Benign paroxysmal positional vertigo or canalithiasis: what it is and what causes it
Canalithiasis or Benign paroxysmal positional vertigo is one of the most common causes of vertigo in the general population, due to an alteration in the function of the balance organ located in the inner ear
The sufferer has the illusory sensation that their surroundings are moving in a rotating direction, as on a merry-go-round, in relation to specific head movements.
Vertigo can occur, for example, when lying down or changing position in bed, or when looking upwards to reach an object.
The inner ear contains the organ of hearing, called the cochlea, and the organ of balance, called the labyrinth.
The labyrinth is made up of three semicircular canals (oriented in space to perceive the rotational acceleration of the head) and two otolithic organs, the utricle and the sacculus (responsible for the perception of gravitational acceleration or gravity).
The latter contain special crystals, the otoliths, immersed in a special liquid that fills the entire inner ear.
The otoliths, being of greater weight than the liquid that contains them, move during head movements and stimulate special receptor cells, which in turn send signals to the brain informing it of changes in the position of the head in space.
What causes canalolithiasis, or benign paroxysmal positional vertigo?
The mechanism behind paroxysmal positional vertigo is related to the displacement of otoliths from their natural location into the semicircular canals, where they mistakenly stimulate receptors that register the rotational accelerations of the head, giving an illusory sensation of rotation of the surroundings with respect to one’s own body.
In most cases, the dislocation of otoliths has no recognisable cause (and thus we speak of idiopathic paroxysmal positional vertigo); in other cases, otoliths may dislocate as a result of head trauma, such as after a car accident.
What are the symptoms of canalolithiasis, benign paroxysmal positional vertigo?
Paroxysmal positional vertigo is characteristically manifested by the appearance of sudden vertigo (that is why it is called ‘paroxysmal’), of short duration (seconds), resulting from certain head movements (that is why it is called ‘positional’).
This disorder can occur in certain common life situations, such as bending over to pick up an object from the floor, looking up to pick up a book from a bookcase, lying down and getting out of bed, turning over in bed.
In most cases vertigo is associated with other symptoms, called ‘neurovegetative’ symptoms, such as nausea, vomiting, cold sweating, tachycardia (heartbeat).
As a rule, this disorder is not associated with cochlear symptoms, such as ear muffling or tinnitus.
Diagnosis of canalithiasis
The diagnosis is based on the patient’s description of the characteristics of vertigo (duration, relation to head movements, association with nausea and vomiting, absence of other ear disorders).
The diagnostic suspicion is confirmed during the specialist evaluation with the ENT specialist, using clinical tests, called manoeuvres, which consist of mobilising the patient’s head in relation to the body on a couch.
During these manoeuvres the specialist will observe the patient’s eyes with special glasses (called Frenzel glasses) or with cameras mounted on special masks (videonystagmography), to observe the possible occurrence of a particular reflex eye movement, called nystagmus.
Based on the characteristics of the nystagmus, the specialist can confirm the diagnosis of paroxysmal positional vertigo and plan the most suitable treatment for the individual patient.
Treatments
The therapy is the so-called liberating manoeuvres, which consist of having the patient, with the help of the physician, perform certain head movements in order to remove the otolithic aggregate from the involved semicircular canal.
Often a single liberating manoeuvre is sufficient to resolve the symptomatology, other times it is necessary to repeat it several times.
The same manoeuvres can be repeated by the patient independently at home, subject to instruction by the referring specialist.
Often supportive medical therapy is prescribed to limit the neurovegetative symptoms (nausea or vomiting) that may occur during the manoeuvres themselves.
After the resolution of paroxysmal positional vertigo, a sense of both postural and walking instability may remain (sensation of ‘walking on a mattress or on eggs’, a feeling of ‘head in the clouds’), which may persist for 15-20 days after the vertigo has disappeared.
When should a doctor be consulted?
Whenever the patient notices the onset of more or less intense vertigo triggered by certain head movements.
Is benign paroxysmal positional vertigo dangerous?
Paroxysmal positional vertigo is a condition that generates anxiety and fear in those who experience it, both because of its acute onset and its intensity, and because of the accompanying neurovegetative correlates (nausea, vomiting).
Despite this, it is not to be considered a serious pathology.
The importance of its correct diagnostic framing and appropriate treatment lies, especially in the elderly, mainly in preventing falls or trauma.
In this regard, the specialist will instruct the patient to observe certain good rules of behaviour to avoid potentially dangerous situations, such as climbing stairs or chairs to reach objects, during the acute dizzy phase.
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