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R. Sterling Hodgson, M.D.
1849 NW Kearney Street, Suite 200
Portland, OR 97209-1453

Office: 503.553.3664
Fax: 503.553.3668

Benign Paroxysmal Positional Vertigo (BPPV)

This type of dizziness is provoked when the head and inner ear structures are moved into certain positions. Tipping back in the shower, rolling over in bed and bending over at the waist can initiate sensations of imbalance and floating, but most often true spinning vertigo. The dizziness demonstrates a "crescendo/decrescendo" effect as it increases and then decreases over time. Patients often report that remaining still will help quell the dizziness once it has begun. These "spells" can last for a few seconds but usually not longer than a few minutes.

The dizziness is initiated when tiny crystals inside the inner ear (or "otoconia") become dislodged from their normal resting place and begin to float freely in the fluids of the inner ear. They settle in the lowest part of the inner ear, a motion sensor for vertical head movements. The motion of the crystals as they push on the motion sensor sends an abnormal message to the brain that the body is moving, even when it is not. The crystals can become dislodged by head injury, aging or even without any known or explicable cause. A very simple analogy for BPPV is that of a water-filled toy snow globe. When the globe is in its resting position, the particles are inactive on the floor. Move the globe just a little and the disturbed particles suddenly begin to move around in the water until gravity returns them to a resting position. BPPV can often be treated by maneuvering the otoconia crystals into a repository place in the inner ear that prevents them from free-floating and thereby sending false messages to the balance receptors and brain.

BPPV is mostly commonly diagnosed by doctors using the Dix Hallpike maneuver which puts the patient in a reclined position with the head hanging slightly lower than the rest of the body. If BPPV is present, the patient's eyes will begin to move in a reflexive pattern called "nystagmus". It is easily observable by the doctor and is one of the classic presentations of BPPV.

The particle repositioning treatment can be done in a doctor's office with no anesthesia and no surgery. It involves a series of maneuvers that place the head and body in various positions so the crystals can travel through the inner ear fluid to a new resting place. The doctor will guide you through these positions and the entire process takes just a few minutes. Aftercare is quite specific and involves limited head movement and sleeping on several pillows for a few days and nights. The repositioned crystals need time to settle and following the aftercare instructions is key to this. Most patients experience relief after just one treatment but occasionally a second treatment may be needed weeks, months or even years afterward.

There are surgical treatments available for the rare patient with ongoing BPPV that fails to respond to conventional particle repositioning therapies. Your specialist can help you determine if surgical intervention is appropriate for you and can discuss the risks, benefits and expected outcome for this type of treatment.


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R. Sterling Hodgson, MD | | 503.553.3664
1849 NW Kearney St., Suite 200, Portland, OR 97209


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