), frequency of recurrence, triggering positions (e.g., turning over while lying down or turning the head), and accompanying symptoms (hearing loss, tinnitus, paralysis of the limbs, speech impairment, etc.)
- If possible, a video recorded during an attack (if dizziness or nystagmus is visible, it may help with diagnosis)
- Results of previous tests (hearing tests, imaging tests, MRI, etc.)
- Information to provide the doctor during the visit
- The exact position and timing when symptoms occur
- Whether symptoms have caused falls or limitations in daily activities
- Whether there has been any recent trauma, infection, or medication initiation
Examples of General Questions to Ask the Doctor
- "How can we be sure that the cause of my dizziness is BPPV?"
- "What are the expected effects and side effects of the treatment you recommend (e.g., the Epley maneuver)?"
- "Do I need medication? What side effects should I watch for if I take it?"
- "How should I respond if these symptoms recur? Are there any ways to prevent them?"
- "When can I start driving or return to work?"
Examples of Disease-Specific Questions
- "If I undergo a procedure (canalith repositioning), how likely is it that my symptoms will disappear immediately on the same day? What precautions should I take after the procedure?"
- "If the condition recurs repeatedly, do you recommend additional tests (such as MRI)? What symptoms should raise suspicion of a central cause?"
(Note: Persistent or unimproving dizziness or neurological symptoms (such as paralysis of the limbs, speech impairment, or visual field impairment) may indicate a serious brain disease and require immediate emergency medical care.)