Vertigo is a common symptom that can indicate various illnesses. The best-known and most widespread form of vertigo is benign paroxysmal positional vertigo, or BPLS for short.
In this guide you will find more information about positional vertigo and selected doctors.
With positional vertigo, those affected suffer from recurring attacks of dizziness. They occur whenever the affected person changes their position - for example, when lying down, turning their head, raising or lowering it.
Positional vertigo is only caused by rapid changes in position. Patients are free of vertigo when sitting, lying down or walking.
It is particularly characteristic that the dizziness occurs with a short time delay after the movement. The dizzy spell lasts on average 30 seconds to a maximum of 2 minutes.
It is a harmless condition, but it can have a severe impact on everyday life and quality of life. It is therefore all the more important that those affected learn to live with the symptoms. Acute attacks of vertigo can be significantly alleviated by certain maneuvers.
In most cases, the vertigo is intermittent and can last from a few seconds to a maximum of two minutes.
Like other forms of vertigo, positional vertigo is often accompanied by symptoms such as
sleep disturbances. Older patients in particular also have an increased risk of falling.
Untreated positional vertigo can also lead to avoidance behavior. This in turn has a negative effect on posture. Last but not least, untreated sufferers are more likely to experience depressive moods.
There are small crystals in the inner ear that increase the force of gravity on the sensory cells, the so-called otholites (ear stones). Under certain circumstances, they can become detached from their original location and migrate into the fluid-filled semicircular canal.
The following happens when the head moves: The otholites move with the head and send signals to the brain. However, the brain cannot reconcile the incoming information with that of the other organs, such as the eyes. This leads to dizziness and balance disorders.
The organ of balance in the inner ear © Henrie - Adobe Stock.
The detachment of the otholites is a completely natural ageing process. Positional vertigo therefore usually occurs in older people between the ages of 60 and 80. Women are affected more frequently than men.
Furthermore, the development of benign paroxysmal positional vertigo is favored by the following factors:
If you have recurring dizziness attacks, it is advisable to consult an ear, nose and throat specialist. The family doctor can also be the first port of call. If necessary, they will refer the patient to an ENT specialist or a neurologist.
At the beginning of the examination, a detailed doctor-patient consultation takes place, the so-called anamnesis. This discussion can already give the doctor important clues as to the cause of the dizziness.
He then carries out a hearing test and also tests the balance and hearing organs. This allows him to rule out certain illnesses - such as sudden hearing loss.
If he suspects positional vertigo, he can confirm this using the so-called Dix-Hallpike positional test, for example. He asks the patient to sit upright on the examination couch, turn their head 45 degrees to the side and then lie down.
In the case of benign paroxysmal positional vertigo, the patient now suffers an attack of vertigo. It is often accompanied by involuntary, rapid eye movements(nystagmus). The dizziness subsides within a maximum of two minutes.
Treatment with medication or surgery is not an option for benign paroxysmal positional vertigo. Instead, the patient learns techniques that help them to avoid dizziness or effectively alleviate acute dizziness attacks.
They may also receive instructions from the doctor to perform so-called liberation maneuvers , for which two maneuvers have been developed: the Eplay maneuver and the Brandt-Daroff maneuver. These can be used to move the crystals from the semicircular canals back into the correct organ (the utricle).
When performing the maneuvers, there are some instructions to follow. Patients should therefore be thoroughly instructed in these exercises by their ENT doctor or a physiotherapist. Special positioning training is available for this purpose.
These maneuvers are very easy to perform, even for non-professionals, and in around 80% of cases patients are completely symptom-free after the first treatment.
Positional vertigo is not a matter of habituation, but of eliminating the cause through these exercises.
The prognosis for positional vertigo is good, provided the patient accepts the treatment. The exercises prescribed by the doctor must be carried out consistently.
Benign paroxysmal positional vertigo can thus disappear completely.
In many cases, however, it recurs intermittently. The sufferer can then effectively alleviate or shorten the dizziness attacks with previously learned relief maneuvers.
Although positional vertigo is generally harmless, sufferers should not simply ignore the symptoms. They should always consult a specialist to rule out other illnesses.
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