Benign paroxysmal positional vertigo (BPPV): symptoms and liberating manoeuvres to cure it

By Cristiano Antonino On Sep 6, 2022

Among the most common types of vertigo, there is benign paroxysmal positional vertigo (BPPV), which, unlike other types, does not require the use of drugs, but of liberating manoeuvres to get rid of the sensation that the world is spinning, performed by the ENT specialist in an outpatient setting

What are Benign paroxysmal positional vertigo

Among the most common causes of vertigo are BPPV, or benign paroxysmal positional vertigo.

These peripheral vertigoes are caused by the abnormal displacement of otoliths, perhaps better known as ‘pebbles or crystals’ within the vestibule, which cause an objective dizzy sensation (it is the surroundings that move) resulting from movements of the head in space.

Vertigo usually appears when lying down or changing position in bed; the dizzy sensation may also be associated with nausea or vomiting.

Benign paroxysmal positional vertigo: What are the symptoms?

The clinical manifestations of benign paroxysmal positional vertigo are characterised in different ways, depending on where the otoliths are located.

These calcium carbonate crystals, usually located in the portion of the vestibule called the utricle, can dislocate (either spontaneously or as a result of trauma) within the semicircular canals.

If it involves the posterior semicircular canal, benign paroxysmal positional vertigo manifests itself with rotatory vertiginous crises of about 20-30 seconds that usually appear in the morning upon waking or at bedtime, during transitions from cline to orthostatism (lying down to standing up) and vice versa; sometimes even flexion-extension of the head, especially if fast, can trigger the crisis.

When the lateral semicircular canal is involved, seizures may last up to 1 minute and usually appear during rest when the patient turns onto their side.

Postural instability often also occurs during the seizures and may last for a few days even after the vertigo has been treated.

In any case, we are dealing with a benign condition that requires a diagnosis and positional treatment through the execution of special liberating manoeuvres that the patient must perform with the help of an ENT specialist.

How do the liberating manoeuvres work?

The liberating manoeuvres are movements performed on the patient by the ENT specialist that aim to return the otoliths inside the labyrinth of the ear to their correct position, freeing the patient from the dizzy sensation.

Before performing the liberating manoeuvres, the ENT specialist will assess the characteristics of the vertigo, and will do so through special diagnostic manoeuvres.

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